Mental health's stigma is wearing down our nation’s healers
The biblical proverb, "Physician, heal thyself," can only be attained when we normalize seeking care for all aspects of our well-being.
The month of May is usually associated with Mother's Day and Memorial Day. It is also designated as Mental Health Awareness Month, though every month should be a reminder that we need to prioritize all aspects of our health.
Fortunately, our focus on mental health care for mothers, military members and their families shines a spotlight on these issues for the general public. Unfortunately, that focus fails to include our nation's physicians.
Physicians are taught in medical school that the mind-body connection is powerful. We study how the brain works and the impact of genetics and the environment on the pathophysiology and development of diseases.
Medical innovation has revolutionized mental health treatment modalities from behavioral therapies to medications to devices and digital technologies such as telephone apps and biometric monitoring of speech and pupil dilation in response to stress. Today, mental health care can literally be accessed by the touch of a fingertip on a keypad.
Yet the stigma and shame attached to physicians needing mental health care remains. I have colleagues who would rather talk about their rashes, blood glucose levels or the color of their urine than mental health. Mental health crises are viewed as a form of weakness — that one lacks the “right stuff” to be a health care professional, whose accurate and timely decision-making is critical to protecting patients’ lives.
Stress and a need to highly excel, and even be perfect, don't just happen during a physician’s medical training. The seeds are planted early on. As early as high school, students hoping to pursue medicine put immense pressure on themselves. They try to be at the top of their classes and also to be athletes, community leaders, researchers, entrepreneurs, authors and artists, among other pursuits.
Getting into the best college is seen as a stepping stone to the best medical schools and training programs. Along the way, students are awarded for academic excellence and setting themselves apart from the pack.
We reward those who persevere against all odds, including overcoming physical challenges. But we rarely applaud those who have done so with mental health issues. In fact, these often go undiagnosed or are hidden away, for fear that they could derail one's career before it even begins.
It is not surprising that this prejudice persists — the roots are deep and shrouded in fear. But the result is staggering. More than 50 percent of physicians admit to burnout, which is characterized by "emotional exhaustion, depersonalization and a lack of a sense of personal accomplishment." Compared to the general population, suicide is far more common among doctors.
Substance abuse also often goes underdiagnosed or is only detected later, which can lead to disastrous consequences for the clinician, both personally and professionally. In a study of 27,276 physicians, 12.4 percent of male physicians and 21.4 percent of female physicians met diagnostic criteria for alcohol abuse or dependence. In another study, it was revealed that 10-15 percent of doctors develop a problem with drugs.
The cone of silence surrounding clinicians protects them from three losses: a loss of respect, a loss of livelihood and the loss of a license to practice. This can be deadly.
The COVID-19 pandemic has exacerbated this problem. Clinicians went from being revered to often being ostracized during the crisis. Images of neighbors banging pots and pans to honor clinicians' contributions early in the pandemic have faded. Health professionals are now harassed for wearing masks, discussing methods to protect patients and having little to offer to treat Long COVID — adding to the growing sense of despair and grief.
Questions about how the psychological health of the practitioner impacts the health care system such as access to care, patient safety and quality care have been extensively studied.
An Agency for Health Care Research and Quality funded project, Minimizing Error, Maximizing Outcomes found that more than half of the primary care physicians surveyed felt stressed because of time pressures and other work conditions, though their reactions didn't translate into poorer quality care. If there was a quality-of-care issue, it was due to the organization that burned the doctors out.
Fortunately, professional societies and the National Academy of Medicine Collaborative on Clinician Well-Being and Resilience now provide interventions to emotionally support health professionals. Recommendations include scheduling monthly meetings focused on work-life balance issues and providing medical assistants for record-keeping and logistics duties.
The American Medical Women's Association, has launched Humans Before Heroes to reframe medical licensure questions to remove barriers to seeking care.
The American Medical Women's Association says that its 10 recommendations "balance the medical board’s mission to protect patients from impaired physicians while allowing physicians to seek care without fear of losing one’s license."
How do we destigmatize mental health care for physicians? One of the first steps is to integrate it early on into all of our lives. Just as doctors ask questions about diet and exercise, we need to ask about mental health and easily provide access to treatment without future punishment or retribution.
The biblical proverb, "Physician, heal thyself," can only be attained when we normalize seeking care for all aspects of our well-being.
Saralyn Mark, MD is a former senior medical and policy advisor to the White House, the Department of Health and Human Services and NASA. She is the American Medical Women’s Association's lead for COVID-19 and health innovation and the founder and president of SolaMed Solutions, LLC and iGIANT.