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Abstract
Many physicians are ”wounded healers”; yet they are expected to work long hours, achieve high success, and show great stoicism. Many fear that admitting that they have mental problems could destroy their careers, so they suffer in silence.
Medicine has historically not paid enough attention to physician mental health despite evidence of untreated depression and increased suicide rate. To make matters worse, physicians with psychiatric disorders often encounter overt and covert discrimination in medical licensing; hospital privileges; health and malpractice insurance; and professional advancement.
Doctors may develop any psychiatric illness. However, the most common are mood disorders, substance use disorders, anxiety disorders, adjustment disorders, personality disorders, obsessive compulsive disorder , eating disorders and some DSM-IV “V” code(other conditions that may be a focus of clinical attention” such as partner relational problems, or academic problem) and mental disorders due to a general medical condition.
Although the nature and scope of addictive disease are commonly reported in the lay press, the problem of physician addiction has largely escaped the public’s attention. Physicians’ addictive disease (when compared with the general public) is typically advanced before Identification and Intervention. This delay in diagnosis relates to physicians’ tendency to protect their workplace performance and Image well beyond the time when their life outside of work has deteriorated and become chaotic.
Some of Signs of Impairment are deterioration of hygiene or appearance, isolation or withdrawal, complains of excessive work load, frequent or unexplained absences, inaccessible, frequent trips to the restroom, excessive personal drug use, complaints by patients or staff, lack of or inappropriate responses to pages or calls, decreasing quality of performance or patient care, unreliability or neglect of commitments, frequent or unusual accidents.
The majority of physicians receive 90 day residential treatment, while the rest receive intensive outpatient treatment.
After treatment, the physicians continue with aftercare that includes 12-step support, regular counselling meetings, and monitoring that includes random drug testing.
Stress and physician impairment can begin in medical school and residency, where emotional requirements are too often ignored and technical aspects of care emphasized, Peer rivalry begins, and Obsessive-compulsive traits, delayed gratification, competitiveness, and personal sacrifice are common. Sleep needs are neglected, personal free time is limited, and work life is compartmentalized from home life and emotional life. Hard work, long hours, dedication to quality patient care and constantly striving to remain apprised of current medical knowledge characterize daily life. All of these can, and do, predispose physicians to burnout.
To continue on the motivational aspects of burnout management, goal-orientation construct was introduced and should be considered in relation to burnout. Goal orientation is the framework within which individuals react to, and interpret events and is related to several other important constructs such as locus of control, engagement and motivation. In general, two different goal orientations have been distinguished: 1) learning orientation: the motivation of individuals to increase their competence 2) ego orientation: the motivation to gain favourable judgements of their competence or to avoid negative ones.
In addition, an extensive social support network is a personal resource that can protect against the development of burnout. Professional isolation, social isolation, and/or lack of other support limit the physician’s capability to respond to periods of stress.
Many physicians attempt suicide in response to a malpractice threat. Physicians have been trained to be high achievers. Threats of humiliation, failure, loss of autonomy, and loss of financial stability may be tremendously stressful. If the physician talks about suicide, death, or no reasons to live in this context, it must be taken extremely seriously.
Sometimes physicians will show signs of detaching from the environment. This may manifest as taking risks, non-compliance with medication, making out a will, or giving away prized possessions. Such behaviour should result in immediate screening for depression and/or substance abuse. Both these conditions can be associated with suicidal thoughts.
Generally suicide can be managed by: Physician Education, Pharmacotherapy, Means Restriction, Screening programs have reported some success in identifying individuals with known risk factors for suicide, Psychotherapy alone or in combination with some antidepressants can be an effective treatment for depression, for suicidal ideation, and for preventing new attempts after a suicide attempt, After a suicide attempt, better structured collaboration between hospitals and teams providing follow-up care may improve compliance with treatment and decrease new attempts, Strategies for influencing how the media reports suicide need to be implemented and evaluated .
Many physicians with cognitive impairment lack insight into their problem and may minimize or deny the degree of their impairment. Similarly, there are no overall estimates of the extent of knowledge and skill dyscompetencies. About 10% of physicians will demonstrate significant deficiencies in knowledge or skills at some point in their career.
Remediation programs designed to assist impaired physicians may not be effective for those with cognitive impairment because the decline in cognitive functioning associated with illnesses such as Alzheimer’s disease often is progressive
Maintaining clear professional boundaries is an important aspect of patient care. However, medicine has deliberately become less formal, and doctors are increasingly urged to focus on developing just, respectful relationships with their patients, rather than rigidly adhering to rule-based systems of ethics. With this approach, doctors may cross professional boundaries more often. One of the most serious violations of professional boundaries is a sexual relationship between doctor and patient. While sometimes a result of the predatory behaviour of “rogue” doctors, these relationships often develop as the final stage of a series of boundary crossings.
For the foreseeable future, the greatest ethical issues facing psychiatry and the rest of medicine revolve around methods of financing medical treatment and radical changes that are underway in health care delivery. The juxtaposition of new models deriving from social justice considerations or driven only by market forces has led to massive debate in all of medicine. The fact that medicine has become more businesslike and that treatment may soon be viewed as commodity has proved intolerable and intrinsically impossible for many who value other traditions.