EP’s and Depression from EP Monthly

This month’s EP Monthly (terrific and getting better if that’s possible) has published the results of their survey of depression in Emergency Physicians. It surprised them, and me:

Features: Survey Says Many EPs Suffer in Silence

BY: LOUISE B. ANDREW MD, JD

“I have had the pistol in my mouth and would have pulled the trigger, save for leaving my child without a parent.” Thus began one response to EPM’s December article and survey “Silent Treatment.” The respondent continued: “Does anyone honestly think that anyone in our position would report this type of thought to any board? Go under the microscope? Lose our ability to provide for our families? For as much hype as is given to diagnosis and treatment of depression, state boards and everyone else hold their physicians to a different standard. If I were a plumber or musician, I would just go see my psychiatrist, take medication, and go on with my life, better off for having done so. We are held to an impossible double standard.”

This desperation was echoed in countless other anonymous responses, each reinforcing the need to understand physician depression better and do away with stereotypes that might hinder treatment. Here now are our findings, and the many voices that cry for understanding.

Granted, this is a self-report so there’s a selection bias, but the numbers were surprising:

In our EPM survey, 73% of 108 respondents had experienced symptoms that they felt might have been depression.

Suicide, on the other hand, is far more prevalent among physicians than the public, with the most reliable estimates ranging from 1.41% to 2.27% times the rate in the general population. More alarming is that, after accidents, suicide is the most common cause of death among medical students…

Sadly, though physicians have a lower mortality risk from cancer and heart disease relative to the general population, presumably relating to self-care and early diagnosis, we have a significantly higher risk of dying from suicide.

Okay, a sample size of 108 isn’t statistically meaningful, but the numbers presented are surprising to me. And, I would imagine the “%” above was meant to be times.


Comments

  1. Reminds me of a survey showing that professional women had a depression rate of 80%…
    When my girlfriend and I discussed it, we decided it was a low number, since we didn’t know anyone who was NOT depressed.
    Alas, unlike the old days when Docs were “god” and got respect and support, we do not…indeed, as a woman doc, it is worse, since alas too many nurses resent that you earn more than they do…as for family support, at least my husband helped and gave me support…

  2. TheNewGuy says:

    There is a way to take care of this.

    Go to another city (NOT the one where you practice), and park down the street from a psychiatrist’s office (if you’re really paranoid, take the bus). Walk in, and ask to speak to the psychiatrist one-on-one (if necessary, tell the receptionist that it’s a private matter, and identify yourself as a colleague). DO NOT give your name, present any sort of ID, insurance card, or documentation.

    Once you’re one-on-one, do the following: identify yourself as a physician, advise him that you think you may need some help, but that you’re in a position where you cannot be known to be receiving psychiatric treatment, offer to pay cash, and give him an assumed name (don’t tell him you’re using a false name… leave him some plausible deniability in case anything happens).

    You’d be surprised how many psychiatrists would be willing to treat a colleague under those circumstances (this strategy was suggested to me by a psychiatric colleague).

    If all of this seems excessively paranoid, consider the effect that spectre/stigma of “psychiatric” treatment could have on your professional reputation, divorce proceedings, or your next malpractice case.

  3. Not surprised by this….

  4. I’m not quite sure what to say, but I find this disturbing . . .

  5. Lets see…………. sicker patients, more of them per hour, less $$ per hour, more liability, hospitals always full, other ER’s closing, more uninsured and illegal aliens, less specialty back up help, declining reimbursements from all payers, more CMS mandated bullshit, pain scales, nursing shortage, HMO hassles, antibiotics and blood cultures in 4 hours in case they “might have pneumonia”, hospital administration pulling your balls and flexing their muscles, patient satisfaction surveys, drunk cursing ingrates, meth smoking dope heads, entitled patients, obese patients needing an airway, rude patients, threatening patients, defensive medicine, futile medicine, fibromyalgia and chronic back pain at 2am, plaintiff attorneys, expectations to be 100% right, no time to grab a handful of nuts or take a piss.

    I think I am crazy that I am not depressed!!!!!

  6. My husband is finishing up his doctorate in clinical psychology and after his internship, plans on establishing a practice dedicated to what he’s termed “executive medicine.” He has a strong desire to help those in need who will not otherwise get access to counseling (physicians, CEOs, politicians). The pressures dealt with by physicians are so unique (unlike most other businesses, medical practices usually have variable expenses with fixed (and often declining) income). His brother and father in law are both practicing physicians and he routinely hears about the ongoing frustrations they face in the current medical environment.

    He’s hoping to incorporate elements of internet therapy into the practice as a way to reach executives in other communities that won’t seek care locally.

    Hopefully, as the psychological field expands and becomes more accepting of alternate ways to provide treatment, access will open up and all of us in positions where we can’t see a therapist and bill our insurance will have opportunities for highly confidential, accessible medicine.

  7. Anonymous says:

    Lets see…………. sicker patients, more of them per hour, less $$ per hour, more liability, hospitals always full, other ER’s closing, more uninsured and illegal aliens, less specialty back up help, declining reimbursements from all payers, more CMS mandated bullshit, pain scales, nursing shortage, HMO hassles, antibiotics and blood cultures in 4 hours in case they “might have pneumonia”, hospital administration pulling your balls and flexing their muscles, patient satisfaction surveys, drunk cursing ingrates, meth smoking dope heads, entitled patients, obese patients needing an airway, rude patients, threatening patients, defensive medicine, futile medicine, fibromyalgia and chronic back pain at 2am, plaintiff attorneys, expectations to be 100% right, no time to grab a handful of nuts or take a piss.

    Sorry but I stole this because if you change a few words it sounds like my classroom- people want moore more more for less less less, the kids themselves are completely unprepared for the school environment, the parents fight with the teacher and blame them for everything- I SWEAR IF I HEAR I SHOULD LOVE SOMEONE’S KID EVER AGAIN I WILL PUKE!!!!!!! Autism and learning disabilities and behaviour disorders are rampant. 10 years ago there might be one kid in a school with signifigant issues- in most schools now there are 6 KINDERGARTEN kids with something that needs attention. Where I live there is a crapload of tests done on numerous kids to test speech /ot and psych – just to get me- a teachers aide into a class where five year olds are beating up the teachers. Admin support??? Not so you would notice. They are too busy managing and attending countless required meetings, and are just not able to do as much as they once did either.

    So my reason for connecting this together is why are people such nasty ass jerks these days? Is there anyone out there addressing these issues? It just seems that there is a dearth of respect and manners. Teachers and doctors almost seem to be at war (not their choice) with the people they serve, and life is more difficult. Parents and patients have abdicated personal responsibility and figure it is someone elses job to do what once considered their own. I almost feel like I am hearkening back to a golden age in this comment, but I really do not remember this level of abuse and disrespect 20 years ago when I was a kid.

    Depression is difficult especially if you are seen as the strong one. Doctors are, and I don’t have any advice for anyone other than get whatever support you need however you can and know that occasionally there are patients who give two hoots about you as a person.

  8. I had to come back to this one . . .I recently took my son to the ED with a head injury. He was okay, but it happened at bedtime–I watched him tumble from his bunkbed head-first on the hardwood floor. I didn’t feel comfortable tucking him in without first making sure he was okay. We spent about three hours there–my son sleeping, I and my daughter waking him up every 15 minutes to make sure that he was okay. He saw a bright-eyed (at midnight!) resident who was praised by her attending for not jumping to order a CT scan. She examined him thoroughly and was very kind. She made me feel comfortable in taking him home and letting him sleep. They both explained what to watch for and kept him from sports for the following week. The doctors were wonderful. The department, however, was in utter chaos. While we waited, there were many people there with seemingly fine kids (runny noses?). No one really seemed to be in distress–most folks were watching TV and visiting. A drunk almost fell on me . . .ewwwww. I volunteer at this hospital in the NICU, so I am familiar with that area of the hospital. Let me tell you, the restrooms in other areas of the hospital are . . .much cleaner. I was grossed out by the ladies room. Anyhow, my point is that I can see how different the ED is compared to other areas of the hospital–it really is a different world. For another take on the ED, go to http://www.xanga.com/swinginislanddoc/468332631/item.html . . .

  9. anon 8:01,

    You are very correct. My brother was a middle school teacher and is now principal of a Jr. High. We often swap stories. We deal with the same meth smoking toothless wonders that somehow managed to push out 6-7 kids they can’t afford but seem entitled to everything, and of which nothing can be their fault.

  10. Catherine says:

    Speaking as a lay person, couldn’t the high percentage of physician suicides be attributed to the fact that they know the workings of the human body and how to successfully extinguish life, as well as having wider access to the means of doing so? Just a thought from someone who unsuccessfully attempted suicide last December herself.

  11. Catherine:
    Yes, that’s certainly a possibility. However, it must be weighed against the realization that those same doctors have (presumably) more insight and access to psych care.

    I hope youre getting help yourself.