Some physicians have opined their belief that physician health plans (PHP) are contributing to the increasing physician suicidality. These beliefs have been used to attack PHPs and unfortunately, steer those in need to other resources or even have those in need not getting help.
Blaming the PHP for suicide is like blaming the physician who is unable to cure his or her patient of their stage IV cancer because of the patient’s or family’s lack of recognition of the problem or delay in seeking care. We physicians are unique in that it has been ingrained throughout medical school, residencies, and fellowships that we are the problem solvers. Yet until recently, there was little thought given to self-care. Except for those in psychiatry, little emphasis has been attributed to the spirit and psyche.
William Mayo once said he had to know the patient who had the disease in order to treat that person. Another physician caring for tuberculosis patients in a sanitarium; one was accepting of his illness, recovered, and was home in six months while the other who bemoaned and refused to accept his fate was dead. Both men came from similar backgrounds and had what seemed to be a comparable disease. Yet one lived, and the other died. Why? In this day of timed visits and electronic records complete with guidelines, how often do we get to know our patients? How often do we get to know ourselves?
As the fixers, we sublimate our selves to the point of elimination of self. Clinical distance is important but not at the expense of self-elimination of which suicide is the ultimate act. Physicians are good at covering up their problems – too good. This makes any attempt at intervention late in the course of the disease of hopelessness and depression. There is a progressive downward spiral for physicians (and indeed most people) where family, community, finances, emotional health, physical health, and finally, job performance deteriorate in that order. Medical marriage is hard; parenting is hard, and yet those closest to her or him try to help by taking on additional duties and chores. In recovering circles, we call this enabling. Much of this is done innocently, but it becomes a pattern where there is little chance of recovery without intervention.
Physicians need individuals who can see through the smoke screens of denial and understand what stressors can trigger downward spirals into hopelessness and despair. All too often, the mega health care entities do not care for their physicians but only see them as numbers generating revenue. PHPs are focused on the special problems of physicians because the physician is special. Long years of training and long, stress-filled workdays plus journal reading and continuing medical education (CME) for certification and re-certification make us valuable resources. We cannot afford to lose physicians in this time of increased stress as we are needed.
Let your state’s PHP help you. Work with your state medical association to help your PHP be the best it can be. Let’s not blame PHPs for the physician who arrives late and far advanced in their downward spiral. Let us help and care for one another by assuring that our PHPs can do their work of life and career-saving by supporting PHPs rather than castigating by anecdotes. Be in communication with your PHP and understand confidentiality, compassion and competent care are the pillars. Support PHPs as PHPs prevent suicide. Stay safe. Be well.
Virginia E. Hall is an obstetrics-gynecology physician and chair, Foundation of the Pennsylvania Medical Society.
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