Updated: Jul 19
We have been hearing stories recently about physicians and increased suicide risks rates due to COVID-19 and treating patients. What we don’t realize is that this is not new. Physicians have increased barriers to care, their needs are poorly understood by the community, their stress and depression are taught to be put aside, and they are taught to have a “culture of silence.” In addition, they are in fear of losing their jobs and livelihood if they seek out the treatment they so desperately need because of their malpractice insurance, and other factors that could impede them being able to practice.
According to the Missouri Medicine Journal of the Missouri Medical Association:
“Firstly, physician suicide is poorly understood. Not only is there inconsistent reporting and a paucity of descriptive data, but investigative work in this area— including prevention-based studies—has been limited. Secondly, despite extensive training, physicians often struggle to identify depression and other mental illnesses— in patients, colleagues and themselves. Although mental illness can impair an affected individual’s insight, the culture of medicine also plays a role in this phenomenon. Stoic training environments normalize stress and distress as inherent or even requisite components of physician identity. Sleep deprivation and long hours are viewed as badges of honor. Physicians and trainees are encouraged to see their peers as competition, instead of support. As a result, physicians may feel alone or even like imposters. This lack of social support then correlates with greater burnout. Isolated within competitive training environments, trainees often learn to ignore signs and symptoms of burnout, depression and suicide. Thus the medical profession sustains a dangerous “culture of silence.”
• Therapist must offer cash pay to all clients, but especially those in the helping field. This offers the client the opportunity to not have their mental health diagnosis, if they even have one, to go into their medical record, or other records should they be requested by their board. Secondly, insurance requires a mental health diagnosis to bill. There is often times that a diagnosis isn’t necessary or even accurate. However in order for a therapist to be paid, they must give one. This takes out the need for this and the need to give a diagnosis that may not even be accurate.
• Therapists must keep accurate but brief notes. There is no need to have long extensive notes. That does not mean that the notes are not accurate and concise, but they must not impede the client. Remember always write notes as if it could be subpoenaed.
• Therapists must offer flexible times for physicians and health care professionals. These professionals often have odd hours and a therapist must have flexibility to see these professionals at odd times and at different times. They may not have the ability to schedule the same day every week.
• Therapists must be flexible with their no-show policy with physicians. Typically I have a 24 hour cancellation policy. However with physicians I am much more flexible due to the nature of their job. I know that they need the flexibility to change their appointments due to what may come up that is outside of their control
• Listen to understand, know that you cannot understand what they are going through, validate their experiences, and empathize with their struggles.
I would be remiss if I did not discuss COVID-19 and how it has affected the healthcare system. The rates of depression, anxiety, and trauma have increased. Doctors, nurses, and all healthcare professionals are affected by the trauma of this pandemic. The numbers and rates of suicide are rising during this pandemic. As a society, and as a profession it is imperative that we find a way to reach out to our healthcare professionals and ensure they are given the resources that they need, and allowed a safe place to land.
I leave you with this from the American Foundation for Suicide Prevention:
“An estimated 300 physicians die by suicide per year, and rates may be rising. Each time, the headlines are saddening—even shocking. Rather than remain in denial, however, it is essential to call for change. To create the necessary cultural shift, individuals and institutions must not only agree that physician wellness is a priority, but also make tangible changes. Otherwise, the ranks of the medical profession will continue to be decimated—and that is a loss for everyone.”