The dark side of doctoring

Family physician Katherine J. Gold, MD, MSW, shares with her physician colleagues an interest in saving lives. It's her focus on a certain category of people at risk that sets her interest apart.

Dr. Gold, an assistant professor at the University of Michigan in Ann Arbor, recently led an analysis of physician suicides, using data from the National Violent Death Reporting System. The results, published online by General Hospital Psychiatry on Nov. 5, 2012, compared information on 203 physicians who had committed suicide to more than 30,000 nonphysician suicides.

The physicians were significantly different from nonphysicians on several fronts, including their demographics, their treatment rates for depression and their suicide methods. Dr. Gold recently spoke with ACP Hospitalist about how to understand these differences and take action to reduce the risk of physician suicide.

Q: What led you to analyze these data on physician suicide?

A: One of the authors on the study, [Dr.] Tom Schwenk, had done a study on depression in medical students and the amount of stigma around it. Among my own colleagues, I see a lot of stigma on depression. I discovered this data set with all these variables that could be linked together to give us information that we hadn't had before.

Q: What data did you find most surprising?

A: Most surprising to me was that job stress was a key predictor of physician suicide and much more common among physicians than nonphysicians. It makes a lot of sense because physicians often identify with their job in a very strong way, but I was surprised it was so much bigger a factor for doctors than others. The other thing that was sobering was the high level of prescription medications, like benzodiazepines and barbiturates, found in the blood of doctors who had died by suicide, suggesting that overdose is perhaps a more lethal method for doctors than nonphysicians.

Q: Your study also showed that physicians who committed suicide were more likely to be married and less likely to have diagnosed substance abuse than nonphysician suicides. What could that mean?

A: The physician demographics were not what you would expect in a population of people who had committed suicide. Yet this still is an affected population, so it speaks to the issue of job stress being a key thing, and the whole issue of mental health and depression. These are people who should have been able to get help if they needed it.

Doctors have good access to health care, but study after study shows doctors are less likely to have a primary care doctor and less likely to get basic health care and take care of themselves, even though they may advocate that for their patients. We know anecdotally that many doctors who get mental health care will go outside of their community or they will self-prescribe.

A lot of that revolves around this whole issue of stigma and fear of judgment by other people, some of which may just be a perception and some of which may be real. We don't have any data that physicians who are depressed aren't safe doctors, but with the licensing requirements like they are in some places, people worry that they will be perceived that way.

Q: What action should be taken in response to these findings?

A: There are some state boards that require reporting of things like depression. And there's a lot of hesitation among physicians to seek treatment when they feel like this might affect their job if they seek treatment.

Q: Are there additional research questions you'd like to pursue in this area?

A: The one thing that I couldn't find in all the literature was [data on] the extent of mental health problems among physicians, beyond just depression. I tried to look up a lot of other disorders and what we know about them in this population and there's just no data out there. We need to understand what's going on with physicians' mental health if we're going to help try to get people treatment, if we're going to help try to prevent suicide, if we're going to help try to improve people's quality of life.

Q: Based on your research, what advice would you give to individual physicians?

A: We know that doctors are a high-risk group. We also have ways of treating depression and suicidal feelings, unlike some diseases that we treat that don't have good options. Many health systems have methods set up so that physicians can get confidential health treatment. Physicians should not be treating themselves; they should not be writing their own antidepressant [prescriptions]. They need to understand that this is an illness, just like diabetes, and I'd encourage them to get help.

Also, while poisoning was more common among doctors than nonphysicians, the number one method for everybody was firearms. I think that still is a big issue connected to suicides in this country that we need to think about.