To Seek or Not to Seek Treatment... That is the Question
In the time of the COVID-19 pandemic, physician mental health and treatment is more important to discuss than ever. Physicians are expected to model the behaviors they recommend for their patients such as taking medications as prescribed. Most physicians are unlikely to shy away from taking a statin if indicated. However, although most doctors would recommend an antidepressant to a patient who is depressed or rehabilitation for a patient with alcohol use disorder, doctors are more likely to avoid treatment for these conditions. As leaders in society, physicians are uniquely positioned to help change the stigma surrounding mental health and substance use disorders by seeking treatment. Many doctors who experience mental illness or substance use disorder avoid or delay seeking treatment in part due to the fear of repercussions in licensing.
Multiple state licensing bodies not only ask about current mental health treatment but also ask about prior mental health treatment. There is an implication that physicians are less likely to optimally perform their job if they declare any mental illness, history of certain mental illnesses or substance use treatment. This leads to a more in-depth inquiry regarding their mental status. It is illegal to ask questions about disabilities prior to hiring an employee in most settings. On the other hand, due to concerns regarding patient safety, it is legal to ask if the physician has a condition that impairs their ability to perform their job duties.
However, some states go further and ask hypothetical statements asking if the physician could be impaired rather than if they are impaired. Physicians can also be required to obtain letters from all practitioners that have treated them. The stigma and burden associated with these conditions lead some physicians to avoid mental health treatment. With access to drugs and barriers to mental health treatment, some physicians resort to self-medication. Physicians may get medications, such as narcotics, rather than antidepressants to avoid getting a mental health diagnosis such as depression. Depressed physicians are known to make more errors. However, it is likely that a treated physician will provide better care for a longer time than an unmedicated or self-medicated physician.
If questions regarding mental health and substance use treatment are asked, a physician responsible enough to seek treatment should be trusted to limit their patient care if it endangers patient safety. A possible question that would not decrease treatment seeking would be to ask if a physician has been required to enter treatment for substance use or mental illness due to patient safety concerns.
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Jones JTR, North CS, Vogel-Scibilia S, Myers MF, Owen RR. Medical Licensure Questions About Mental Illness and Compliance with the Americans With Disabilities Act. Journal of the American Academy of Psychiatry and the Law Online. 2018;46(4):458-471. doi: 10.29158/JAAPL.003789-18
This article was authored by Sagarika Arogyaswamy, medical student at the California University of Science and Medicine in Colton, CA. Arogyaswamy will be graduating in 2022 and has been involved with quality improvement with hopes to continue this involvement throughout medical school and beyond.