Disturbing Issues in Medicine


I filled out an interesting survey sent by the AMA concerning physician well being. It was a very thought provoking set of questions developed by the Mayo Clinic. As I finished the questionnaire I realized that some of the concern by our organization was burnout and suicide. This was interesting to me due to the number of suicides that have occurred in the last few months, from well-known actors/comedians to local doctors. I also started to think about the applications to my life and my practice and wondered why the problems exist to make one consider such a life-ending strategy. I was also reviewing a recent article on Physician Suicide written by Louise B. Andrew, M.D./J.D., et. al. written in July in “Medscape”, of this year and I wanted to include a part of the overview:

“It has been reliably estimated that on average the United States loses as many as 400 physicians to suicide each year (the equivalent of at least one entire medical school).

Sadly, although physicians globally have a lower mortality risk from cancer and heart disease relative to the general population (presumably related to self care and early diagnosis), they have a significantly higher risk of dying from suicide, the end stage of an eminently treatable disease process. Perhaps even more alarming is that, after accidents, suicide is the most common cause of death among medical students.

In all populations, suicide is usually the result of untreated or inadequately treated depression, coupled with knowledge of and access to lethal means.[1] Depression is at least as common in the medical profession as in the general population, affecting an estimated 12% of males and 18% of females. Depression is even more common in medical students and residents, with 15-30% of them screening positive for depressive symptoms. A 2011 survey of 50,000 practicing physicians and medical students in Australia demonstrated a dramatically increased incidence of severe psychological distress and a twofold increased incidence of suicidal ideation in physicians compared with the general population.

However, because of the stigma often associated with depression, self-reporting likely underestimates the prevalence of the disease in both of the above populations. Indeed, although physicians seem to have generally heeded their own advice about avoiding smoking and other common risk factors for early mortality, they are decidedly reluctant to address depression, a significant cause of morbidity and mortality that disproportionately affects them. (Depression is also a leading risk factor for myocardial infarction in male physicians.)

Perhaps in part because of their greater knowledge of and better access to lethal means, physicians have a far higher suicide completion rate than the general public; the most reliable estimates range from 1.4-2.3 times the rate in the general population. Although female physicians attempt suicide far less often than their counterparts in the general population, their completion rate equals that of male physicians and, thus, far exceeds that of the general population (2.5-4 times the rate by some estimates).

A reasonable assumption is that underreporting of suicide as the cause of death by sympathetic colleagues may well skew these statistics; consequently, the real incidence of physician suicide is probably somewhat higher.

Are the stresses in our world in general becoming so much more difficult for us to handle?

Did you all realize these numbers-1.4-2.3 times the rate in the general population? In the medical profession what additional stresses, pressures, additional work would make us so frustrated and depressed to lead us to suicide?

Do our families and friends around us realize our weaknesses and potential problems?

Evidently not or the people in jeopardy would get the assistance that they need.

Will the new health care system make matters worse or will it help the issues causing the mental stresses and seemingly disappearing into the deep black hole?

Think about what I have been harping about for many weeks. The stresses will be monstrous with the increased numbers of patients needing health care, the lack of sufficient health care workers, both nurses and doctors, and the restrictions in money spent in the delivery of care-unless we can find that ole money tree in our back yard.

Physicians, as I have pointed out before, are being told how to practice medicine, being paid less and less each year form the government (Medicare and Medicaid) and our responsibilities grow daily with increasing penalties if we don’t subscribe to the Kool Aid philosophies.

I do realize the potential benefits from a health care system that covers all the population, but the whole system has to change. Doctors will be just some more Blue Collar workers who just care about their paycheck and forget their oath to care for our patients’ health needs.

How do we bridge the gap form the needs of the patients, the needs of the physicians and nurses and hospitals and the onerous laws and restrictions of having government involvement in our health care system?

Presently I need to continue to educate the masses of uninformed Americans “forced” into a system that they didn’t vote for and count on our educated voters to assist in the change so that we can modify the present law, making it more palatable to all.

I should correct my last statement. Never will any group of lawmakers/ politicians make anything palatable to ALL. But we can try.

Look to the future of the ACA, at least for the next year. A study by Dr. Avik Roy, a senior fellow at the Manhattan Institute for Policy Research showed the goal will be to vastly expand the use of exchanges, with Medicare and Medicaid beneficiaries required to obtain coverage through the government-run marketplaces. In addition, the new blueprint would allow insurers to charge older, sicker patients up to six times more than younger, healthier ones, up from the current 3-to-1 ratio, and allow the sale of “bronze plans” designed to cover just 50% of medical costs. So cost to the consumer goes up again. Most of the insurers predict the premiums and deductibles will rise next year by as must as 15-40%

More stress to the practicing physicians is the new ICD-10 codes, which when they are rolled out increase the diagnostic codes (how we code for the disease or condition that you are being treated for or operated on) a little more of 6,000 codes to almost 76,000 codes. You realize that with that change alone the practices and hospital will have to totally upgrade all their medical records or EMR systems. The cost for each practice will be in the thousands of dollars. Add that to the additional burden of new regulations, audits, and denials of payment if the powers that be don’t believe that you are providing “quality” care, even in the non-compliant unreliable patient. All this and the potential of being sued by their patients and their lawyers are a formula for disaster leading to the increase stressing of physicians of this fine country in transition.

What should we all do?

Suggestions for my compatriots from the country of the medical profession, that is we physicians, take the AMA/Mayo Clinic “The Physician Well-Being Study” Survey. If this survey identifies some aspects of your lives that would normally identify potential concerns in one of your patients and push you to seek a referral to a psychologist or psychiatrist? Seek professional assistance before the stresses push you over the edge. If you are stressed or recognize the uncomfortable feelings of burnout, or lack of enjoyment of your practice, change your practice model, spend time with your family, and take a vacation. In other words rebalance your life. It, life, is too short to ignore the warning signs.

To our patients, please watch out for your physicians. My ideal health care equation is a Team effort. If you recognize a change in behavior of your physicians, out of what you are used to ask your doctor or their nurse, or their physicians’ assistance how they are doing or ask their staff. Communicate within the practice and save a life. Remember in the article that I cited, physicians are reluctant to self-report due to the stigma.

Let’s help each other!

Thanks for allowing me to take a detour from my original plan to dissect the Affordable Care Act. Next week I will return to my original plan.


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