Physician Health 101
A basic lesson when treating a physician
Posted Apr 18, 2017
I treated my first physician-patient on Christmas Day 1970. A middle-aged man (I’ll call him Dr. Watson) was brought into our emergency room mid-day. He was preceded by a litany of expletives coming from the parking bay for emergency vehicles outside the entrance to the ED. Dr. Watson was accompanied by the police, called to the airport for “an unruly passenger.” He had been loud and disruptive just prior to take-off when the flight attendant refused to serve him alcohol. The words of the police officer are etched in my brain: “We got a real wild one here doc – he’s wound up like a top, he won’t shut up and get this, he says he’s a doctor.” The incredulity of the officer was not atypical for the era. What we now know about the mental health issues for physicians was not public knowledge back then.
Making the diagnosis was a slam-dunk. Dr. Watson met all the DSM-II criteria for manic depressive illness. He was grandiose and delusional, his speech was flighty and pressured, he was irritable and socially disinhibited, and completely lacking in insight. But what was most challenging and the biggest hurdle was ensuring that he got the correct treatment for his condition. A single injection of chlorpromazine calmed him down and within a couple of hours, he was more rational. Despite the anguished pleas of his terrified wife and children that we keep him in the hospital, the majority opinion of my team that day was that he was safe to leave. Dr. Watson convinced them that he was “ok now” and ready to go. He promised them that he would take medication and go for outpatient care. I was the sole dissenting voice. I prevailed and overruled, that he needed to be held involuntarily and admitted to our inpatient psychiatric unit. I could see that my normally savvy and very experienced colleagues were trying to protect Dr. Watson's reputation and privacy; they had allowed themselves to be lured into minimizing his psychotic condition and releasing him.
The story of Dr. Watson illustrates one of the basic lessons for mental health professionals mastering “Physician Health 101”: never let your clinical judgment be compromised by your patient’s occupation. More specifically with this man, Dr Watson needed to be viewed first as a very ill psychotic individual who just happened to be a physician. The examples are legion of doctor-patients being underdiagnosed and undertreated with horribly sad and tragic consequences.
Although Dr. Watson launched my decades long career as a “doctors’ doctor”, I had become sensitized to the vulnerabilities – and the humanity – of physicians since medical school. In 1962, my room-mate and fellow medical student killed himself over the Thanksgiving weekend. Although Bill’s death, like so many suicides, was a complete shock and came out of the blue, my confusion and grief sparked my curiosity about the psychological makeup of doctors. That passion remains with me till this day. It is foundational and drives my clinical work, my teaching, my advocacy, and my scholarly focus.
My latest book “Why Physicians Die by Suicide: Lessons Learned from Their Families and Others Who Cared” is full of stories gleaned from families and intimate others of doctors who have ended their lives. The accounts are gripping and heartbreaking, yet suffused with hope and frank dialogue. There is an emerging groundswell for truth-telling, stigma busting and overdue change in the world of medicine. I’ve melded these narratives with several disguised vignettes from my clinical practice. I will discuss these findings, recommendations and other insights from physician health research in future blogs. So stay tuned!
To quote Dr David Satcher, former Surgeon General of the United States, “Suicide prevention is everyone’s business.” I strongly believe that collectively we can reduce the number of doctors who take their own lives each year in this country.