Now, in an effort to combat stigma and burnout among the medical profession, Massachusetts has become the first state to eliminate questions about mental illness and addiction for health care workers throughout its health care system. In about two dozen other states, professional boards that license physicians have discontinued the practice. But Massachusetts went further, removing the question from the credentialing forms used by virtually all hospitals, health plans, insurance companies, and medical licensing boards in the state.
“This is a breakthrough,” said Dr. James Baker, president of the Massachusetts Society of Addiction Medicine and a physician at the Haverhill hospice care facility. “The power of this new policy is to open the door for physicians battling depression, anxiety, and substance use disorders to fearlessly get the help they need.”
This question stems from the idea that medical professionals should be held to higher standards and that their lives are at risk if they are under the influence of alcohol or drugs while on the job.
But questions about mental health history and past drug use have long had a chilling effect on doctors seeking professional help, research has found. In the 2017 survey, Almost 40 percent of American physicians He said he is reluctant to seek treatment for mental illness because he is concerned about the impact on his medical license. In another studynearly half of female doctors said they met criteria for mental illness but did not seek treatment for fear of being reported to the medical licensing board.
During the pandemic, efforts to eradicate questions about drug use and mental health gained momentum as rates of physician burnout and mental distress rose. In 2022, 46% of healthcare workers nationwide will report frequently feeling burnt out, up from 32% in 2018. According to a survey It was announced by the Centers for Disease Control and Prevention last fall. According to one study, an estimated 300 to 400 physicians commit suicide each year, making the suicide rate for physicians more than twice that of the general population. American Psychiatric Association analysis.
Still, it is death in the spotlight The story of a New York doctor who galvanized hospitals and medical professional organizations to address the issue in the early days of the pandemic.
In April 2020, Dr. Lorna Breen, an emergency room physician at NewYork-Presbyterian Hospital in Manhattan, was overwhelmed with an unrelenting number of sick patients, many of whom were dying in hospital waiting rooms and hallways, her family said. Told. After Breen worked a 12-hour shift, she called her sister and told her she couldn't get up from her chair at her house. Her worried family and friends drove Breen to her childhood home of Charlottesville, Virginia, where she was admitted to an inpatient psychiatric unit.
While in a psychiatric ward, Breen repeatedly told relatives he feared he would lose his medical license and hospital certification for seeking mental health care, according to his family.
Days after expressing these fears, Breen took his own life.
“These questions are definitely [Breen’s] It’s death,” said J. Corey Feist, Breen’s brother-in-law and co-founder. national foundation to defend remove biased questions From the medical certification and licensing process. “Much of her self-identity was closely tied to being a doctor. … If she threatened to take away that lifelong pursuit of hers, it could lead to suicide. ”
In recent years, medical boards in at least 26 states have changed the language on their licensing applications to remove questions about a physician's mental health, a change affecting 673,000 physicians nationwide. It is said that there is. Dr. Lorna Breen Heroes Foundation.
It took more than a year of meticulous work to find and remove this language.of Massachusetts Health and Hospital Association It has started collecting certificates of eligibility from all hospitals, health insurance companies and medical licensing boards in the state. Institute staff then carefully review numerous documents, many of them 20 pages or more, to identify potentially prejudicial questions regarding past treatment or diagnosis of mental illness or substance use disorders. I did.
The association found that many of the forms had not been updated in decades and reflected outdated views about the nature of addiction and mental illness. Some placed questions about past mental health or drug use treatment in the same category as questions about criminal convictions. Many hospitals and health insurance plans standard shape It hadn't been updated since 2004.
Such questions are a “huge disincentive” for doctors seeking help with mental health and substance use issues, said Dr. Steve DeFosses, a neuroradiologist at Tufts Medical Center and vice president of clinical integration for the State Hospital Association. He said that. At the hospital, such certification forms are shared with up to 30 hospital staff and administrators, from the hospital accreditation committee to the board of directors, DeFosse said.
“If someone has a disease that's still being stigmatized, there's no reason to expose it to dozens of strangers and colleagues you work with,” DeFosse said. “Another option is for your doctor to hide it and you won’t get the help you need.”
Health care workers are especially vulnerable to burnout when combined with high stress levels, long work hours and repeated exposure to trauma, according to medical organizations. Confidential peer support groups designed for health care workers exist across the state. The Massachusetts Medical Society offers a program known as. doctor health serviceswhich provides treatment and monitoring for physicians with substance use and mental health issues.
Baker is not ashamed to say that she sought psychiatric counseling in response to her grief after losing her 23-year-old son Max to a heroin overdose seven years ago. However, he resented having to disclose this fact when renewing his certification every two years. Typically, he would write an asterisk next to the question and scribble a short explanation, noting that he sought psychiatric treatment “due to a family tragedy.”
“What happened to my son was a terrible tragedy, but it should be my personal business that I asked for his care,” Baker said. “These questions don't improve patient care. All they do is deter doctors from seeking treatment on their own.”
Chris Serres can be reached at [email protected] him @ChrisSerres.
