The unwieldy name of the resolution was "Lessening the Stigma and Potential for Negative Professional Consequences to Physicians Seeking Mental Health Care Services." It sailed through the Idaho Medical Association House of Delegates without comment on Friday July 21 during the first session. But when it came time to vote on Sunday morning, the reference committee requested more input from delegates. Suddenly what sounded like a no-brainer to most physicians became the most contested resolution at the IMA's Annual Meeting, hosted this year in Sun Valley.
The resolution sought to promote an atmosphere where physicians are able to freely seek mental health care without being afraid of losing their job, their license or their professional standing when they admit it. (See recent University of Michigan study on this issue.)
Take this example, shared on a national residency faculty listserv:
"Talk about shame and stigma - one of our residents is currently applying for his full license in another state (moving there for a new job after graduation). Apparently, the application asked about mental health disorders and he checked 'yes' for his hx of MDD (stable, no relapses x years, on same dose of meds x years and wouldn't know it unless he told you about it). He now has to pay for a forensic psych eval (about $1800 at least, out of pocket), arrange for his PCP to speak to the BOM-contracted psychologist, do drug-testing and then wait to hear if he will be able to move forward, have to enter a monitoring program, or be denied his license (unlikely I think)."
I have to trust the doctors I know personally who have served on Idaho's Board of Medicine. To their credit, they claim that IBOM always treated physicians in situations like these reasonably quickly and fairly. Unfortunately, I've heard one too many blood-curdling instances in-state where peer-review processes by employers and groups meant to improve patient care have been weaponized against physicians.
Unquestionably, public and patient safety has to be maintained and that is the primary goal of application and review processes. But I contend when those processes are not fair or transparent and doctors are forced to run blind-folded through an administrative gauntlet, this burdens them with an additional layer of avoidable trauma and fear that is too much for some. Whether the above examples were warranted and repeated or not, word travels fast among physicians that can have a chilling effect on healthy disclosure and that is not in the best interest of patient safety.
Doctors forced to run blind-folded through an administrative gauntlet burdens them with an additional layer of avoidable trauma and fear.
The direction I hope all Idaho employers, licensors and credentialing boards start moving in is to provide the positive message that "if you are a medical provider, we encourage you, we want you, maybe even expect you to seek mental health care preventively. It's good for you and it's good for your patients. And unless there is a real impairment, we're not going to be punitive when you tell us about it. In fact, to encourage you to do so we're going to be very open about our review process."
I believe that the employers, hospitals, practices and states which are the most transparent, whose medical cultures allow for doctors to remain human, are the ones where doctors will gravitate to as the burnout epidemic takes its toll.
Eventually, the House of Delegates resolution was referred to the IMA Board of Directors for further study. Clearly, this was no simple matter to be debated in short order while trying to finish up HOD business. As ACMS continues to advocate for physicians, I invite you to share stories that would help various institutions understand what it feels like to sit on the other side of the desk.