The dilemma facing doctors in an emotional crisis is illustrated by an article this monthin the Sydney Morning Herald by Professor Steve Robson, president of Royal Australian and New Zealand College of Obstetricians and Gynaecologists, entitled “ THE KNOCK ON THE DOOR THAT STOPPED MY SUICIDE …….”. He said that he “ found medical school difficult – I was not a natural academic……Halfway through 1988, I felt overwhelmed with inadequacy. I had a patient die and I felt responsible. My consultants ….were not exactly glowing in their feedback……I had an all pervasive sense of failure….I could see no way out…So one night I made careful plans to kill myself…..I stole some supplies from the wards…..Incredibly , a work colleague arrived unexpectedly and began knocking on the door…That impromptu visit saved my life….I made an appointment with a GP ( Family Medicine Practitioner)in the town. To this day I remember this GP’s advice: Under no circumstances tell anybody or see a psychiatrist…..If I had a record of suicidality or mental illness, I would never be able to income-protection insurance and I would probably never get a good job….I tried antidepressant treatment but I remember it being very unpleasant ……The GP warned me that if anyone found out about prescriptions for antidepressants I might be in trouble with the Queensland Medical Board, perhaps struck off until I could prove myself….. Today, I am president of my college. I have had a good career. There was light at the end of the long, dark tunnel. I just couldn’t see it at the time……Today I am not ashamed of how I felt or what I did 30 years ago. I am ashamed that I have not used my position to advocate more strongly for colleagues in difficult emotional circumstances. …. When trainees of the college of which I am president took their own lives , I stayed silent. When a junior doctor took his own life while working at the same hospital where I tried the same thing I stayed silent. Enough silence……If you feel the way I did 30 years ago , seek help. Who knows where you might end up.”

In the US, the primary issue is not shame in having an episode of “mental illness” per se (a poor term itself), it’s being corralled into a state-sponsored diagnosis and treatment racket and then having your career ruined. The very intervention causes mental illness! Finally, due to the efforts of diverse groups, state medical boards have been cautioned about asking invasive questions on license applications and renewals about one’s personal history of such illness.

Even there, the primary issue wasn’t about the asking of the questions, it was what happened after one answered in the affirmative about a current (and in treatment) or past episode of a “mental illness” like an episode of depression or anxiety. One would then be sent to what amounts to a pseudo-psychiatric RICO and then have one’s life ruined by a supposedly benevolent agency acting on behalf of the state to “protect the public.”

Part of this horrific scenario has to do with these agencies’ play on the taboos around the term “mental illness.” Having an episode of a readily treatable emotion-centric illness which has somatic representations, i.e. depression or anxiety, takes on an entirely different meaning under the term “mental illness.” Thus, all situational episodes of such an illness get classed under this term which has too many taboo associations which evoke images of zombie-like people walking around Frankenstein-like with frontal lobectomies.

It’s a compound problem that can’t be fully addressed here. Suffice it to say that 1) having an episode of a mental-based illness which is treatable is not the same as being “mentally ill;” and 2) such is nevertheless rightfully in the domain of one’s utmost protected health information and should never be revealed to a licensing entity without solidly established cause and protection from harm. And I would add an additional caveat: given the horror stories from states across the country pertaining to abuses of psychiatry by state-sponsored physician health programs (PHPs), no physician in their right mind should participate in one without thorough research into its integrity, sensitivity and mechanism of grievance. PHPs’ own trade association FSPHP refuses to intervene in cases of reported abuse by its members and refuses to allow institution of a nationally standardized external audit. What are they afraid of?

Why is the general press not aware of what is going on?  It seems that there is a consensus of opinion here – physicians prepared to go ‘on the record’.  What has been said in this article is surely a national scandal! I am British (although living in Colorado) and have elsewhere on Medscape commented on our own Doctors Support Network, run by doctors for doctors. We are a small nation and comparable in size to ‘one state’ in many ways, so I realize that comparisons are not valid.

The British physician regulatory body the GMC (General Medical Council) has been brought to task, because of the seriously high rate of suicide of doctors who are ‘referred’ to them for ‘investigation’. It is a worldwide problem.

Doctors are patients too. They require the same degree of high quality, confidential advice and treatment as anyone else – more so when mental health is concerned. When this is not in place, fear prevents timely help and treatment – we all know that – it is obvious. I wrote something similar to this as a letter to the ‘GMC News’ in 2004, three years after my complete  recovery and return to work from a prolonged and severe depression.

However the reality is that until doctors start speaking out about their mental health, the successful treatment and recovery, as well as the horror stories, this will not change.

Thank you to those who have done this already. We need more to come forward. The shroud of secrecy needs to be broken. We cannot tell our patients that there is no shame in being mentally ill if we do not believe this ourselves.

We have needed this for so long now!

I don’t think that I have ever seen a MedScape article on such a controversial subject that received unanimous support from so many commentators and from many extremely prominent senior physicians whom I respect for their ethical and common sense approach to difficult issues. My heart goes out to the woman who lost her son due to the over-reaching and inappropriate actions of a State PHP, and to all the practitioners who described the Kafka-esque treatment they received. And if the AMA and other National Medical Associations won’t investigate and put an end to these abuses, where are our State Medical Boards in sorting out this mess? Surely they aren’t all run by persons with COIs that are personally profiting at the expense of the physicians (and their patients) being destroyed by unsubstantiated allegations and diagnoses! Obviously, the takeover of US healthcare by for-profit companies has done more harm than lining the pockets of health corporation executives and insurance companies with the resources that should be going into service delivery.

Rise up-fight the Power!

Dr Kernan Manion is to be congratulated for founding the Centre for Physicians Rights after his own shocking treatment by the Medical Board and its Physician Health Program.

We had the same problem in Australia until a spate of young doctor suicides forced authorities to look again at this entire process including the Mandatory Reporting Laws concerning health professionals. Such secretive processes are open to abuse and are now being reviewed.

The most high profile case was that of Dr Chloe Abbott , a 29 year old doctor in training , and a former national representative swimmer. She was a tireless advocate for doctors in training and a representative on AMA and national health bodies negotiating with political leaders.

When a close friend, also a doctor in training , committed suicide Chloe became depressed. Her registration was suspended and she was committed to a psychiatric hospital for two months. After her discharge she also took her own life. Her family were appalled at the way she was treated. Her sister Micaela Abbott summed up the way Chloe had been treated , “ eaten alive by the medical profession.” Her mother Leonie Eagles said she would advise all parents not to let their children study medicine.

These Physician Health Programs seem to have more in common with totalitarian government’s “re-education” camps than the humane therapeutic programs that Dr Karl Menninger would have provided.

One has to wonder whether enforced psychiatric treatment is more harmful than no treatment at all.

When one also considers the high rate of burn out and suicide in the medical profession and that many doctors regret that they chose medicine and would not advise their own children to study medicine then something is surely wrong.

Once again thank you Dr Kernan Manion for your well needed and courageous initiative.

I am happy to see that such an organization exists.  Too often physicians are vilified for relatively minor indiscretions.  There does not appear to be an alternative to help physicians who may want it or need it.  Rather, their admission is penalized so  many suffer in silence as they are afraid to come forward.  Furthermore, those that submit anonymous accusations are not held accountable if they are wrong.  By then, the physicians reputation and status is ruined.

The AMA’s “not my department” response is unacceptable.  It is the same tinkering with the laws and statutes of the local state legislature that has allowed this to occur. The fundamental freedoms and rudimentary rights of health care practitioners have been removed all under the banner of “protecting the public.”  They are not protecting the public and many are being harmed. Silence, deflection and anonymity in response to a nationwide and serious problem is unacceptable. DisruptedPhysician,com/blog

Over the five year course of our Physician Advocacy Study Group, we – about a dozen physicians of various specialties – have spoken or corresponded with literally hundreds of physicians around the country who have shared horror stories about their abuse at the hands of medical boards, physician health programs (“professional assistance” type programs) and dishonest (sham) peer review committees.

Some in the group are themselves survivors of this abuse; others are deeply impassioned ethical physicians who have consulted on and treated falsely diagnosed or falsely framed physicians.

Our inquiry began with a belief that this was a travesty of justice for just a few unfortunate physicians caught up in an unregulated system. But as we compared notes, and then commented in articles just like this one, and received emails and phone cals from other physicians and lawyers around the country, we realized this was much larger than just a few docs wrongfully apprehended in a disciplinary roundup.

As @Dr. Jesse Cavenar & @ Dr. Anne Phelan-Adams noted in their Niemoeller quote, there’s a natural tendency to avoid involvement with issues like this. For one, the administrative injustice and the accompanying psychological abuse is so mind-boggling as to be unbelievable – as in “that just can’t be.” For another, there’s fear of retaliation. And another, the comforting belief that there MUST be justice available for these docs, or that surely they MUST’VE done something wrong.

I and our study group can assure you – this abuse is real and its breadth and severity jaw-dropping. And it shows no signs of letting up. Because there is no government oversight of these regulatory entities and no legal accountability. Boards can make whatever accusations they want and legally overpower you and drive you to bankruptcy. PHPs can make up whatever diagnosis they want, order you to their “ referred” programs and essentially brand you as mentally ill for life. And there is utterly NO INTEREST by the professional societies which should protect physicians’ rights in investigating this. One must wonder why.

And physicians must begin demanding answers.

Check out the website: http://www.physicianrights.net. We’re going to be publishing a book very soon featuring physicians’ stories and practical advice. Sign up on the website to stay informed and join us in making positive change to protect physicians’ – and patients’ – rights.

I am heartened to see this article and to know that these amazing people are doing something I have only dreamed about doing myself.

I wish this group success. ‘What is potent for good’ (the protection of the public) ‘is powerful for evil’ by an unregulated and unchecked abuse of power which oppresses good doctors. How is that in the public interest? The ghost of Kafka still shuffles its faltering way through the rack employed by unethical abuse of power and lack of due process.

Dr Jim Behan Psychiatrist

As mentioned in the article, my interest in this issue stems from a longstanding concern about physician suicide based on the several I’ve been aware of during my career (see e.g. http://bit.ly/MDSuicide ).  I am a 5th generation physician, and have never had any involvement with a MLB except as a legal consultant, or with a PHP.  Except that I used to strongly support the latter for physicians struggling with health issues. ( http://bit.ly/PHP_MLB ) Now that I have been studying these organizations for a number of years, I must agree with the sentiments of Dr. Shackelford, Dr. Miday and others who have recognized a seemingly systematized pattern of abuse coming from many of these institutions that can have career- or life-ending consequences for physicians.

And having been a doubter myself that this could happen in a country based on democratic principals of rule of law and fundamental fairness, I can relate to Dr. Cavenar’s reminder about Martin Niemoller’s warning as applied to this situation. (“I did not speak out…because I was not a drug user….”disruptive” physician…or aging doc…”)  Eventually you will attain a category that is being subjected to this scrutiny (in the name of public safety).

I have taught for years about the ravages of litigation stress on physicians.  There is something called a “white coat myth”, employing which doctors tell themselves that as long as they do the best they can, for as many as they can, for as long as they can, that they will be safe from harm such as malpractice lawsuits and other professional insults that feel unfair.

If you subscribe to this myth of safety based upon your fundamental uprightness, then you will be able to categorize those physicians who experience difficulties with malpractice claims or medical board challenges as “not like me”, and thus insulate yourself for a time…until one of these things DOES come for you.

WHEN that happens, it will be easy for you to recognize the unfairness.  But it might be too late.

I would encourage everyone who reads this article to explore further the underpinnings of the organization in formation http://bit.ly/CPRSite  and to help in any way that you can.

It certainly seems like there have been some abuses of these processes. I’m not surprised that the AMA has no no arm to protect physicians from this kind of thing. I left that organization several years ago.

@ Dr. Anne Phelan-Adams  I have now practiced medicine for 55 years as a Navy flight surgeon, general surgeon, psychiatrist and psychoanalyst. I have served as an expert witness in many state, federal, and military trials and never have I seen anything as outrageous and egregious as certain PHPs and medical boards. I believe there is a complete lack of integrity and veracity in some members of certain PHPs and medical boards. Further, it is my opinion that if the courts had not found that these same PHPs and medical boards have sovereign immunity, the PHPs and medical boards would have massive major litigation brought again them and would have a major problem in trying to defend their actions.

Until organized medical groups complain loudly, nothing is likely to change. The passivity and self-interest of some physicians is overwhelming to me.  I am reminded of:

“First they came for the socialists, and I did not speak out—because I was not a socialist. Then they came for the trade unionists, and I did not speak out— because I was not a trade unionist. Then they came for the Jews, and I did not speak out—because I was not a Jew. Then they came for me—and there was no one left to speak for me.”

There are a number of physicians who read of these issues concerning PHPs and medical boards and think to themselves, “Thank goodness I haven’t been caught up in this” and refuse to get involved. To paraphrase the quote above, …”there is no one left to speak for” the vast majority of physicians.  It is a deplorable state when one allows personal passivity to permit the situation to get to its present state, in my opinion.

As I have been asked recently if I have been in personal difficulty with the PHP or medical board, let me state for the record that I have not. I do not use alcohol, and do not take meds except for diagnosed medical issues. In the interest of full disclosure, let me note that I have been counseled twice for singing too loudly in church. I am trying to do better.

Jesse O. Cavenar, Jr., M.D.

I only wish that CPR was up and running before my physician son died by suicide in 2012. His final calls were to his state PHP. Instead of urging him to follow through with the treatment plan he and his psychiatrist had decided upon that day, which involved seeking a recovery program of his own choosing, they recommended that he report to them first. He was found dead the following morning. I have no doubt that his fear of loss of licensure was what drove him over the edge. He had already suffered the humiliation of a mandated 90 day stay at a residential treatment program, where he was diagnosed as “alcohol dependent” when he clearly was not. It is clear that PHP’s tailor the diagnosis to the treatment, rather than the other way around. My hope is that Dr. Manion’s much needed advocacy group will save physician lives. Although too late for my son, it is not too late for others.

Among many other good reasons for formation of this advocacy group is to provide education – to physicians and to the greater community. Incoming medical students should be aware that they are committing to a path that essentially strips them of rights many Americans take for granted – including the right to autonomy when making healthcare decisions and the right to privacy with respect to personal health information. It is undoubtedly necessary to have a mechanism to protect the public from impaired doctors, but over the years, medical boards and physician health programs have expanded their “mission” with what appears to be an underlying financial and professional agenda that now makes it necessary to create mechanisms to protect doctors. A pattern of widespread abuse has resulted from lack of accountability for procedures and practices that are mandated by self-appointed experts, who have institutionalized their expertise by creating the addiction medicine specialty, and who use the threat of loss of career, reputation, and professional identity to ensure compliance with a system in which they are the primary beneficiaries. The Center for Physician Rights will counter the silence once engendered by shame and an automatic presumption of guilt derived from the moral authority vested in institutions such as medical boards.

I cannot tell you how heartened I am to hear about this.  Twenty years ago I was driven out of my hometown (and a Pediatric Practice I started from scratch) for defying the threats of hospital executives to answer a terrified nurse’s call in the middle of the night, saving a baby’s life and reporting it to hospital Peer Review.  I was fired two weeks later – without ANY review of what happened or due process conducted.  I was in public service – a National Health Service Corps provider!?!  The Federal government dived under a desk when I begged for help.  All of what happened was reported to the NC Medical Board (and JCAHO) and they DID NOTHING with regards to the despicable/unprofessional behavior of the doctor I reported – and certainly nothing to assist me legally.  You see the doctors on the Peer Review Committee are protected from legal scrutiny – but those who report ARE NOT.  Whistleblower protection is a MYTH.  I litigated to settlement (in my favor) – but (because I had a local lawyer out-of-his-depth) was swindled of fair restitution there – because hospital executives lied about the confidentiality of their “non-profit” books (and what was in them) during discovery.  I reported that – and spent YEARS trying to get my case to the FBI/SBI – but hit a stone wall with the local DA’s office – who would not make a simple referral (protecting all of the bigwigs who sat on the hospital board and donated to his campaign).  I was a woman who had the courage to stand up/report malfeasance when it happened and was brutalized for it.  OBTW, the hospital involved is now floundering, desperately searching for a bail-out – courtesy of the overpaid/overrated executives who destroyed my hometown dream.

Fast forward twenty years to 2017 and almost the same thing happened again – this time I was a university employee sold across a state line as a slave – courtesy of a merged system that is supposedly overseen by two states (who were told what was going on before the approved the merger) . . . and that after over a year living and working under constant threats against my career and livelihood by hospital executives who made their bonuses/cooked their books by not paying me fairly for my overtime and teaching.  It was brazen age/sex discrimination AND retaliation (for reporting bad behavior/bad care) – yet state and Federal oversight is NON-EXISTENT to the point of collusion (the Russians have NOTHING on these people).  You’re supposed to hire the $500/hour lawyer to fight a case when you have to concentrate on surviving/moving on.

It’s CRIMINAL what these hospitals and regulatory bodies are doing to good doctors just trying to do right by patients.  Employed/contracted physicians, in particular, have ZERO basic rights.  And the Medical Boards have DONE ZIP to advocate for their licenses.

THANK YOU !!!

College of physicians and surgeons in Canada just like your board is aprosecutor, investigator, judge and after you finish nerve breaking launched disciplinary process denies your elementary right of appeal their some times monstruous decision, does that sound familiar? Yes of course its typical for autoritative dictatorship which is rarely seen today and only in some bana countries and college of physicians unfortunatelly in the most developed countries, what a match…then we have this CMPA (whatever is called in USA) who collect significant amount of money from us yet, engage second hand lawyers to “defend” us from these vultures at the college of course with poor or no positive results at all. This raketeering organisation exists because of this crazy system that shows no respect whatsoever to their “colleauges”,treat us like criminals, forces us to prove that the claim is or might be false or has no merit (guilty until proven otherwise). Personally I remember asking these “high profile”lawyers to take the medical act to court as in addition to other crazy/ irrational things set in it the same it denies our elementary rights ( rights waranted by constitution) the one that even the most notorious criminals have and that is the right of appeal, they say that is not their job, of course its not because if these crazy medical acts were not the way they are these second class lawyers would have no job to do. Its unbeleivable how tolerant or better said big cowards we physicians can be. Obviously we dont care much, for as long as its not about me, not thinking that soon these wich hunters will come after you and get you just like many other colleagues………..

For some thirty years while practicing at Duke University, as I was both a psychoanalyst and psychiatrist, I was the “doctor’s doctor”. I saw physician patients who had been diagnosed and treated at the NCPHP; I was alarmed at some of the diagnoses that these patients had been given, as I believed those diagnoses to be markedly in error. Several colleagues agreed with my concern and we attempted to approach NCPHP personnel about our concerns. After being rebuffed, we went to the Governor, spoke with his Chief of Staff, and the NC State Auditor did a yearlong performance audit of the NCPHP. That audit is public information and can be found on the internet.

I attempted to assist one young physician who was diagnosed as having alcohol abuse. However, this man had never been given a Breathalyzer or had a blood alcohol done. He met none of the required diagnostic criteria for alcohol abuse, and even the NCPHP psychiatric consultant stated to me in writing that the man did not meet the required diagnostic criteria. NCPHP personnel refused to discuss this with me even after the young physician gave me a power of attorney to represent him.  This man was detained in the NCPHP for thirteen months at a cost in time and money of $100,000.

I attempted to discuss this with the NCMB and met with a stone wall.  A NCMB investigator refused to take documentation from me that clearly demonstrated that the diagnosis of this man was in error, and the NCMB refused to respond in a meaningful manner to various questions I directed to them.

Most alarming, however, is the fact that the attorney who represented this man has told me in writing that the NCPHP personnel acknowledged that this man “was not an alcoholic” but that treatment wouldn’t hurt him and the NCPHP was treating him prophylactically so that he wouldn’t develop a problem in the future.  This will leave most physicians shaking their head in disbelief.  It would be analogous to a physician stating that he put a patient in intensive care for a lengthy period even though the patient had no symptoms, did not meet the diagnostic criteria for any illness, but was put into intensive care so that he didn’t develop some illness.  This strikes me and my colleagues as sheer nonsense.

I regret to report that this is not an isolated case.  Far from it.

Jesse O. Cavenar, Jr., M.D.

Professor and Vice Chairman Emeritus

Department of Psychiatry

Duke University

Associate Chief of Staff (Ret)

Veterans Administration Medical Center

Durham, NC

Colonel, Medical Corps, U.S. Army (Ret)

Unfortunately, State Medical Licensing Boards can be kangaroo courts.  You have all the risks and none of the rights of a defendant in a court of law.  And there is no judge to monitor the prosecution.

This sounds like an important support group for doctors. Well done!