Suicide

Doctor suicides prompt calls for overhaul of mandatory reporting laws – Australian Broadcasting Corporation

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http://abc.net.au/news/2017-04-13/doctor-suicides-prompt-calls-for-overhaul/8443842?pfmredir=sm

By Elise Worthington and Paige MacKenzie

Posted 13 Apr 2017, 6:14am

Chloe AbbottPHOTO: Chloe Abbott was doing her physician training when she took her own life. (Supplied: Jessica Abbott)
RELATED STORY: Female health professionals at greater risk of suicide, study finds
MAP: Sydney 2000

The suicides of three young doctors in New South Wales within just five months has led to calls for a review of mandatory reporting laws, which many health professionals believe are stopping doctors from asking for help.

Psychiatrist Dr Helen Schultz said practitioners were reluctant to come forward for fear of losing their medical licence.

“I get really caught between that R U OK Day and tell everyone [about your mental health] and there’s no stigma … to actually, tell nobody, keep it to yourself. Because that grey area could end up being misused against you,” Dr Schultz said.

A mature-aged student when she came to medicine, Dr Schultz struggled with her own mental health. She sought help after the suicide of a colleague, but wasn’t sure she would do so today.

“I was feeling very disenfranchised with doing medicine … I was crying driving to work, I felt very low self-esteem at the time and I went and saw this person and this person got me help,” she said.

“But would I tell somebody now if I was that fourth year student in an era of mandatory reporting? I don’t know.”

‘They were going to save many lives’

If you or anyone you know needs help:

Professor Brad Frankum, president of the Australian Medical Association (NSW), said mandatory reporting could be “a very challenging and threatening experience for anybody”.

“If a doctor discloses to their treating [doctor] that they have drug addiction problems or mental health problems, then it is mandatory for that treating doctor to report that to AHPRA [Australian Health Practitioner Regulation Agency],” he told 7.30.

“Once that report happens, AHPRA can’t ignore it of course and an investigation needs to take place.”

Prof Frankum said in the past 12-18 months he was aware of three young doctors in training who had taken their lives, as well as two senior doctors and a young medical student.

“They were going to save many lives and do great things, and that potential is lost,” he said.

Family could see young doctor was struggling

Chloe Abbott's familyPHOTO: Chloe Abbott (far right) with (from left) mother Leonie Eagles and sisters Micaela and Jessica Abbott. (Supplied: Jessica Abbott)

One of those young doctors was Chloe Abbott, who had just landed a job at Sydney’s St Vincent’s Hospital to do her physician training, with dreams of becoming an endocrinologist.

“It was just this calling that she had that she wanted to help others. She wanted to make other people’s lives better,” her mother Leonie Eagles said.

Last year those closest to Chloe began to notice the determined young doctor was struggling.

“I did say to Chloe in September 2015 that I was really worried that this job was going to cost her her life,” her sister Jessica said.

Chloe’s friend, Dr Zac Turner, recalled Chloe was also grappling with the death of a colleague, a young registrar who had taken her own life.

“Quite dramatically it affected Chloe. They were working together at Campbelltown, they were part of the same network,” Dr Turner said.

“You work from before dawn to well after dusk at night with people. There’s a real community and family and camaraderie, in some aspects, in the hospital and I don’t think she processed that particularly well, I don’t know if the support was there.”

Chloe Abbott campaigningPHOTO: Chloe Abbott, pictured with Labor candidate Chris Gambian and Opposition Leader Bill Shorten, as she advocated for young doctors. (Supplied: Jessica Abbott)

Late last year Chloe was admitted to a psychiatric inpatient ward.

Few knew at the time that Chloe was facing a career crisis: her medical registration had been suspended.

In January this year, Chloe took her own life. Her family is still struggling to come to terms with it.

“Six months ago I never would have thought I’d have a daughter that would have committed suicide,” Leonie Eagles said.

“I had a daughter who loved her life, sisters, boyfriend, and to think that she’s given that up because of the positions medicine has put her in is just heartbreaking.

“They can’t sweep this under the carpet and say we’ll look at it in six months, 12 months. Four more people could have lost their lives in six months.”

‘Young doctors need to be supported’

Memorial plaque for Chloe AbbottPHOTO: The memorial plaque for Chloe Abbott. (Supplied: Jessica Abbott)

Seven weeks into the job, NSW Health Minister Brad Hazzard says his department is taking the issue of young doctor suicides seriously.

“It’s a cultural issue which goes back for decades and we need to make sure that the older doctors supervising the younger doctors understand in this day and age those pressures need to be recognised, and the young doctors need to be supported,” he said.

“We’re bringing a forum of all these young doctors and older doctors as well together in June to allow them to express their concerns.”

Psychiatry registrar Dr Ben Veness is seeking a special commission of inquiry, and has written to Mr Hazzard on behalf of 150 of his colleagues.

“In our letter we ask for an in depth investigation into what are the factors that are underlying doctors’ distress,” Dr Veness said.

“What I think we need to do is something different from what’s been done before and that is looking at other industries as well, having expertise from outside, things like the mining industry which has also suffered from high suicide rates.

“Also we’d like to see what are the things that are being done or could be done to identify doctors who are at risk, so we’re not waiting for a tragic event like one of these suicides.”

See:  The+Future+of+the+VDHP.+A+Discussion+Paper+prepared+on+behalf+of+AMAVic+MPBV++VDHP  The future of the Victorian Doctors Health Program

Physician Suicide and “Physician Wellness” –Time to start talking about the elephant in the room!

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Screen Shot 2016-05-24 at 7.30.05 PM

Physician Suicide and the Elephant in the Room

Michael Langan, M.D.

Although no reliable statistics exist, anecdotal reports suggest an alarming upsurge in physician suicide. This necessitates a reappraisal of known predisposing risk factors such as substance abuse and depression but also requires a critical examination of what external forces or vulnerabilities might be unique to doctors and how they might be involved in the descent from suicidal ideation to suicidal planning to completed suicide.

Depression and Substance Abuse Comparable to General Population

Depression and substance abuse are the two biggest risk factors for suicide. The prevalence of depression in physicians is close to that of the general population1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria suggest that physicians have the same rates (8-14%) of substance abuse and dependence as the rest of the population 3 and slightly lower rates compared to other occupations.4,5 Epidemiological surveys reveal the same. Hughes, et al.6 found a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

State Physician Health Programs

Perhaps it is how physicians are treated differently when they develop a substance abuse or mental health problem.

Physician Health Programs (PHP) may be considered the equivalent to Employee Assistance Programs (EAPs) for other occupations. PHPs meet with, assess and monitor doctors who have been referred to them for substance use or other mental or behavioral health problems. Originally developed as “impaired physician” programs, the PHPs were created to help doctors who developed problems with substance abuse or addiction as an alternative to disciplinary action by State Medical Boards. These programs existed in almost every state by 1980. Often staffed by volunteer physicians and funded by State Medical Societies, “impaired physician” programs served the dual purpose of both helping sick colleagues and protecting the public. Preferring rehabilitation to probation or license revocation (so long as the public was protected from imminent danger)  most medical boards accepted the concept with support and referral.   However, most EAPs were developed with the collaboration of workers unions or some other group supporting the rights and interests of the workers.  Not so with PHPs  as there is no such organization representing doctors.   PHPs developed in the absence of regulation or oversight.    As a consequence there is no meaningful accountability.   

In Ethical and Managerial Considerations Regarding State Physician Health Programs published in the Journal of Addiction Medicine in 2012, John Knight, M.D. and J. Wesley Boyd, M.D., PhD who collectively have more than 20 years experience with the Massachusetts PHP state that:

“Because PHP practices are unknown to most physicians before becoming a client of the PHP, many PHPs operate out- side the scrutiny of the medical community at large. Physicians referred to PHPs are often compromised to some degree, have very little power, and are, therefore, not in a position to voice what might be legitimate objections to a PHP’s practices.”8

Noting that “for most physicians, participation in a PHP evaluation is coercive, and once a PHP recommends monitoring, physicians have little choice but to cooperate with any and all recommendations if they wish to continue practicing medicine,” Knight and Boyd raise serious ethical and managerial questions about current PHP policies and practice including conflicts of interest in referrals for evaluation and treatment, lack of adherence to standards of care for forensic testing of substances of abuse, violations of ethical guidelines in PHP research, and conflicts of interest with state licensing boards.

Knight and Boyd recommend “that the broader medical community begin to reassess PHP’s as a whole” and that “consideration be given toward the implementation of independent ethical oversight and establish and appeals process for PHP clients who feel they are being treated unfairly.” 8 They also recommend the relationship of PHP’s between the evaluation and treatment centers and licensing boards be transparent and that national organizations review PHP practices and recommend national standards “that can be debated by all physicians, not just those who work within PHPs.”8 Unfortunately this has not happened. Most physicians have no idea that the state physician health programs have been taken over by the “impaired physicians movement.”

In his Psychology Today blog,  Boyd again recommends oversight and regulation of PHPs.   He cites the North Carolina Physicians Health Program Audit released in April of 2014 that reported the below key findings:

As with Knight and Boyd’s paper outlining the ethical and managerial problems in PHPs, the NC PHP audit finding that abuse could occur and not be detected generated little interest from either the medical community or the media.

Although state PHPs present themselves as confidential caring programs of benevolence they are essentially monitoring programs for physicians who can be referred to them for issues such as being behind on chart notes. If the PHP feels a doctor is in need of PHP “services” they must then abide by any and all demands of the PHP or be reported to their medical board under threat of loss of licensure.

State PHP programs require strict adherence to 12-step doctrine9 yet many of the physicians monitored by them are neither addicts nor alcoholics. Some do not even have substance abuse issues and there are reports of “disruptive” physicians being diagnosed with “character defects” at the “PHP-approved” facilities that do these assessments.   PHPs require abstinence from drugs and alcohol yet use  non-FDA approved Laboratory Developed Tests in their monitoring programs. Many of these tests were introduced to commercial labs and promoted by ASAM/FSPHP physicians.10-12

LDTs bypass the FDA approval process and have no meaningful regulatory oversight.   The LDT pathway was not designed for “forensic” tests but clinical tests with low risk.   Some are arguing for regulation and oversight of LDTs due to questionable validity and risk of patient harm.13

These same physicians are claiming a high success rate for PH programs9 and suggesting that they be used for random testing of all physicians.14

As with LDTs, the state PHPs are unregulated, and without oversight. State medical societies and departments of health have no control over state PHPs.

Their opacity is bolstered by peer-review immunity, HIPPA, HCQIA, and confidentiality agreements. The monitored physician is forced to abide by any and all demands of the PHP no matter how unreasonable-all under the coloration of medical utility and without any evidentiary standard or right to appeal.

The ASAM has a certification process for physicians and claim to be “addiction” specialists. This“board certification” is not recognized by the American Board of Medical Specialties and is not a recognized medical specialty. The goal of the ASAM is to be recognized as the experts in addiction medicine with the consensus expert opinion based on the 12-step prohibitionist brain disease model. The ASAM has aligned itself with a number of inpatient drug treatment centers  (Hazelden, Talbott, Marworth, Bradford,etc) and are heavily funded by the drug testing industry.   It is in fact a “rigged game.”

State PHPs are non-profit non-governmental organizations and have been granted quasi-governmental immunity by most State legislatures from legal liability.

By infiltrating “impaired physician” programs they have established themselves in almost every state by joining, gaining power, and removing dissenters. Groupthink and 12-step indoctrination are the goals. By advertising as advocates for doctors who are “caring,” “confidential resources,” “giving help,” and advocating for “colleagues in need” the outward appearance is one of benevolence.

The biggest obstacle is that this system allows them to throw the normal rules of conduct under the imperative of a higher goal assumed to trump all other consideration. Those outside of programs either defend or ignore the reports of ethical and criminal violations, complacent in their trust of these “experts” claiming they are just helping sick doctors and protecting the public.

With no oversight or regulatory body involved this is all done with impunity, immunity, and undercover. They use the accusation of substance abuse as an indication to disregard the claims of the accused. The physician is left without rights, depersonalized, and dehumanized. The imposition of confinement, stigmatization, lack of oversight of the organizations, peer-review protected confidentiality, and lack of procedural protection is a one-way train to hopelessness and despair.

By establishing a system that of coercion, control, secrecy, and misinformation, the FSPHP is claiming an “80% success rate” 15and deeming the “PHP-blueprint” as “the new paradigm in addiction medicine treatment.

The ASAM/FSPHP had a major influence on the DSM-V where drug abuse and dependence are no longer separate entities. They are also working behind the scenes to get legislation to randomly drug test all physicians.

They are now after the “disruptive physician” and the evidentiary criteria are fairly low and red flags include “deviating from workplace norm in dress or conduct” and being tardy for meetings.

They have identified “the aging physician” as a potential problem because “as the population of physicians ages,””cognitive functioning” becomes “a more common threat to the quality of medical care.”

The majority of physicians are unaware that the Federation of State Medical Boards House of Delegates adopted an updated Policy on Physician Impairment in 2011 that uses addiction as an example of a “potentially impairing illness.”  According to the Federation of State Physician Health Programs …”physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years. This is a critically important distinction. Illness is the existence of a disease. Impairment is a functional classification and implies the inability of the person affected by disease to perform specific activities.”

“Process addiction” was added as a potentially impairing illness including compulsive gambling, compulsive spending, compulsive video gaming, and “workaholism.” According to the FSPHP “the presence of a process addiction can be problematic or even impairing in itself, and it can contribute to relapse of a physician in recovery. As such, process addictions should be identified and treated.” They define three levels of relapse including the novel “relapse without use.”

Bullying, Helplessness, Hopelessness and Despair

Perceived helplessness is significantly associated with suicide.16 So too is hopelessness, and the feeling that no matter what you do there is simply no way out17,18 Bullying is known to be a predominant trigger for adolescent suicide19-21 One study found that adolescents in custody who were bullied were 9.22 times more likely to attempt suicide than those were not bullied.22

Heightened perceptions of defeat and entrapment are known to be powerful contributors to suicide.23,24 The “Cry of Pain” model 25,26 specifies that people are particularly prone to suicide when life experiences are interpreted as signaling defeat which is defined as a sense of “failed struggle” or loss of social position and resources.. The person is unable to identify an escape from or resolution to a defeating situation, a sense of entrapment proliferates with the perception of no way out, and this provides the central impetus for ending ones life.

There is also evidence that rescue factors such as social supports may play a role in preventing suicide. These rescue factors act buffers to protect against suicide in the face of varying degrees of life stress.27,28 The study of female physicians revealed meetings to discuss stressful work experiences as a potential protective factor, 29 and support at work when difficulties arose appeared to be a protective factor for the male physicians.30   Research involving Finnish physicians found that control over one’s work and organizational justice were the most important determinants of work-related wellbeing.31,32 Organizational justice is related to fairness and refers to an individuals perception of an organizations behaviors, decisions, and actions and how these influence one’s own attitudes and behaviors and has been identified as a psychosocial predictor of health and wellbeing33 34Low organizational justice has been identified as a notable risk factor for psychological distress and depression.35,36

A recent report indicates that job stress, coupled with inadequate treatment for mental illness may play a role in physician suicide..

Using data from the National Violent Death Reporting System the investigators compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician.1

Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians.

They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”

I can think of nothing more institutionally unjust than an unregulated zero-tolerance monitoring program with no oversight using unregulated drug and alcohol testing of unknown validity.

We have heard of numerous suicides due to these institutionally unjust programs.   Three doctors died by suicide in Oklahoma in a one month period alone (August 2014).   All three were being monitored by the Oklahoma PHP.   I went to an all boys high-school of less than 350 students yet a classmate a couple years ahead of me died by suicide a few months ago. He was being monitored by the Washington PHP. His crime?  A DUI in 2009–a one-off situational mistake that in all likelihood would never have recurred.  But as is often the case with those ensnared by state PHPs he was forced to have a “re-assessment” as his five-year monitoring contract was coming to an end.  These re-assessments are often precipitated by a positive Laboratory Developed Test (LDT) and state medical boards mandate these assessments can only be done at an out-of-state “PHP-approved” facility.    Told he could no longer operate and was unsafe to practice medicine by the PHP and assessment center he then hanged himself.  And at the conclusion of Dr. Pamela Wible’s haunting video below are listed just the known suicides of  doctors; many were being monitored by their state PHPs–including the first name on the list– Dr. Gregory Miday.

None of these deaths were investigated. None were covered in the mainstream media.   These are red flags that need to be acknowledged and addressed!    This anecdotal evidence suggests the oft-used estimate of 400 suicides per year (an entire medical school class) is a vast underestimation of reality—extrapolating just the five deaths above to the entire population of US doctors suggests we are losing at least an entire medical school per year.

As physicians we need to demand transparency, oversight, regulation and auditing by outside groups. This is a public health emergency.

To wit:

They first came after the substance abusers and I did not speak out because I was not a substance abuser.

They then came for those with psychiatric diagnoses and I did not speak out because I was not diagnosed with a psychiatric disorder.

They then came after the “disruptive physician” and I did not speak out because I was not disruptive.

They then came after the aging physician and I did not speak out because I was young.

They then came after me and there was no one else to speak out for me.

  1. Ford DE, Mead LA, Chang PP, Cooper-Patrick L, Wang NY, Klag MJ. Depression is a risk factor for coronary artery disease in men: the precursors study. Archives of internal medicine. Jul 13 1998;158(13):1422-1426.
  2. Frank E, Dingle AD. Self-reported depression and suicide attempts among U.S. women physicians. The American journal of psychiatry. Dec 1999;156(12):1887-1894.
  3. Brewster JM. Prevalence of alcohol and other drug problems among physicians. JAMA : the journal of the American Medical Association. Apr 11 1986;255(14):1913-1920.
  4. Anthony J, Eaton W, Mandell W, al. e. Psychoactive Drug Dependence and abuse: More Common in Some Occupations than in Others? Journal of Employee Assistance Res.1992;1:148-186.
  5. Stinson F, DeBakely S, Steffens R. Prevalence of DSM-III-R Alcohol abuse and/or dependence among selected occupations. Alchohol Health Research World. 1992;16:165-172.
  6. Hughes PH, Brandenburg N, Baldwin DC, Jr., et al. Prevalence of substance use among US physicians. JAMA : the journal of the American Medical Association. May 6 1992;267(17):2333-2339.
  7. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.Archives of general psychiatry.Jun 2005;62(6):593-602.
  8. Boyd JW, Knight JR. Ethical and managerial considerations regarding state physician health programs. Journal of addiction medicine. Dec 2012;6(4):243-246.
  9. DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians’ Health Programs. Journal of Medical Regulation. Mar 2010;95(4):10-25.
  10. Skipper GE, Weinmann W, Thierauf A, et al. Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders. Alcohol and alcoholism.Sep-Oct 2004;39(5):445-449.
  11. Skipper GE, Thon N, Dupont RL, Baxter L, Wurst FM. Phosphatidylethanol: the potential role in further evaluating low positive urinary ethyl glucuronide and ethyl sulfate results.Alcoholism, clinical and experimental research. Sep 2013;37(9):1582-1586.
  12. Skipper GE, Thon N, DuPont RL, Campbell MD, Weinmann W, Wurst FM. Cellular photo digital breathalyzer for monitoring alcohol use: a pilot study.European addiction research.2014;20(3):137-142.
  13. Sharfstein J. FDA Regulation of Laboratory-Developed Diagnostic Tests: Protect the Public, Advance the Science. JAMA : the journal of the American Medical Association. Jan 5 2015.
  14. Pham JC, Pronovost PJ, Skipper GE. Identification of physician impairment.JAMA : the journal of the American Medical Association. May 22 2013;309(20):2101-2102.
  15. McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. Bmj. 2008;337:a2038.
  16. Rivers I, Noret N. Potential suicide ideation and its association with observing bullying at school.The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S32-36.
  17. Lester D, Walker RL. Hopelessness, helplessness, and haplessness as predictors of suicidal ideation. Omega. 2007;55(4):321-324.
  18. Beck AT. Hopelessness as a predictor of eventual suicide. Annals of the New York Academy of Sciences. 1986;487:90-96.
  19. Hinduja S, Patchin JW. Bullying, cyberbullying, and suicide. Archives of suicide research : official journal of the International Academy for Suicide Research. 2010;14(3):206-221.
  20. Hertz MF, Donato I, Wright J. Bullying and suicide: a public health approach. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S1-3.
  21. Kim YS, Leventhal B. Bullying and suicide. A review. International journal of adolescent medicine and health. Apr-Jun 2008;20(2):133-154.
  22. Kiriakidis SP. Bullying and suicide attempts among adolescents kept in custody.Crisis.2008;29(4):216-218.
  23. Taylor PJ, Gooding P, Wood AM, Tarrier N. The role of defeat and entrapment in depression, anxiety, and suicide. Psychological bulletin. May 2011;137(3):391-420.
  24. Lester D. Defeat and entrapment as predictors of depression and suicidal ideation versus hopelessness and helplessness. Psychological reports. Oct 2012;111(2):498-501.
  25. Williams JMG. Cry of Pain. Harmondsworth: Penguin; 1997.
  26. Williams JMG, Crane C, Barnhofer T, Duggan DS. Psychology and suicidal behavior: elaborating the entrapment model. In: Hawton K, ed. Prevention and treatment of suicidal behavior: from science to practice. Oxford: Oxford University Press; 2005:71-89.
  27. Borowsky IW, Ireland M, Resnick MD. Adolescent suicide attempts: Risks and protectors.Pediatrics. 2001;107(485).
  28. Clum GA, Febbraro GAR. Stress, social support and problem-solving appraisal/skill: Prediction of suicide severity within a college sample.Journal of Psychopathology and Behavioral Assessment. 1994;16:37-46.
  29. Fridner A, Belkic K, Marini M, Minucci D, Pavan L, Schenck-Gustafsson K. Survey on recent suicidal ideation among female university hospital physicians in Sweden and Italy (the HOUPE study): cross-sectional associations with work stressors. Gender medicine. Apr 2009;6(1):314-328.
  30. Fridner A, Belkic K, Minucci D, et al. Work environment and recent suicidal thoughts among male university hospital physicians in Sweden and Italy: the health and organization among university hospital physicians in Europe (HOUPE) study. Gender medicine. Aug 2011;8(4):269-279.
  31. Lindfors PM, Meretoja OA, Toyry SM, Luukkonen RA, Elovainio MJ, Leino TJ. Job satisfaction, work ability and life satisfaction among Finnish anaesthesiologists. Acta anaesthesiologica Scandinavica. Aug 2007;51(7):815-822.
  32. Heponiemi T, Kuusio H, Sinervo T, Elovainio M. Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators. European journal of public health. Aug 2011;21(4):520-525.
  33. Elovainio M, Kivimaki M, Vahtera J. Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health. Jan 2002;92(1):105-108.
  34. Lawson KJ, Noblet AJ, Rodwell JJ. Promoting employee wellbeing: the relevance of work characteristics and organizational justice. Health promotion international. Sep 2009;24(3):223-233.
  35. Hayashi T, Odagiri Y, Ohya Y, Tanaka K, Shimomitsu T. Organizational justice, willingness to work, and psychological distress: results from a private Japanese company. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. Feb 2011;53(2):174-181.
  36. Lang J, Bliese PD, Lang JW, Adler AB. Work gets unfair for the depressed: cross-lagged relations between organizational justice perceptions and depressive symptoms. The Journal of applied psychology. May 2011;96(3):602-618.

 

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Michael Langan, M.D.

Physician Suicide, Organizational Injustice and the Urgent Need for Open Discourse

mllangan1 4 Comments

They can be a terror to your mind and show you how to hold your tongue
They got mystery written all over their forehead
They kill babies in the crib and say only the good die young
They don’t believe in mercy
Judgement on them is something that you’ll never see
They can exalt you up or bring you down main route
Turn you into anything that they want you to be–Bob Dylan, Foot of Pride


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Although no reliable statistics yet exist, anecdotal reports suggest a marked rise in physician suicide in recent years. From the reports I am receiving it is a lot more than the oft cited “medical school class” of 400 per year.

This necessitates an evaluation of predisposing risk factors such as substance abuse and depression, but also requires a critical examination of what external forces may be involved in the descent from suicidal ideation to suicidal planning to completed suicide.  What are the cumulative situational and psychosocial factors in physicians that make suicide a potential option and what acute events precipitate the final act?

Depression and Substance Abuse no Different from General Population

The prevalence of depression in physicians is close to that of the general population 1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria indicate that physicians have the same rates (8-14%) of substance abuse and dependence as the general population,3 and slightly lower rates compared to other occupations.4,5 Epidemiological surveys reveal the same. Hughes, et al.6 reported a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

Job Stress and Untreated Mental Illness Risk Factors

Job stress coupled with inadequate treatment for mental illness may be factors contributing to physician suicide according to one recent study. Using data from the National Violent Death Reporting System, Gold, Sen, & Schwenk, 2013 8 compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician. Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians. They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”8

Few studies have evaluated the psychosocial stressors surrounding physician suicide but there is no reason to believe they are any different from the rest of the population. Although the triggering life events and specific stressors may vary outside, the inner psyche and undercurrent of thoughts and feelings should remains the same.   Perhaps the same drivers of suicide identified in other populations are contributing to physician suicide.

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Perceived Helplessness, Hopelessness, Bullying and Defeat

Perceived helplessness is significantly associated with suicide as is9 Hopelessness10,11 Bullying is known to be a predominant trigger for adolescent suicide12-14 One study found that adolescents in custody who were bullied were 9.22 times more likely to attempt suicide than those were not bullied.15

Heightened perceptions of defeat and entrapment are known to be powerful contributors to suicide.16,17 The “Cry of Pain” model 18,19 specifies that people are particularly prone to suicide when life experiences are interpreted as signaling defeat which is defined as a sense of “failed struggle” or loss of social position and resources.. The person is unable to identify an escape from or resolution to a defeating situation, a sense of entrapment proliferates with the perception of no way out, and this provides the central impetus for ending ones life. There is a helplessness and hopelessness that precipitates the descent from ideation, to planning, and then to finality.

Organizational Justice Important Protective Factor

In a study on Italian and Swedish female physicians, degrading experiences and harassment at work were found to be the most powerful independent variables contributing to suicidal thoughts.20 Degrading work experiences harassment, and lack of control over working conditions were found to be associated with suicidal thoughts among Italian and Swedish male university physicians.21

Evidence exists for the role of rescue factors (i.e. social support) as buffers against suicide in the face of varying degrees of life stress.22,23 The study of female physicians revealed meetings to discuss stressful work experiences as a potential protective factor, 20 and support at work when difficulties arose appeared to be a protective factor for the male physicians.21   In line with this, studies of Finnish physicians found that control over one’s work and organizational justice were the most important determinants of work-related wellbeing.24,25 Organizational justice has been identified as a psychosocial predictor of health and wellbeing26 27 Low organizational justice has been identified as a notable risk factor for psychological distress and depression.28,29

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Historical Precedent-the Suicides at Ridgeview

Could these factors be playing a role in physician suicide?   They evidently did at the Ridgeview Institute, a drug and alcohol treatment program for impaired physicians in Metropolitan Atlanta created by G. Douglas Talbott. Talbott helped organize and served as past president of the American Society of Addiction Medicine (ASAM) and was a formative figure in the American Medical Association’s (AMA’s) Impaired Physician Program. He has owned and directed a number of treatment facilities for impaired professionals, most recently the Talbott Recovery Campus in Atlanta, one of the preferred referrals for physicians ordered into evaluation and treatment by licensing boards.

After creating the DeKalb County Impaired Physicians Committee for the Medical Association of Georgia, Talbott founded the Georgia Disabled Doctors Program in 1975 in part because “traditional one-month treatment programs are inadequate for disabled doctors.” According to Talbott, rehabilitation programs that evaluate and treat the rest of the population for substance abuse issues are incapable of doing so in doctors as they are unlike others. He bases this uniqueness on “incredibly high denial”, and what he calls the “four MDs,” “M-Deity”, “Massive Denial” “Militant Defensiveness”, and “More Drugs.”30

Contingency Management = Extortion Using Medical License

According to Talbott, “impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.” “Terminal uniqueness “ is a phrase Talbott uses to describe doctors’ tendency to think they can heal themselves. “M-Deity” refers to doctors “being trained to think they’re God,”31 an unfounded generalization considering the vast diversity of individuals that make up our profession. This attitude, according to some critics, stems from the personal histories of the treatment staff, including Talbott, who are recovering alcoholics and addicts themselves. One such critic was Assistant Surgeon General under C. Everett Koop John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care and “assume every physician suffering from substance abuse is the same lying, stealing, cheating, manipulating individual they were when they had the illness. Certainly some physicians are manipulative, but it’s naïve to label all physicians with these problems.”32

American Society of Addiction Medicine (ASAM) President (1981-1983) LeClair Bissell was also highly critical of Talbott’s approach. Bissell, co-author of the first textbook of ethics for addiction professionals33 when asked if there was any justification to the claim that doctors are sicker than other people and more vulnerable to addiction replied:

“Well, based on my treatment experience, I think they are less sick and much easier to treat than many other groups. I think one reason for that is that in order to become a physician…one has to have jumped over a great many hurdles. One must pass the exams, survive the screening tests and the interviews, be able to organize oneself well enough to do examinations and so on, and be observed by a good many colleagues along the way. Therefore I think the more grossly psychotic, or sicker, are frequently screened out along the way. The ones we get in treatment are usually people who are less brain-damaged, are still quite capable of learning, are reasonably bright. Not only that, but they are quite well motivated in most cases to hang on to their licenses, the threat of the loss of which is frequently what puts them in treatment in the first place. So are they hard to treat? No! Are they easy patients? Yes! Are they more likely to be addicted than other groups? We don’t know.”34

“I’m not much for the bullying that goes along with some of these programs,” Bissell commented to the Atlanta Journal and Constitution in 1987.31   The constitution did a series of reports after five inpatients committed suicide during a four-year period at Ridgeview.35 In addition there were at least 20 more who had killed themselves over the preceding 12 years after leaving the treatment center.32

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Bissell, the recipient of the 1997 Elizabeth Blackwell Award for outstanding contributions to the cause of women and medicine remarked: “When you’ve got them by the license, that’s pretty strong leverage. You shouldn’t have to pound on them so much. You could be asking for trouble.”31According to Bissell: “There’s a lot of debate in the field over whether treatment imposed by threats is worthwhile…To a large degree a person has to seek the treatment on his own accord before it will work for him.”31

A jury awarded $1.3 million to the widow of one of the deceased physicians against Ridgeview,36 and other lawsuits initiated on behalf of suicides were settled out of court.35

The Constitution reported that doctors entered the program under threats of loss of licensure “even when they would prefer treatment that is cheaper and closer to home.” 37 The paper also noted that Ridgeview “enjoys unparalleled connections with many local and state medical societies that work with troubled doctors,” “licensing boards often seek recommendations from such groups in devising an approved treatment plan,” and those in charge are often “physicians who themselves have successfully completed Ridgeview’s program.”37

The cost of a 28-day program for nonprofessionals at Ridgeview in 1987 was $10,000 while the cost was “higher for those going through impaired-health professionals program,” which lasted months rather than 28 days.32

In 1997 William L. White interviewed Bissell whom he called “one of the pioneers in the treatment of impaired professionals.” The interview was not published until after hear death in 2008 per her request.   Noting her book Alcoholism in the Professions38 “remains one of the classics in the field”, White asked her when those in the field began to see physicians and other professionals as a special treatment population. She replied:

“When they started making money in alcoholism. As soon as insurance started covering treatment, suddenly you heard that residential treatment was necessary for almost everybody. And since alcoholic docs had tons of money compared to the rest of the public, they not only needed residential treatment, they needed residential treatment in a special treatment facility for many months as opposed to the shorter periods of time that other people needed.”39

Talbott claimed a “92.3 percent recovery rate, according to information compiled from a five-year follow-up survey based on complete abstinence and other treatment.”40

“There is nothing special about a doctor’s alcoholism,” said Bissel

“these special facilities will tell you that they come up with really wonderful recovery rates. They do. And the reason they do is that any time you can grab a professional person by the license and compel him or her into treatment and force them to cooperate with that treatment and then monitor them for years, you’ll get good outcomes—in the high 80s or low 90s in recovery rates—no matter what else you do.”39

“The ones I think are really the best ones were not specialized. There were other well-known specialty clinics that claimed all the docs they treated got well, which is sheer rot. They harmed a great many people, keeping them for long, unnecessary treatments and seeing to it that they hit their financial bottom for sure: kids being yanked out of college, being forced to sell homes to pay for treatment, and otherwise being blackmailed on the grounds that your husband has a fatal disease. It’s ugly.”39

Stanton Peele’s “In the Belly of the American Society of Addiction Medicine Beast” describes the coercion, bullying, threats and indoctrination that are standard operating procedure in Talbott’s facilities.41 Uncooperative patients, “and this covers a range of sins of commission or omission including offering one’s opinion about one’s treatment,” are “threatened with expulsion and with not being certified-or advocated for with their Boards.”41 The cornerstone of treatment is 12-step spiritual recovery. All new patients are indoctrinated into A.A. and coerced to confess they are addicts or alcoholics. Failure to participate in A.A. and 12-step spirituality means expulsion from the program with the anticipated result being loss of one’s medical license.

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Fraud, Malpractice, False Diagnoses and False imprisonment

In May 1999 Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) as a jury awarded Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for fraud, malpractice, and the novel claim of false imprisonment.42 The fraud finding required a finding that errors in the diagnosis were intentional. After being accused of excessive prescribing of narcotics to his chronic pain patients, Masters was told by the director of the Florida PHP that he could either surrender his medical license until the allegations were disproved or submit to a four-day evaluation. Masters agreed to the latter, thinking he would have an objective and fair evaluation, but was instead diagnosed as “alcohol dependent” and coerced into the Talbott recovery program. He was forced to stay in the program under threat of his medical license as staff would routinely threaten to report any doctor who questioned any aspect of their diagnosis or treatment to their state medical boards “as being an impaired physician, leaving necessary treatment against medical advice”42  which would mean the loss of his licensure. However, Masters was not an alcoholic. According to his attorney, Eric. S. Block,  “No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children, not his fellow doctors, not his employees, not his employers, No one.” 43  He was released 4 months later and forced to sign a five-year “continuing care” contract with the PHP, also under continued threat of his medical license. Talbott faced no professional repercussions and no changes in the treatment protocols were made. Talbott continued to present himself and ASAM as the most qualified advocate for the assessment and treatment of medical professionals for substance abuse and addiction up until his death last year.44

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Same System Imposed on Doctors Today—Institutional Injustice Worse due to Laboratory Developed Tests. Fortified Scaffold and Tightened the Noose.

In almost all states today any physician referred for an assessment for substance abuse will be mandated to do so in a facility just like Ridgeview. There is no choice. There is one difference however.   When the Ridgeview suicides occurred the plethora of laboratory developed tests were not yet introduced. A decade ago Dr. Gregory Skipper introduced the first laboratory developed test for forensic testing and used it on doctors in physician health programs.   These non-FDA approved tests of unknown validity presented a new unpredictable variable into the mix with a positive test necessitating another assessment at an out of state treatment facility—a “PHP-approved” assessment facility. The addition of this laboratory Russian Roulette renders the current system much worse than it was at the time of the Ridgeview suicides.

And if a positive test occurs there are no safeguards protecting the donor. LDTs are unregulated by the FDA. There is no oversight and no one to file a complaint with.

In addition the PHPs have no oversight by the medical boards, departments of health or medical societies. They police themselves. The PHPs have convinced law enforcement that when it comes to doctors it is a “parochial issue” best handled by the medical community. I have been hearing from doctors all over the country who have tried to report crimes to the local police, the state Attorney General and other law enforcement agencies only to be turned back over to the very perpetrators of the crimes. “He’s a sick doctor, we’ll take care of him.” The “swift and certain consequences” of this are an effective means of keeping the rest of the inmates silent.   Likewise doctors have been going to the media only to have the door slammed in their faces because the media has generally bought in to the “impaired” and “disruptive” physician construct these same people developed through propaganda, misinformation and moral panics and crusades.

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Urgent Need to Admit to the Problem

There has been an increase in physician suicide in the past decade.   By my estimate the numbers are going to be far higher than the oft-cited 400 per year. The speculation as to cause has been unenlightening and in fact frustrating.   Knowledge of anatomy, access to dangerous drugs, increased workload and even student loans have been proposed as contributing factors. Although there has been some tangential mention of physician health programs it has been indirect. Direct and defined discussion is necessary and state PHPs need to be named as a possible contributor to suicide.  Admitting the possibility there is a problem is the first crucial step in defining and addressing the problem.    The 1980s historical precedent is correlated with physician suicide.  The current system is not only based on Ridgeview but has been fortified in scope and power.  The physician health movement has effectively removed due process from doctors while removing answerability and accountability from themselves. And they have not only fortified the scaffold but widened it from substance abusing doctors to all doctors. “Potential impairment” and “relapse without use” were introduced without any meaningful resistance and they are now using a panoply of non-FDA approved laboratory developed tests of unknown validity to test for substances of abuse in a zero-tolerance abstinence based monitoring program.  With no regulatory oversight the stage is set not only for error but misuse as witch-pricking devices for punishment and control.  Doctors across the country are complaining of the very same abuses Leonard Masters did–false diagnoses, misdiagnosis, unneeded treatment and fraud.

In summary, any doctor who is referred to their state PHP today is required to have any assessment and treatment at a “PHP-approved” facility based on Ridgeview.  It is mandated.  There is no choice.  Coercion, control and abuse at Ridgeview was associated with multiple suicides in doctors in the 1980s.  The use of non-FDA approved tests of unknown validity worsens the abuse and fits the “cry of pain” model of hopelessness, helplessness and despair. Locus of control is  lost.  Organizational justice is absent.

The temporal relationship is clear.

Why is this still the elephant in the room?

This needs to be named, defined and openly discussed and debated.  How many more must die before we speak up?

Please help me get the conversation going.

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Do physician health programs increase physician suicides? —Pamela Wible, MD (Over 950 Comments Overwhelmingly Suggest they do!)

mllangan1 2 Comments

Source: Do physician health programs increase physician suicides? —Pamela Wible, MD

“Do Physician Health Programs Increase Physician Suicides?” 

“Do Physician Health Programs Increase Physician Suicides?” by Dr. Pamela Wible was published on Medscape August 28, 2015 and was subsequently posted on KevinMD on September 7 where it quickly became the #1 most popular article of the week and the #3 most popular article of the past six months. 323 comments have been left on Medscape thus far and 258 on KevinMD where comments are now closed.

“Physician Health Programs: More harm Than Good?”  

Pauline Anderson’s article “Physician Health Programs: More harm Than Good?” published August 19, 2015 on Medscape currently has 200 comments and the response from the President of their national organization the Federation of State Physician Health Programs (FSPHP) Doris Gunderson “FSPHP Response to ‘Physician Health Programs: More Harm than Good? published September 8 on Medscape has generated 172 comments.  

Conclusions based on comments = Increased suicide and harm by a landslide

What is the consensus so far regarding the questions raised by Anderson and Wible?    Judging by the comments thus far the overwhelming consensus is that Physician Health Programs are not only causing harm but large-scale, serious, far-reaching and grave harm and this is by a landslide.   Of the over 950 collective comments all but a handful have been extremely negative and critical.   These comments raise specific and serious questions that are not being answered by the FSPHP or their sympathizers and apologists.  

FSPHPs attempt at rebuttal with logical fallacy and authoritative opinion ineffective

Gunderson’s response to Anderson’s article deserves a point-by-point analysis at a later point, but to summarize, her rebuttal attempts to summarily dismiss the serious criticisms raised in Anderson’s article while completely avoiding the specific criticisms and dismissing key facts.  She does this by questioning the integrity and quality of the both the report itself and the sources used for the report.  

Calling it a “biased and unbalanced view of Physician Health Programs (PHPs)” Gunderson implies the piece falls short of the “journalistic excellence” expected of Medscape and that almost all of the information relies on “hearsay, including information from anonymous sources, allegations rather than facts, and a handful of anecdotes.”  She contrasts this to the “six pages of factual information and references to several peer-reviewed articles” that were summarily ignored by Medscape.  

 Quality of that information aside, Anderson’s article is investigative journalism not research.  It is designed to raise questions not compare outcomes.  It essentially expresses the concerns of tangential dissident voices that have previously been unheard  (or silenced) by the perceived authority in question and in doing so fulfills its purpose. Anderson’s paper is not a research based comparison of the literature but the exposure of criticisms involving an organization of alleged absolute power over doctors who have been stripped of due process and appeal; an organization allegedly bereft of accountability and oversight; a purported secretive unregulated system of coercion, disempowerment and control.

Most victims of this system lack the resources to even mount effective challenges, much less undertake their own counter research. Not sure what she was expecting but in situation like this allegations and anecdotes are the only ammunition available and articles such as this are the proper, and sole, means available to voice dissenting opinion and raise awareness and concern.

Gunderson predictably  goes on to present the usual appeals to authority, special knowledge and consequences and inevitably brandishes the “overwhelming success” of PHPs. She also references her own study concluding that PHPs reduce malpractice. She states:

“…research demonstrates that physicians who participate in PHP monitoring for any health issue have a lower malpractice risk compared to the physician population at large, underscoring the relationship between physician health and effective patient care.”

“Overwhelming success” is of course based on Setting the Standard for Recovery: Physicians’ Health Programs, a  poorly designed non-randomized non-blinded retrospective analysis of a single data set with multiple flaws in both reasoning (type I and type II errors) and statistical analysis that render its conclusions invalid. In addition the impact of undeclared but substantial financial conflicts-of-interest (including funding by drug testing and addiction treatment industries) and personal ideological biases (including personal 12-step recovery from addictions) in the authors make it nothing more than authoritative opinion.   Adding the alleged misdiagnosis and over-diagnosis of addiction in physicians by this group incentivized by lucrative self-referral dollars for expensive 90-day treatment programs renders it less than authoritative opinion.

As with the “PHP-blueprint” the claims of lower malpractice risk are based on a single retrospective cohort study (with Gunderson being one of the authors ) comparing malpractice risk prior to and after being enrolled in a state PHP that revealed a reduction in malpractice rates in those who participated in the PHP.    The 20% reduction they speculate:   

“…could be that participants learned skills during their treatment and recovery — skills to communicate better with colleagues, staff, and patients. It may be that experience with the PHP led participants to make use of other professional supports — that is, maybe to seek consultation earlier in their work. Or maybe they were more motivated to practice conservatively and adhere to standards of practice, given what they learned in the PHP program.”

This sounds great until you consider what impact being monitored by a PHP might have on the number of patient encounters a doctor might have before and after being enrolled in a PHP.  I speculate otherwise.

How many had practice restrictions, reduced hours, retired or were working in non-clinical positions after being enrolled in the PHP.  Being subject to PHP monitoring is not comparable to taking a daily dose of vitamin-D.  It has a very serious impact on one’s day to day activities and for a study looking at malpractice risk I would venture to guess that matching the NUMBER OF HOURS SEEING PATIENTS AND NUMBER OF PATIENT ENCOUNTERS  would be an essential part of the study design that should be explicitly and accurately matched especially in a group in which the average age enrolled was 50.   

This is akin to a pre-school claiming that participation in their program leads to a 20% reduction in wet diapers for children because of the skills those little fellers learned at their school.

Unfortunately this combination of logical fallacy and misrepresentation of seriously flawed studies usually sways the target.  Criticisms are dismissed and everyone walks away complacent in the belief these are just good people helping doctors and protecting the public, but that is not what is happening here.

Serious questions raised and silence of FSPHP deafening.

   The comments left here and on the other 3 articles have made it abundantly clear that not only is there a  problem with PHPs but a very serious problem. Allegations included fabricated diagnoses, “diagnosis rigging”, “treatment rigging,” total denial of due process, lab fraud and many other serious concerns.  Faced with these specific and serious criticisms and critical reasoning  the FSPHP has become tongue-tied as the individual horror stories mount.

Now  silence from authority is an acceptable stance when the criticisms are unreasoned and unfounded ad hominem attacks and generalizations based on bias and prejudice but that is not the case here.   The testimonials and criticisms are articulate, specific and remarkably similar.

Need for further exposure, awareness and investigation through mainstream media and others

Patterns are appearing that involve abuse of power and control of information in a system that manages all aspects of testing, assessment and treatment without oversight or regulation; an opaque and rigged game that dismisses all outside opinion with no transparency or apparent accountability (including the provision of information and justification for actions).  Due process has been removed and the  coercion, control and abuse of power are seen in these comments that are not only believable but plausible.  This is crystal clear.

These comments can be seen here:  FSPHP Response to ‘Physician Health Programs_ More Harm Than Good_’ and I urge others to read them, form their own opinions. investigate this area and help expose these issues.  If PHPs are causing this degree of harm and contributing to the suicide epidemic in doctors it needs to be exposed with dispatch and allies are urgently needed.

Medscape Article Critical of Physician Health Programs (PHPs): An Important Milestone in Exposing Abuse and Injustice

mllangan1 1 Comment

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Mainstream Media, Societal Beliefs and Perceived Authority

Iris Martyn’s article below concerns mainstream media bias and the powerful role social media can play in combatting it. Tangential dissident voices often go unheard (or are silenced) when they oppose perceived authority or mainstream societal beliefs and majority mores.

Martyn gives the example of Suffragettes who were frequently accused of “having ‘magnificently succeeded … in their intention of making themselves a nuisance’, a dismissive claim that covers up the threat” and downplays both the validity of the cause and the character of those behind it.

According to cultural theorist Stuart Hall, the media obtain their information from the primary definers of social reality in authoritative positions and amplify those opinions irrespective of the foundation or veracity of those opinions.

Dissenting voices are all too frequently met with a wall of blinkered apathy or openly dismissed or opposed by mainstream media.

As a result valid complaints and concerns are either unreported, underreported or reported as invalid or misguided hyperbole.

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Medscape Article Critical of  Physician Health Programs (PHPs) Opens Door to a more focused attack

The  importance of a recent article published in Medscape  and critical of state Physician Health Programs (PHPs) cannot be overemphasized.

Physician Health Programs- More Harm Than Good? by Pauline Anderson breaks new ground as it is the first mainstream medical publication to address serious and pervasive concerns of the unregulated and unchecked power of these monitoring programs for doctors as an increasing number of reports involving threats, intimidation and fraud come in from doctors across the country.

Originally funded by medical societies and staffed by volunteers, these programs existed in every state by 1980.   PHPs are the equivalent of Employee Assistance Programs (EAPs) for other occupations and meet with, assess and monitor doctors who have been referred for substance use or other mental or behavioral health problems.

Over time these programs have been subverted.  They have become a power unto themselves.  They no longer represent doctors or the public but the interests of the “recovery related racket.”   Doctors are being diagnosed with illnesses they don’t have to provide treatment they don’t need all to line the purses of the drug and alcohol testing, assessment and treatment industry and their associates.  At the same time doctors who are ill and do need help are not getting the proper treatment. They don’t get better but worse and never return to practice.   How many doctors who are perfectly healthy or recovered from illness properly treated are we losing each year to suicide?    How many suffer in silence out of fear of being ensnared by these punitive, rigid and one-size fits all programs that claim to exist to protect the public?

PHPs are needed.  Doctors who develop problems with addiction or psychiatric problems need to be removed from practice and protect the public, receive treatment until they are healthy enough to return to practice and monitored for a period of time to make sure they remain health.   But under current management by the Federation of State Physician Health Programs (FSPHP) this is not happening.   PHPs have become Frankenstein’s of coercion, control and abuse that help a few doctors and cause a great deal of harm to the rest.  Doctors across the country have been going to local media, law enforcement, the state’s  Attorney General,  the ACLU and other agencies only to be turned a deaf ear.  With the PHP as perceived authority these doctors have been labeled “impaired” and the delegitimization and stigma has prevented their truth from being heard.

To date there have been 187 comments on this article and 301 comments on Dr. Pamela Wible’s related piece entitled “Do Physician Health Programs Increase Physician Suicides?” which was published August 28, 2015 on Medscape and subsequently on KevinMD where it has become the most popular article this week with 243 comments to date.  And the consensus so far from reading the more than 700 comments is that PHPs are not only causing harm but serious harm on a large scale.  This is by a landslide. The comments raise specific and serious questions that are not being answered by the FSPHP or their sympathizers and apologists.

The FSPHP is tongue-tied in the face of facts and reason as the  individual horror stories mount.  The testimonials and criticisms are articulate, specific and remarkably similar.   It appears to be a rigged game in which all outside opinion is dismissed and no due process exists. Coercion, control, threats, abuse, intimidation and abuse of power are seen crystal clear.

Minor infractions, one-offs, situational problems, anonymous referrals and even false-reports have led doctors into a system in which they have absolutely no control that includes fabricated drug and alcohol tests, diagnosis rigging and unneeded treatment for three months or longer in “PHP-approved”  cash only inpatient facilities with close ideological and financial ties to the PHPs.  This is political abuse of psychiatry and institutional injustice and it is undoubtedly the cause of the marked increase in physician suicide.

So hats off to Pauline Anderson and Caroline Cassels for having the perspicacity. persistence and courage to shine a light on what was previously ignored or deflected.  As a perceived authority the FSPHP and state PHPs believe they are beyond reproach. Specific serious concerns accumulating testimonials of doctors across the country with similar stories are being met with silence and mainstream media need take note of this.  We need to shine a larger light in this direction and with dispatch.    Sunshine is after all  the best disinfectant

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Injustice In The Media

/ 13/03/2015

By Iris Martyn, Form 6 •

In 1903, outspoken suffragettes “defaced” thousands of one-penny coins by stamping “Votes for Women” onto them and releasing them back into circulation. In fact, ever since complex human social structures came into existence, those who have suffered under their dividing, categorising, and often somewhat arbitrary rules have sought to express themselves in ways that bring to light their humanity and the harsh reality of oppressive conditions.

Often, established media such as print journalism, only enforces the values of a biased society in which the privileged are accustomed to the predominance of their views.

This occurs at the expense of dissident voices. To continue the earlier example, “Suffragettes on the War Path” were frequently accused of having “magnificently succeeded … in their intention of making themselves a nuisance”, a dismissive claim that covers up the threat felt by male politicians at the thought of universal suffrage, and also downplays the aim of the Suffragettes’ cause, reducing them to nothing more than rowdy troublemakers as far as the media is concerned.

However, this is not a carefully preserved historical phenomenon from the bad old days when societal inequality was present, as opposed to our shining, gender-equal, race-blind present. We cannot describe the times when the oppressed spoke out against the status quo, armed with today’s perfect values and the smugness of hindsight.

Even the epicentres of Western civilisation, which hold themselves to be the pinnacle of human creation, by which I mean North America and Western Europe, are riddled with deeply-ingrained bias towards white, old, rich heterosexual men.

When the media outlets cease to present an accurate and unbiased account of events, today’s protestors rely on social media to organise demonstrations, collect evidence of bias, unfair treatment, and eyewitness accounts of injustice.

On the 8th of June, 2014, two right-wing white Neo-Nazis entered a restaurant in Las Vegas, shot two policemen dead, and left a swastika on one of the bodies. This went unreported by Fox News, a major US “news” programme.

On the 9th of August, 2014, an 18-year-old named Michael Brown was shot six times in Ferguson, Missouri, by a police officer in broad daylight. His body lay in the street for several hours. A grand jury chose not to indict his killer. Multiple Fox News hosts were “outraged” at the public anger towards the murderer of an innocent, unarmed boy, as the officer was “doing his job”. The resulting protests from Ferguson’s Black community, during which many civilians were illegally arrested, tear-gassed and shot with rubber-coated metal bullets, were dismissed as having nothing to do with Michael’s murder. Fox News correspondent Rudolph Giuliani, former New York City mayor, claimed that “the racial arsonists … have worked these people up so much with propaganda that facts don’t matter”.

Meanwhile, as support from nearby politicians was lacking, support for Ferguson protestors came, over the internet, from victims of attacks in Palestine. They sent messages of solidarity to the city’s inhabitants, along with advice on how to protect oneself, and recover, from the effects of canisters full of tear gas that were thrown into peaceful protests. As local schools that usually provide a daily meal for schoolchildren closed, a crowdfunding campaign raised $155,000 for the Ferguson foodbank, another raised $130,000 to help Michael Brown’s parents with legal fees, and yet another raised nearly $25,000 to provide college education for his siblings.

Social media was not only used to provide support for the Ferguson community, but to create eyewitness reports on police brutality and racism and to raise public awareness of injustice. In the shooting of yet another young black man, Antonio Martin, witnesses with camera phones documented the mysterious appearance of a gun at the crime scene nearly three hours after his death – planted by the police department.  On one tumultuous night of protests, demonstrators moved aside respectfully to allow an ambulance to pass through. As multiple witnesses assert, the ambulance was full of armed police officers, in defiance of international law.

Yet even this is not the most shocking demonstration of the power of the US police force in recent times. In July 2014, a 43-year-old asthmatic black man was put into an illegal chokehold by a police officer in New York City. His head was hit against the pavement multiple times by another officer. Eric Gartner, described as “just a big teddy bear” by his family, shouted “I can’t breathe” six times as he was choked to death. Despite video evidence from multiple bystanders who filmed his murder, unable to do anything else for fear of attack from the police, again a grand jury chose not to indict his killers. The slogan “I can’t breathe” swept the world when the details of this murder were posted on Twitter, sparking worldwide protests.

When national news outlets focused on the possibility that Michael Brown had just robbed a corner store before his death, or that Eric Gartner was a drug addict, in an attempt to justify their deaths, those who were close to the victims used social media, primarily Facebook and Twitter, to speak out against these character assassinations. Michael Brown’s mother spoke about her son’s kind nature, and her difficulty in persuading him to finish high school – black children are much more unlikely to succeed in the US education system.

Eric Gartner’s friends and family spoke about their disappointment in the judicial system, while photographs of his mother wearing an “I can’t breathe” t-shirt to the grand jury hearing circulated quickly over the internet. When a 13-year-old Black boy was shot dead in North California for carrying a BB gun, a white former robber recalled his aspirations to crime on Tumblr, where the police underwent an hour of patient negotiation to convince him to put down his very real firearm, which contrasts with the utter lack of communication with the friendly, innocent, eighth-grader, Andy Lopez.

Besides filling the role that should be occupied with an unbiased and impartial press, social media is used by individuals to criticise the internalised racism of mainstream media, and its idolatry of the police.

One image in widespread online circulation is a composition of two different edited versions of a New York Daily News article which describes a violent incident in a subway. In the first version, a woman was “grabbed” by a “hulking brute” who “shoved her onto the platform and began choking her in an unprovoked attack, authorities said”. When the attacker turned out to be a police officer, details of the victim, that provoke sympathy in readers, were removed. Now she was “allegedly put into a bear hug, thrown to the floor, and choked”. The addition of the word “allegedly”, the description of the assault as a “bear hug”, and the use of the passive voice all disassociate the officer from his crime.

The majority of people tend to see social media as a harmless diversion from reality, a way of boasting about one’s achievements or reconnecting with old friends.

In our world, which still contains so much injustice, this powerful tool brings together those whose voices go unheard by mainstream media.

It allows them to support one another, collect evidence of injustices that go unreported, humanise the victims of violent crimes, and bring light to the bias and agenda of news corporations.

Physician Suicide: The Role of Hopelessness, Helplessness and Defeat.

mllangan1 31 Comments

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Although no reliable statistics yet exist, anecdotal reports suggest a marked rise inphysician suicide in recent years. From the reports I am receiving it is a lot more than the oft cited “medical school class” of 400 per year.

This necessitates an evaluation of predisposing risk factors such as substance abuse and depression, but also requires a critical examination of what external forces may be involved.  What acute and cumulative situational and psychosocial factors are involved in the descent from suicidal ideation to planning to completion?   What makes suicide a potential option for doctors and what acute events precipitate and trigger the final act?

Depression and Substance Abuse no Different from General Population

The prevalence of depression in physicians is close to that of the general population1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria indicate that physicians have the same rates (8-14%) of substance abuse and dependence as the general population,3 and slightly lower rates compared to other occupations.4,5  Epidemiological surveys reveal the same. Hughes, et al.6 reported a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

Job Stress and Untreated Mental Illness Risk Factors

Job stress coupled with inadequate treatment for mental illness may be factors contributing to physician suicide according to one recent study. Using data from the National Violent Death Reporting System, Gold, Sen, & Schwenk, 2013 8 compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician.

Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians. They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”8

Few studies have evaluated the psychosocial stressors surrounding physician suicide but there is no reason to believe they are any different from the rest of the population. Although the triggering life events and specific stressors may vary outside, the inner psyche and undercurrent of thoughts and feelings should remains the same.   Perhaps the same drivers of suicide identified in other populations are contributing to physician suicide.

Perceived Helplessness, Hopelessness, Bullying and Defeat

Perceived helplessness is significantly associated with suicide as is9Hopelessness10,11  Bullying is known to be a predominant trigger for adolescent suicide12-14   One study found that adolescents in custody who were bullied were 9.22 times more likely to attempt suicide than those were not bullied.15

Heightened perceptions of defeat and entrapment are known to be powerful contributors to suicide.16,17

The “Cry of Pain” model 18,19 specifies that people are particularly prone to suicide when life experiences are interpreted as signaling defeat which is defined as a sense of “failed struggle” or loss of social position and resources.. The person is unable to identify an escape from or resolution to a defeating situation, a sense of entrapment proliferates with the perception of no way out, and this provides the central impetus for ending ones life. There is a helplessness and hopelessness that precipitates the descent from ideation, to planning, and then to finality.

Organizational Justice Important Protective Factor

In a study on Italian and Swedish female physicians, degrading experiences and harassment at work were found to be the most powerful independent variables contributing to suicidal thoughts.20 Degrading work experiences harassment, and lack of control over working conditions were found to be associated with suicidal thoughts among Italian and Swedish male university physicians.21

Evidence exists for the role of rescue factors (i.e. social support) as buffers against suicide in the face of varying degrees of life stress.22,23 The study of female physicians revealed meetings to discuss stressful work experiences as a potential protective factor, 20 and support at work when difficulties arose appeared to be a protective factor for the male physicians.21   In line with this, studies of Finnish physicians found that control over one’s work and organizational justice were the most important determinants of work-related wellbeing.24,25 Organizational justice has been identified as a psychosocial predictor of health and wellbeing. 26 27  Low organizational justice has been identified as a notable risk factor for psychological distress and depression.28,29

Historical Precedent-the Suicides at Ridgeview

Could these factors be playing a role in physician suicide?  They evidently did at the Ridgeview Institute, a drug and alcohol treatment program for impaired physicians in Metropolitan Atlanta created by G. Douglas Talbott.

Talbott helped organize and served as past president of the American Society of Addiction Medicine (ASAM) and was a formative figure in the American Medical Association’s (AMA’s) Impaired Physician Program. He has owned and directed a number of treatment facilities for impaired professionals, most recently the Talbott Recovery Campus in Atlanta, one of the preferred referrals for physicians ordered into evaluation and treatment by licensing boards.

After creating the DeKalb County Impaired Physicians Committee for the Medical Association of Georgia, Talbott founded the Georgia Disabled Doctors Program in 1975 in part because “traditional one-month treatment programs are inadequate for disabled doctors.” According to Talbott, rehabilitation programs that evaluate and treat the rest of the population for substance abuse issues are incapable of doing so in doctors as they are unlike others. He bases this uniqueness on “incredibly high denial”, and what he calls the “four MDs,” “M-Deity”, “Massive Denial” “Militant Defensiveness”, and “More Drugs.”30

Contingency Management = Extortion Using Medical License

According to Talbott, “impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.” “Terminal uniqueness “ is a phrase Talbott uses to describe doctors’ tendency to think they can heal themselves. “M-Deity” refers to doctors “being trained to think they’re God,”31 an unfounded generalization considering the vast diversity of individuals that make up our profession. This attitude, according to some critics, stems from the personal histories of the treatment staff, including Talbott, who are recovering alcoholics and addicts themselves. One such critic was Assistant Surgeon General under C. Everett Koop John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care and “assume every physician suffering from substance abuse is the same lying, stealing, cheating, manipulating individual they were when they had the illness. Certainly some physicians are manipulative, but it’s naïve to label all physicians with these problems.”32

American Society of Addiction Medicine (ASAM) President (1981-1983) LeClair Bissell was also highly critical of Talbott’s approach. Bissell, co-author of the first textbook of ethics for addiction professionals 33 when asked if there was any justification to the claim that doctors are sicker than other people and more vulnerable to addiction replied:

“Well, based on my treatment experience, I think they are less sick and much easier to treat than many other groups. I think one reason for that is that in order to become a physician…one has to have jumped over a great many hurdles. One must pass the exams, survive the screening tests and the interviews, be able to organize oneself well enough to do examinations and so on, and be observed by a good many colleagues along the way. Therefore I think the more grossly psychotic, or sicker, are frequently screened out along the way. The ones we get in treatment are usually people who are less brain-damaged, are still quite capable of learning, are reasonably bright. Not only that, but they are quite well motivated in most cases to hang on to their licenses, the threat of the loss of which is frequently what puts them in treatment in the first place. So are they hard to treat? No! Are they easy patients? Yes! Are they more likely to be addicted than other groups? We don’t know.”34

“I’m not much for the bullying that goes along with some of these programs,” Bissell commented to the Atlanta Journal and Constitution in 1987.31

The Constitution did a series of reports after five inpatients committed suicide during a four-year period at Ridgeview.35  In addition there were at least 20 more who had killed themselves over the preceding 12 years after leaving the treatment center.32

Bissell, the recipient of the 1997 Elizabeth Blackwell Award for outstanding contributions to the cause of women and medicine remarked: “When you’ve got them by the license, that’s pretty strong leverage. You shouldn’t have to pound on them so much. You could be asking for trouble.” 31

According to Bissell: “There’s a lot of debate in the field over whether treatment imposed by threats is worthwhile…To a large degree a person has to seek the treatment on his own accord before it will work for him.”31

A jury awarded $1.3 million to the widow of one of the deceased physicians against Ridgeview,36 and other lawsuits initiated on behalf of suicides were settled out of court.35

The Constitution reported that doctors entered the program under threats of loss of licensure “even when they would prefer treatment that is cheaper and closer to home.” 37

The paper also noted that Ridgeview “enjoys unparalleled connections with many local and state medical societies that work with troubled doctors,” “licensing boards often seek recommendations from such groups in devising an approved treatment plan,” and those in charge are often “physicians who themselves have successfully completed Ridgeview’s program.”37

The cost of a 28-day program for nonprofessionals at Ridgeview in 1987 was $10,000 while the cost was “higher for those going through impaired-health professionals program,” which lasted months rather than 28 days.32

In 1997 William L. White interviewed Bissell whom he called “one of the pioneers in the treatment of impaired professionals.” The interview was not published until after hear death in 2008 per her request.   Noting her book Alcoholism in the Professions 38 “remains one of the classics in the field”, White asked her when those in the field began to see physicians and other professionals as a special treatment population. She replied:

“When they started making money in alcoholism. As soon as insurance started covering treatment, suddenly you heard that residential treatment was necessary for almost everybody. And since alcoholic docs had tons of money compared to the rest of the public, they not only needed residential treatment, they needed residential treatment in a special treatment facility for many months as opposed to the shorter periods of time that other people needed.”39


Talbott claimed a “92.3 percent recovery rate, according to information compiled from a five-year follow-up survey based on complete abstinence and other treatment.”40

“There is nothing special about a doctor’s alcoholism,” said Bissel

“”These special facilities will tell you that they come up with really wonderful recovery rates. They do. And the reason they do is that any time you can grab a professional person by the license and compel him or her into treatment and force them to cooperate with that treatment and then monitor them for years, you’ll get good outcomes—in the high 80s or low 90s in recovery rates—no matter what else you do.”39

“The ones I think are really the best ones were not specialized. There were other well-known specialty clinics that claimed all the docs they treated got well, which is sheer rot. They harmed a great many people, keeping them for long, unnecessary treatments and seeing to it that they hit their financial bottom for sure: kids being yanked out of college, being forced to sell homes to pay for treatment, and otherwise being blackmailed on the grounds that your husband has a fatal disease. It’s ugly.”39

Stanton Peele’s “In the Belly of the American Society of Addiction Medicine Beast” describes the coercion, bullying, threats and indoctrination that are standard operating procedure in Talbott’s facilities.41 Uncooperative patients, “and this covers a range of sins of commission or omission including offering one’s opinion about one’s treatment,” are “threatened with expulsion and with not being certified-or advocated for with their Boards.”41 The cornerstone of treatment is 12-step spiritual recovery. All new patients are indoctrinated into A.A. and coerced to confess they are addicts or alcoholics. Failure to participate in A.A. and 12-step spirituality means expulsion from the program with the anticipated result being loss of one’s medical license.

Fraud, Malpractice, False Diagnoses and False imprisonment

In May 1999 Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) as a jury awarded Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for fraud, malpractice, and the novel claim of false imprisonment.42  The fraud finding required a finding that errors in the diagnosis were intentional. After being accused of excessive prescribing of narcotics to his chronic pain patients, Masters was told by the director of the Florida PHP that he could either surrender his medical license until the allegations were disproved or submit to a four-day evaluation. Masters agreed to the latter, thinking he would have an objective and fair evaluation, but was instead diagnosed as “alcohol dependent” and coerced into the Talbott recovery program. He was forced to stay in the program under threat of his medical license as staff would routinely threaten to report any doctor who questioned any aspect of their diagnosis or treatment to their state medical boards “as being an impaired physician, leaving necessary treatment against medical advice”42  which would mean the loss of his licensure.

However, Masters was not an alcoholic. According to his attorney, Eric. S. Block,  “No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children, not his fellow doctors, not his employees, not his employers, No one.” 43   He was released 4 months later and forced to sign a five-year “continuing care” contract with the PHP, also under continued threat of his medical license. Talbott faced no professional repercussions and no changes in the treatment protocols were made. Talbott continued to present himself and ASAM as the most qualified advocate for the assessment and treatment of medical professionals for substance abuse and addiction up until his death last year.44

Same System Imposed on Doctors Today—Institutional Injustice Worse due to Laboratory Developed Tests. Fortified Scaffold and Tightened the Noose.

In almost all states today any physician referred for an assessment for substance abuse will be mandated to do so in a facility just like Ridgeview. There is no choice. There is one difference however.   When the Ridgeview suicides occurred the plethora of laboratory developed tests were not yet introduced.

A decade ago Dr. Gregory Skipper introduced the first laboratory developed test for forensic testing and used it on doctors in physician health programs.   These non-FDA approved tests of unknown validity presented a new unpredictable variable into the mix with a positive test necessitating another assessment at an out of state treatment facility—a “PHP-approved” assessment facility. The addition of this laboratory Russian Roulette renders the current system much worse than it was at the time of the Ridgeview suicides.

And if a positive test occurs there are no safeguards protecting the donor. LDTs are unregulated by the FDA. There is no oversight and no one to file a complaint with.

In addition state PHPs have no oversight or regulation.  They police themselves. Medical boards, departments of public health and medical societies provide no oversight.  Accountability is absent.

Moreover they have apparently convinced law enforcement that when it comes to doctors it is a “parochial issue” best handled by the medical community. I have been hearing from doctors all over the country who have tried to report crimes to the local police, the state Attorney General and other law enforcement agencies only to be turned back over to the very perpetrators of the crimes. “He’s a sick doctor, we’ll take care of him.”

The “swift and certain consequences” of this are an effective means of keeping the majority silent.   Likewise doctors have been going to the media only to have the door slammed in their faces because the media has generally bought in to the “impaired” and “disruptive” physician construct these same people developed through propaganda, misinformation and moral panics.

Urgent Need to Admit to the Problem

There has been an increase in physician suicide in the past decade.   By my estimate the numbers are going to be far higher than the oft-cited 400 per year. The speculation as to cause has been unenlightening and in fact frustrating.   Knowledge of anatomy, access to dangerous drugs, increased workload and even student loans have been proposed as contributing factors. Although there has been some tangential mention of physician health programs it has been indirect.

Direct and defined discussion is necessary and state PHPs need to be named as a possible contributor to suicide.  Admitting the possibility there is a problem is the first crucial step in defining and addressing the problem.    The 1980s historical precedent is correlated with physician suicide.  The current system is not only based on Ridgeview but has been fortified in scope and power.  The physician health movement has effectively removed due process from doctors while removing answerability and accountability from themselves.

And they have not only fortified the scaffold but widened it from substance abusing doctors to all doctors. “Potential impairment” and “relapse without use” were introduced without any meaningful resistance and they are now using a panoply of non-FDA approved laboratory developed tests of unknown validity to test for substances of abuse in a zero-tolerance abstinence based monitoring program.

With no regulatory oversight the stage is set not only for error but misuse as witch-pricking devices for punishment and control.  Doctors across the country are complaining of the very same abuses Leonard Masters did–false diagnoses, misdiagnosis, unneeded treatment and fraud.

In summary, any doctor who is referred to their state PHP today is required to have any assessment and treatment at a “PHP-approved” facility based on Ridgeview.  It is mandated.  There is no choice.  Coercion, control and abuse at Ridgeview was associated with multiple suicides in doctors in the 1980s.  

The use of non-FDA approved tests of unknown validity worsens the abuse and fits the “cry of pain” model of hopelessness, helplessness and despair.

Locus of control is  lost.  Organizational justice is absent. The temporal relationship is clear.

Why is this still the elephant in the room?

This needs to be named, defined and openly discussed and debated.  How many more must die before we speak up?

Please help me get the conversation going.  I need allies.

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  26. Elovainio M, Kivimaki M, Vahtera J. Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health. Jan 2002;92(1):105-108.
  27. Lawson KJ, Noblet AJ, Rodwell JJ. Promoting employee wellbeing: the relevance of work characteristics and organizational justice. Health promotion international. Sep 2009;24(3):223-233.
  28. Hayashi T, Odagiri Y, Ohya Y, Tanaka K, Shimomitsu T. Organizational justice, willingness to work, and psychological distress: results from a private Japanese company. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. Feb 2011;53(2):174-181.
  29. Lang J, Bliese PD, Lang JW, Adler AB. Work gets unfair for the depressed: cross-lagged relations between organizational justice perceptions and depressive symptoms. The Journal of applied psychology. May 2011;96(3):602-618.
  30. Gonzales L. When Doctors are Addicts: For physicians getting Molly Kellogg is easy. Getting help is not. Chicago Reader. July 28, 1988, 1988.
  31. King M, Durcanin C. The suicides at Ridgeview Institute: A Doctor’s treatment program may be too tough, some say. Atlanta Journal and Constitution.December 18, 1987a, 1987: A12.
  32. Durcanin C, King M. The suicides at Ridgeview Institute: Suicides mar success at Ridgeview with troubled professionals. Atlanta Journal and Constitution.December 18, 1987, 1987: A13.
  33. Bissell L, Royce JE. Ethics for Addiction Professionals. Center City, Minnesota: Hazelden; 1987.
  34. Addiction Scientists from the USA: LeClair Bissell. In: Edwards G, ed.Addiction: Evolution of a Specialist Field. 1 ed: Wiley, John & Sons, Incorporated; 2002:408.
  35. Durcanin C. The suicides at Ridgeview Institute: Staff members didn’t believe Michigan doctor was suicidal. Atlanta Journal and Constitution. December 18, 1987, 1987: A8.
  36. Ricks WS. Ridgeview Institute loses $1.3 million in suit over suicide. Atlanta Journal and Constitution. October 11, 1987, 1987: A1.
  37. King M, Durcanin C. The suicides at Ridgeview Institute: Many drug-using doctors driven to Ridgeview by fear of losing licenses. Atlanta Journal and Constitution. December 18, 1987b, 1987: A1.
  38. Bissell L, Haberman PW. Alcoholism in the Professions. Oxford University Press; 1984.
  39. White W. Reflections of an addiction treatment pioneer. An Interview with LeClair Bissell, MD (1928-2008), conducted January 22, 1997. Posted athttp://www.williamwhitepapers.com. 2011.
  40. Williams c. Health care field chemical dependency threat cited. The Tuscaloosa News. January 16, 1988, 1988: 16.
  41. Peele S. In the Belly of the American Society of Addiction Medicine Beast. The Stanton Peele Addiction Website (accessed March 28, 2014)http://web.archive.org/web/20080514153437/http://www.peele.net/debate/talbott.html.
  42. Ursery S. $1.3M verdict coaxes a deal for doctor’s coerced rehab. Fulton County Daily Report.May 12, 1999b 1999.
  43. Ursery S. I was wrongly held in alcohol center, doctor charges. Fulton Count y Daily Report. April 27, 1999a 1999.
  44. Parker J. George Talbott’s Abuse of Dr. Leon Masters MD (http://medicalwhistleblowernetwork.jigsy.com/george-talbott-s-abuse-of-leon-masters ).Medical Whistelblower Advocacy Network.

Physician Suicide and “Physician Wellness” Programs–It’s time we start talking about the elephant in the room!

mllangan1 2 Comments

Screen Shot 2015-06-11 at 8.17.34 PMPhysician Suicide and the Elephant in the Room

Michael Langan, M.D.

Although no reliable statistics exist, anecdotal reports suggest an alarming upsurge in physician suicide. This necessitates a reappraisal of known predisposing risk factors such as substance abuse and depression but also requires a critical examination of what external forces or vulnerabilities might be unique to doctors and how they might be involved in the descent from suicidal ideation to suicidal planning to completed suicide.

Depression and Substance Abuse Comparable to General Population

Depression and substance abuse are the two biggest risk factors for suicide. The prevalence of depression in physicians is close to that of the general population 1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria suggest that physicians have the same rates (8-14%) of substance abuse and dependence as the rest of the population 3 and slightly lower rates compared to other occupations.4,5 Epidemiological surveys reveal the same. Hughes, et al.6 found a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

State Physician Health Programs

Perhaps it is how physicians are treated differently when they develop a substance abuse or mental health problem.

Physician Health Programs (PHP) can be considered an equivalent to Employee Assistance Programs (EAPs) for other occupations. PHPs meet with, assess and monitor doctors who have been referred to them for substance use or other mental or behavioral health problems. Originally developed as “impaired physician” programs, the PHPs were created to help doctors who developed problems with substance abuse or addiction an alternative to disciplinary action by State Medical Boards. These programs existed in almost every state by 1980. Often staffed by volunteer physicians and funded State Medical Societies, these programs served the dual purpose of helping sick colleagues and protecting the public. Preferring rehabilitation to probation or license revocation so long as the public was protected from imminent danger, most medical boards accepted the concept with support and referrals. Most EAPs were developed with the collaboration of workers unions or some other group supporting the rights and interests of the workers.  As there is no such organization representing doctors, PHPs developed in the absence of regulation or oversight.    As a consequence there is no meaningful accountability.   

In Ethical and Managerial Considerations Regarding State Physician Health Programs published in the Journal of Addiction Medicine in 2012, John Knight, M.D. and J. Wesley Boyd, M.D., PhD who collectively have more than 20 years experience with the Massachusetts PHP state that:

“Because PHP practices are unknown to most physicians before becoming a client of the PHP, many PHPs operate out- side the scrutiny of the medical community at large. Physicians referred to PHPs are often compromised to some degree, have very little power, and are, therefore, not in a position to voice what might be legitimate objections to a PHP’s practices.”8

Noting that “for most physicians, participation in a PHP evaluation is coercive, and once a PHP recommends monitoring, physicians have little choice but to cooperate with any and all recommendations if they wish to continue practicing medicine,” Knight and Boyd raise serious ethical and managerial questions about current PHP policies and practice including conflicts of interest in referrals for evaluation and treatment, lack of adherence to standards of care for forensic testing of substances of abuse, violations of ethical guidelines in PHP research, and conflicts of interest with state licensing boards.

Knight and Boyd recommend “that the broader medical community begin to reassess PHP’s as a whole” and that “consideration be given toward the implementation of independent ethical oversight and establish and appeals process for PHP clients who feel they are being treated unfairly.” 8 They also recommend the relationship of PHP’s between the evaluation and treatment centers and licensing boards be transparent and that national organizations review PHP practices and recommend national standards “that can be debated by all physicians, not just those who work within PHPs.”8 Unfortunately this has not happened. Most physicians have no idea that the state physician health programs have been taken over by the “impaired physicians movement.”

In his Psychology Today blog,  Boyd again recommends oversight and regulation of PHPs.   He cites the North Carolina Physicians Health Program Audit released in April of 2014 that reported the below key findings:

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As with Knight and Boyd’s paper outlining the ethical and managerial problems in PHPs, the NC PHP audit finding that abuse could occur and not be detected generated little interest from either the medical community or the media.

Although state PHPs present themselves as confidential caring programs of benevolence they are essentially monitoring programs for physicians who can be referred to them for issues such as being behind on chart notes. If the PHP feels a doctor is in need of PHP “services” they must then abide by any and all demands of the PHP or be reported to their medical board under threat of loss of licensure.

State PHP programs require strict adherence to 12-step doctrine9 yet many of the physicians monitored by them are neither addicts nor alcoholics. Some do not even have substance abuse issues and there are reports of “disruptive” physicians being diagnosed with “character defects” at the “PHP-approved” facilities that do these assessments.   PHPs require abstinence from drugs and alcohol yet use  non-FDA approved Laboratory Developed Tests in their monitoring programs. Many of these tests were introduced to commercial labs and promoted by ASAM/FSPHP physicians.10-12

LDTs bypass the FDA approval process and have no meaningful regulatory oversight.   The LDT pathway was not designed for “forensic” tests but clinical tests with low risk.   Some are arguing for regulation and oversight of LDTs due to questionable validity and risk of patient harm.13

These same physicians are claiming a high success rate for PH programs9 and suggesting that they be used for random testing of all physicians.14

As with LDTs, the state PHPs are unregulated, and without oversight. State medical societies and departments of health have no control over state PHPs.

Their opacity is bolstered by peer-review immunity, HIPPA, HCQIA, and confidentiality agreements. The monitored physician is forced to abide by any and all demands of the PHP no matter how unreasonable-all under the coloration of medical utility and without any evidentiary standard or right to appeal.

The ASAM has a certification process for physicians and claim to be “addiction” specialists. This“board certification” is not recognized by the American Board of Medical Specialties and is not a recognized medical specialty. The goal of the ASAM is to be recognized as the experts in addiction medicine with the consensus expert opinion based on the 12-step prohibitionist brain disease model. The ASAM has aligned itself with a number of inpatient drug treatment centers  (Hazelden, Talbott, Marworth, Bradford,etc) and are heavily funded by the drug testing industry.   It is in fact a “rigged game.”

State PHPs are non-profit non-governmental organizations and have been granted quasi-governmental immunity by most State legislatures from legal liability.

By infiltrating “impaired physician” programs they have established themselves in almost every state by joining, gaining power, and removing dissenters. Groupthink and 12-step indoctrination are the goals. By advertising as advocates for doctors who are “caring,” “confidential resources,” “giving help,” and advocating for “colleagues in need” the outward appearance is one of benevolence.

The biggest obstacle is that this system allows them to throw the normal rules of conduct under the imperative of a higher goal assumed to trump all other consideration. Those outside of programs either defend or ignore the reports of ethical and criminal violations, complacent in their trust of these “experts” claiming they are just helping sick doctors and protecting the public.

With no oversight or regulatory body involved this is all done with impunity, immunity, and undercover. They use the accusation of substance abuse as an indication to disregard the claims of the accused. The physician is left without rights, depersonalized, and dehumanized. The imposition of confinement, stigmatization, lack of oversight of the organizations, peer-review protected confidentiality, and lack of procedural protection is a one-way train to hopelessness and despair.

By establishing a system that of coercion, control, secrecy, and misinformation, the FSPHP is claiming an “80% success rate” 15and deeming the “PHP-blueprint” as “the new paradigm in addiction medicine treatment.

The ASAM/FSPHP had a major influence on the DSM-V where drug abuse and dependence are no longer separate entities. They are also working behind the scenes to get legislation to randomly drug test all physicians.

They are now after the “disruptive physician” and the evidentiary criteria are fairly low and red flags include “deviating from workplace norm in dress or conduct” and being tardy for meetings.

They have identified “the aging physician” as a potential problem because “as the population of physicians ages,””cognitive functioning” becomes “a more common threat to the quality of medical care.”

The majority of physicians are unaware that the Federation of State Medical Boards House of Delegates adopted an updated Policy on Physician Impairment in 2011 that uses addiction as an example of a “potentially impairing illness.”  According to the Federation of State Physician Health Programs …”physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years. This is a critically important distinction. Illness is the existence of a disease. Impairment is a functional classification and implies the inability of the person affected by disease to perform specific activities.”

“Process addiction” was added as a potentially impairing illness including compulsive gambling, compulsive spending, compulsive video gaming, and “workaholism.” According to the FSPHP “the presence of a process addiction can be problematic or even impairing in itself, and it can contribute to relapse of a physician in recovery. As such, process addictions should be identified and treated.” They define three levels of relapse including the novel “relapse without use.”

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Bullying, Helplessness, Hopelessness and Despair

Perceived helplessness is significantly associated with suicide.16 So too is hopelessness, and the feeling that no matter what you do there is simply no way out17,18 Bullying is known to be a predominant trigger for adolescent suicide19-21 One study found that adolescents in custody who were bullied were 9.22 times more likely to attempt suicide than those were not bullied.22

Heightened perceptions of defeat and entrapment are known to be powerful contributors to suicide.23,24 The “Cry of Pain” model 25,26 specifies that people are particularly prone to suicide when life experiences are interpreted as signaling defeat which is defined as a sense of “failed struggle” or loss of social position and resources.. The person is unable to identify an escape from or resolution to a defeating situation, a sense of entrapment proliferates with the perception of no way out, and this provides the central impetus for ending ones life.

There is also evidence that rescue factors such as social supports may play a role in preventing suicide. These rescue factors act buffers to protect against suicide in the face of varying degrees of life stress.27,28 The study of female physicians revealed meetings to discuss stressful work experiences as a potential protective factor, 29 and support at work when difficulties arose appeared to be a protective factor for the male physicians.30   Research involving Finnish physicians found that control over one’s work and organizational justice were the most important determinants of work-related wellbeing.31,32 Organizational justice is related to fairness and refers to an individuals perception of an organizations behaviors, decisions, and actions and how these influence one’s own attitudes and behaviors and has been identified as a psychosocial predictor of health and wellbeing33 34 Low organizational justice has been identified as a notable risk factor for psychological distress and depression.35,36

A recent report indicates that job stress, coupled with inadequate treatment for mental illness may play a role in physician suicide..

Using data from the National Violent Death Reporting System the investigators compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician.1

Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians.

They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”

I can think of nothing more institutionally unjust than an unregulated zero-tolerance monitoring program with no oversight using unregulated drug and alcohol testing of unknown validity.

We have heard of numerous suicides due to these institutionally unjust programs.   Three doctors died by suicide in Oklahoma in a one month period alone (August 2014).   All three were being monitored by the Oklahoma PHP.   I went to an all boys high-school of less than 350 students yet a classmate a couple years ahead of me died by suicide a few months ago. He was being monitored by the Washington PHP. His crime?  A DUI in 2009–a one-off situational mistake that in all likelihood would never have recurred.  But as is often the case with those ensnared by state PHPs he was forced to have a “re-assessment” as his five-year monitoring contract was coming to an end.  These re-assessments are often precipitated by a positive Laboratory Developed Test (LDT) and state medical boards mandate these assessments can only be done at an out-of-state “PHP-approved” facility.    Told he could no longer operate and was unsafe to practice medicine by the PHP and assessment center he then hanged himself.  And at the conclusion of Dr. Pamela Wible’s haunting video below are listed just the known suicides of  doctors; many were being monitored by their state PHPs–including the first name on the list– Dr. Gregory Miday.

None of these deaths were investigated. None were covered in the mainstream media.   These are red flags that need to be acknowledged and addressed!    This anecdotal evidence suggests the oft-used estimate of 400 suicides per year (an entire medical school class) is a vast underestimation of reality—extrapolating just the five deaths above to the entire population of US doctors suggests we are losing at least an entire medical school per year.

As physicians we need to demand transparency, oversight, regulation and auditing by outside groups. This is a public health emergency.

To wit:

They first came after the substance abusers and I did not speak out because I was not a substance abuser.

They then came for those with psychiatric diagnoses and I did not speak out because I was not diagnosed with a psychiatric disorder.

They then came after the “disruptive physician” and I did not speak out because I was not disruptive.

They then came after the aging physician and I did not speak out because I was young.

They then came after me and there was no one else to speak out for me.

 

  1. Ford DE, Mead LA, Chang PP, Cooper-Patrick L, Wang NY, Klag MJ. Depression is a risk factor for coronary artery disease in men: the precursors study. Archives of internal medicine. Jul 13 1998;158(13):1422-1426.
  2. Frank E, Dingle AD. Self-reported depression and suicide attempts among U.S. women physicians. The American journal of psychiatry. Dec 1999;156(12):1887-1894.
  3. Brewster JM. Prevalence of alcohol and other drug problems among physicians. JAMA : the journal of the American Medical Association. Apr 11 1986;255(14):1913-1920.
  4. Anthony J, Eaton W, Mandell W, al. e. Psychoactive Drug Dependence and abuse: More Common in Some Occupations than in Others? Journal of Employee Assistance Res. 1992;1:148-186.
  5. Stinson F, DeBakely S, Steffens R. Prevalence of DSM-III-R Alcohol abuse and/or dependence among selected occupations. Alchohol Health Research World. 1992;16:165-172.
  6. Hughes PH, Brandenburg N, Baldwin DC, Jr., et al. Prevalence of substance use among US physicians. JAMA : the journal of the American Medical Association. May 6 1992;267(17):2333-2339.
  7. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.Archives of general psychiatry. Jun 2005;62(6):593-602.
  8. Boyd JW, Knight JR. Ethical and managerial considerations regarding state physician health programs. Journal of addiction medicine. Dec 2012;6(4):243-246.
  9. DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians’ Health Programs. Journal of Medical Regulation. Mar 2010;95(4):10-25.
  10. Skipper GE, Weinmann W, Thierauf A, et al. Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders. Alcohol and alcoholism.Sep-Oct 2004;39(5):445-449.
  11. Skipper GE, Thon N, Dupont RL, Baxter L, Wurst FM. Phosphatidylethanol: the potential role in further evaluating low positive urinary ethyl glucuronide and ethyl sulfate results. Alcoholism, clinical and experimental research. Sep 2013;37(9):1582-1586.
  12. Skipper GE, Thon N, DuPont RL, Campbell MD, Weinmann W, Wurst FM. Cellular photo digital breathalyzer for monitoring alcohol use: a pilot study. European addiction research.2014;20(3):137-142.
  13. Sharfstein J. FDA Regulation of Laboratory-Developed Diagnostic Tests: Protect the Public, Advance the Science. JAMA : the journal of the American Medical Association. Jan 5 2015.
  14. Pham JC, Pronovost PJ, Skipper GE. Identification of physician impairment. JAMA : the journal of the American Medical Association. May 22 2013;309(20):2101-2102.
  15. McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. Bmj. 2008;337:a2038.
  16. Rivers I, Noret N. Potential suicide ideation and its association with observing bullying at school.The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S32-36.
  17. Lester D, Walker RL. Hopelessness, helplessness, and haplessness as predictors of suicidal ideation. Omega. 2007;55(4):321-324.
  18. Beck AT. Hopelessness as a predictor of eventual suicide. Annals of the New York Academy of Sciences. 1986;487:90-96.
  19. Hinduja S, Patchin JW. Bullying, cyberbullying, and suicide. Archives of suicide research : official journal of the International Academy for Suicide Research. 2010;14(3):206-221.
  20. Hertz MF, Donato I, Wright J. Bullying and suicide: a public health approach. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. Jul 2013;53(1 Suppl):S1-3.
  21. Kim YS, Leventhal B. Bullying and suicide. A review. International journal of adolescent medicine and health. Apr-Jun 2008;20(2):133-154.
  22. Kiriakidis SP. Bullying and suicide attempts among adolescents kept in custody. Crisis.2008;29(4):216-218.
  23. Taylor PJ, Gooding P, Wood AM, Tarrier N. The role of defeat and entrapment in depression, anxiety, and suicide. Psychological bulletin. May 2011;137(3):391-420.
  24. Lester D. Defeat and entrapment as predictors of depression and suicidal ideation versus hopelessness and helplessness. Psychological reports. Oct 2012;111(2):498-501.
  25. Williams JMG. Cry of Pain. Harmondsworth: Penguin; 1997.
  26. Williams JMG, Crane C, Barnhofer T, Duggan DS. Psychology and suicidal behavior: elaborating the entrapment model. In: Hawton K, ed. Prevention and treatment of suicidal behavior: from science to practice. Oxford: Oxford University Press; 2005:71-89.
  27. Borowsky IW, Ireland M, Resnick MD. Adolescent suicide attempts: Risks and protectors.Pediatrics. 2001;107(485).
  28. Clum GA, Febbraro GAR. Stress, social support and problem-solving appraisal/skill: Prediction of suicide severity within a college sample. Journal of Psychopathology and Behavioral Assessment. 1994;16:37-46.
  29. Fridner A, Belkic K, Marini M, Minucci D, Pavan L, Schenck-Gustafsson K. Survey on recent suicidal ideation among female university hospital physicians in Sweden and Italy (the HOUPE study): cross-sectional associations with work stressors. Gender medicine. Apr 2009;6(1):314-328.
  30. Fridner A, Belkic K, Minucci D, et al. Work environment and recent suicidal thoughts among male university hospital physicians in Sweden and Italy: the health and organization among university hospital physicians in Europe (HOUPE) study. Gender medicine. Aug 2011;8(4):269-279.
  31. Lindfors PM, Meretoja OA, Toyry SM, Luukkonen RA, Elovainio MJ, Leino TJ. Job satisfaction, work ability and life satisfaction among Finnish anaesthesiologists. Acta anaesthesiologica Scandinavica. Aug 2007;51(7):815-822.
  32. Heponiemi T, Kuusio H, Sinervo T, Elovainio M. Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators. European journal of public health. Aug 2011;21(4):520-525.
  33. Elovainio M, Kivimaki M, Vahtera J. Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health. Jan 2002;92(1):105-108.
  34. Lawson KJ, Noblet AJ, Rodwell JJ. Promoting employee wellbeing: the relevance of work characteristics and organizational justice. Health promotion international. Sep 2009;24(3):223-233.
  35. Hayashi T, Odagiri Y, Ohya Y, Tanaka K, Shimomitsu T. Organizational justice, willingness to work, and psychological distress: results from a private Japanese company. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. Feb 2011;53(2):174-181.
  36. Lang J, Bliese PD, Lang JW, Adler AB. Work gets unfair for the depressed: cross-lagged relations between organizational justice perceptions and depressive symptoms. The Journal of applied psychology. May 2011;96(3):602-618.

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27 thoughts on “The Elephant in the Room: Physician Suicide and Physician Health Programs”

  1. Wow! Thank you for this! This article may very well be far beyond its time, and thus, that much more impactful. There is so much to be added to the discussion of the mental and physical state of the modern day physician. It could provide so much more insight not only into the lives of physicians, but also their patients. Much like the police, there is a code of silence among the medical and scientific community; one so static and unwavering, it is much of the cause of the staggering amount of deaths and illnesses abound in our current society. Because by default, everyone is either a patient or a physician, by building the platform for this conversation, pieces of writing like this may prove to be the key to saving every single person in the world. Literally. Again, thank you!

    REPLY

    • Thanks! The problem is the mainstream medical bloggers will not address the role of physician health programs and physician suicide. In fact many of my comments on these blogs regarding this have been removed as “spam.” This barrier has been very hard to break for various reasons. How do we solve a problem most doctors will not even mention? To address the problem we need to acknowledge it and that is just not happening.

      Liked by you and 2 other people

      REPLY

      • So, so true! Please, just don’t stop what you’re doing. No matter how much blow back and obstacles you face, keep getting this message out there. People are watching and waiting for the courage to join in the conversation. People like you, with the courage to be the first on the dance floor, so to speak, are the reason the party gets started. No matter how long it may seem that you’re dancing alone, you’re not. And right when you last expect it, the whole world will begin acknowledging the significance of physician health and physician suicide, as if it’s been around as long as sliced bread. People like you and I rarely get the credit we deserve, but what’s credit, compared to saving lives. I can’t emphasize enough how important research, data and discussions like this are for the necessity of literally, saving lives. I get it. I really, really do. I’ve personally seen what can and continues to happen as a result of us ignoring what the lacking physician health programs and growing physician suicide. So, yea, just keeping going, please. For the children who may never meet you, but will live longer lives from the sacrifices you’ve made. Much peace, love and blessings be to you always! A’se (and so it is)!

        Liked by you and 1 other person

  2. So is it suicide or accidental overdose? I had a physician who was found dead by his wife, overdosed on a prescription med. It has bothered me all these years, wondering if it was deliberate or an accident. I tell myself it was accidental, because that’s what I want to believe, and yet, you all have so much responsibility weighing on your shoulders. How do you cope?

    Liked by you

    REPLY

    • The 400 figure is an underestimate as death certificates and other traditional sources of information have proven unreliable. In addition most of these deaths are not investigated –especially if there was a PHP involved. Last August 3 doctors died by suicide in a 30 day period who were under monitoring by the state PHP and it did not even make the local news. In many cases it is difficult to determine if death is a result of suicide or an accident and suicides are often underreported to protect the victim or family from stigma or insurance investigations. An insurance company will more easily pay on a claim due to a “drug misadventure” than a suicide.

      Liked by 2 people

      REPLY

    • That’s understandable, but so sad. Everything seems to boil down to insurance now, what they will or will not pay for. From a patient’s point of view, it gets frustrating that we all pay because of the ones who abuse the system, and from your side, it means extra work because some of the patients abuse the system, so all patients must be subjected to the same embarrassing testing. And you suffer because the patients hold you responsible, so it is an uphill battle all the way. I’m glad the COD is not included in obits that are seen in newspapers, and also glad autopsies are not required in every case. I can remember when they were, and how hard it was on families. In the case of my doctor, an autopsy was ordered and it was all over the front page of the local paper. Not a good thing for his family to live with.

      Liked by you and 1 other person

      REPLY

  4. (forgive if this is a redundant entry – left one yesterday but didn’t get posted.)

    Another brilliantly incisive piece, Michael!

    In what is sure to be a seminal work, Tom Bourne and colleagues examined the psychiatric impact of board complaint investigations on physicians in Britain (the GMC there is the equivalent of state licensing boards here) and found a 100% increase from baseline in depression, anxiety and suicidal ideation. Hmmm … any possible link between board “investigations,” PHP sham “diagnoses” and physician suicide?

    (see: Bourne T, et al. BMJ Open 2015;4:e006687. doi:10.1136/bmjopen-2014-006687)

    You would have expected medical boards (consisting of physicians who took an oath, for godsakes!) and PHPs (with their “oh-so-concerned-about-physician-health” mantra) to have shuddered at this finding and rushed out to investigate whether this could possibly be true.

    Now, optimists that you are, brace yourself … not one medical board or PHP member has responded to the Medscape article which announced this, nor apparently countered the finding in any other forum. (As in “oh, board and PHP inquiries are really benign … see all our happy campers … our studies show everybody’s doing well and what great work we’re doing.”

    Have you heard of any investigation by FSPHP or FSMB into whether this finding might be true? Or at least an expression of concern? Nah ….

    Or perhaps the AMA …? Nah.

    Oooh, oooh, maybe the APA which by all rights should be concerned about the illicit activities of unlicensed PHPs operating as “public charities” conducting career and life altering psychiatric and substance abuse evaluations under the sham rubric of “peer review,” referring, under board order based on their pontifical findings (whose report they adamantly refuse to provide to the subject physician), to pre-selected “preferred institutions” with whom there is a prearranged “understanding” of the admission diagnosis and impairment severity and the gross abuse of the field of psychiatry by the denial of due process and ensuing torture these programs commit…? Maybe they’d be concerned, right??? … nah. Multiple parties have emphatically tried to rouse them from their institutional slumber to utterly no avail but an insulting response implying that the complainer is nothing but a personality-disordered whiner who’s unhappy with “the program.” (Yes, the “program.” That’s like telling a Jew in 1940’s Germany that he shouldn’t be complaining about the free train ride the government is offering.)

    As has been explicitly documented by the NC State Auditor in its comprehensive performance evaluation report on the NCPHP (see NCOSA Performance Evaluation of NCPHP April 2014, available online), NCPHP systematically violated the due process rights of over 1,140 physicians over the preceding decade. (Even the writing of the phrase does not convey the extremity of the violation – one has not only been denied justice and screwed by one’s own pathetically impotent lawyers, one has lost one’s career and even personal identity – all in one fell swoop by an agency with no oversight or accountability.)

    Now, answer me this: if you were falsely accused of something, falsely diagnosed, had laboratory data falsified in order to both reinforce the false diagnosis and punish you for your defiant challenge, and had your due process rights violated, and you then were entirely deprived of your career and then so publicly shamed by the published proceedings based on the false but incontestable findings, and your practice was abruptly upended, and you then were forced to witness your patients’ suffering as a result of the disruption of their care with you, and you then were forced to bear the news of one of your patients committing suicide as a direct result of this abusive disruption of care, would you be … upset?

    Keep up the extraordinary work, Michael. While there are innumerable docs who have been utterly obliterated by this combined board / PHP abuse and their manipulation of their privilege – and, yes, some have tragically taken their lives being put in such an impossible bind, there are a few of us who are determined to confront this abuse and demand that protections be put in place so that it never occurs again, without severe consequences ensuing to the offending party.

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  7. (From a resident physician who wishes to remain anonymous)

    Dr. Langan:

    Thank you for your articles and research regarding PHPs and “impaired” physicians. I have become involved in this issue after someone close to me struggled with depression during residency. Sadly, they lacked the resources, support and coping skills and ended up committing a crime with a misdemeanor charge. Despite their treatment and rehabilitation, they were dismissed from residency. Not sure if they will ever get to practice clinical medicine. It is very sad. they are very smart, great doctor and very empathetic towards patients.

    After their situation, I started looking on blogs and found that many residents had shared similar instances. Many reported struggling with depression and the stresses of residency put them over the edge– like the perfect storm of stress, fatigue, and loneliness that could exploit anyone’s weaknesses. It seems like during residency, we are emotionally as well as legally vulnerable. Many of these residents have never been able to resume training at their institutions despite their demonstration of clinical competence and emotional maturation. According to that medscape article, that is a huge loss to society, socially and financially.

    Sadly, there still so much stigma surrounding mental health, and I think it may be worse in our profession.

    I am very concerned regarding the future of our profession. We are becoming robots in a health care factory. Our own personal lives are being compromised as well as quality patient care.

    I appreciate all you are doing to shed light on this very important issue.

    Thank you for your time and consideration

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  9. I was sent the letter below by e-mail. Dr. Roop has specifically requested that it be published here with his contact information and I applaud his courage.

    On Mar 5, 2015, at 4:04 PM, Jonathan Crane Roop MD wrote:

    Name: Jonathan Crane Roop MD
    Email: jonathanroop@hotmail.com
    Comment: I am Board Certified in Internal medicine. I have endured years of emotional, psychological and spiritual abuse at the hands of the Washington Physician’s Health Program. I have suffered through a long list of injustices without recourse. They include, but are not limited to discrimination, abuse of power, breach of contract and repeated and WILLFUL medical negligence.

    Because the actions of the WPHP have been SO egregious, I assumed what was happening to me must be extraordinarily rare.

    I have nothing to hide. And I have shared my story with any and all who would listen. To date, my voice, my rights and now my life have been dismissed as unimportant. MY LIFE!! It’s apparently better that I die than my tormentors be questioned and compelled to defend their indefensible and evil behavior.

    I am meeting with one last attorney tomorrow. I fully expect him to ignore the basic, indisputable and well documented facts of my case. Namely, there is massive and systematic malfeasance being committed by a tax payer funded agency in the State of Washington who act with omnipotence and without oversight. I have no reason to believe he will respond any differently than the others with whom I have met. HE WON’T CARE! HE WILL NOT BE MOVED. He will make statements that suggest I DESERVE this treatment. And that my life, as well as my imminent death, is unworthy of his time or efforts.

    Once my assumptions about this last meeting are officially confirmed, I am committed to the only course of action available to me. The only thing which will put an end to this nightmare.

    Today I stumbled upon your website. And today, for the first time, I have learned that my case is not rare. I suspect the other physician victims in this matter have occasionally allowed themselves to dream wistfully of justice. Justice which they have seen thwarted at every turn. Perhaps they, like me, have dreamily imagined the relief and joy and LIFE they would experience if the truth were simply presented and the perpetrators held accountable. I have imagined standing up in court and triumphantly affecting justice for myself as well as all of the other current and future victims. I deliver a powerful defense of justice. My ‘dream speech’. I have imagined that I might still live. And then I wake up.

    And so today, imagine my shock, when I found my ‘dream speech’ here. My speech. Reasonable. Honest. Consistent. And based firmly in truth, justice and defense of the powerless against the (arbitrarily) powerful. My speech, it seemed, but authored by another.

    Thank you, Dr. Langan. You have given a voice to my struggles. Please never stop speaking for me, and people like me, many of whom, I fear, will not survive to see justice.

    Despite my intention to die, I actually WANT TO LIVE! And I will live and fight on if I ever believe that there is even a small chance of justice for me and the other innocent victims of PHP’s and the ‘treatment’ centers with whom they contract (Talbott in my case. Purely evil and loathsome human beings, for the record).

    So, because I do WANT to live…PLEASE HELP ME, SIR!

    Can you refer me to attorneys, individuals or groups who might advocate for me and the other victims? Do you have any specific words of hope or encouragement?

    Please note my name. Please add me to the list of innocent victims of these power hungry, narcissistic BULLIES.

    I don’t expect to live through this. And in a way, the PHP, Talbott and the addiction ‘experts’ with whom I have been tragically acquainted are correct…My life is worth very little. But this issue is so much larger than I. I can die with some serenity if I believe there will be meaningful justice for others like me. And that those responsible will be held to account.

    Thank you Dr. Langan. Thanks to all of those involved in the creation and maintenance of this website. Although your shining beacon is barely perceivable through the darkness of injustice which surrounds and seeks to extinguish it…it is the only glimmer of hope I have found during my slow death by PHP.

    Jonathan Crane Roop MD

    811 S Cowley St #48
    Spokane WA 99202

    509-710-4641

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  10. These miscarriages of justice remind one of nothing so much as Victor Hugo’s “Les Miserables”. That was, of course, a mere novel. Sadly, the experiences described here are real. The loss of capable physicians is doubly tragic — not only for the physicians involved, but for society at large. I would add only that God is capable of giving our lives purpose, even after what is most precious to us has been taken. Life can be worth living, despite great loss.

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    • I have been hearing from 2 or 3 every day. Nearly all of them are afraid to leave comments here (even anonymously) for fear the PHP will find out. There is a “learned helplessness” because there is no lifeline. The Medical Boards are complicit, The Medical Societies have no oversight, Law enforcement turns a deaf ear because the perpetrators have convinced them it should be kept within the medical profession. Attempting to report valid crimes are refused and they are often reported back to the Board or PHP and further punished. The media is not interested because they have been labeled “impaired”or “disruptive” and no matter how strong the truth, evidence or facts are they take the PHPs word over theirs. And almost all of the doctors I have talked to are good doctors who are kind hearted and honest. But bad doctors are rarely sanctioned by medical boards; they have to do something so egregious that turning a blind eye would be noticed. And doctors who are bad people who have engaged in terrible behavior often get reinstated by claiming they were “helpless” over that behavior but are now “in recovery.” They go to extremes to protect sexual violators in these programs and also believe they can monitor pedophiles with polygraphs and treat them with 12-step. Just look at the case below. An adolescent psychiatrist gets arrested with child pornography and admits to a longstanding attraction to young boys. The PHP gives him a polygraph test “proving” he’s a looker not a toucher and he is back practicing medicine in no time. The PHP speaks as if he is a Saint. Perhaps they had a slot to fill in the “sexual addiction” department in one of the “PHP-approved” assessment and treatment centers.

      http://www.psychsearch.net/montana-psychiatrist-james-h-peak-convicted-of-child-porn-wants-license-back/

      http://billingsgazette.com/news/local/peak-s-medical-license-reinstated-on-lifetime-probationary-status/article_fab77fef-188c-5f29-8013-4a86c87d32a8.html

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  13. Doctors, I can sympathize with your pain although I am not a physician. I was trained at a university medical facility in laboratory medicine and during my sophomore year it was found that I was suffering from what their psychologist called “delayed grief” from the loss of my mother. Long story short, they pushed me out of school until I could get it together. I am a disabled, Christian and pastor of a small church now and not in laboratory technology practice anymore. My website http://thelivingmessage.com, is my way of bringing the hope of Jesus to those who are searching for answers in a world that seems not to want to hear them. Please feel free to refer any of your friends to my site or even to email me through it. I will be glad to pray with and for any or all of you in your time of pain and suffering. God gave you your talents and abilities so please don’t throw them away if possible.

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  14. The list really touched me….I have been close to just ending it before. I used to think it was something only “other” people experienced. This is so sad !!

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Letters From Those Abused and Afraid

mllangan1 5 Comments

Letters From Those Abused and Afraid.

I’m hearing from more and more doctors via my survey, emails and phone calls.  At this point the patterns are becoming crystal clear and they involve the same “physician wellness” actors, the same “PHP-approved” assessment and treatment facilities and the same commercial “forensic” drug testing labs.

It is all the same M.O.  A false accusations  is made followed by misrepresentation of laboratory developed tests (LDTs) or outright forensic fraud.    A referral is then made for an “evaluation” at one of the “PHP-approved” facilities where an “assessment” is “tailored” to fit a pre-determined diagnosis.  The PHP then says do anything and everything we say or we will “end you.”  And all too often that is exactly what they do.   It is Political Abuse of Psychiatry plain and simple.   It does not get any more egregious than this folks.

The Doctors dying from this system of institutional injustice are not dying by suicide.  This is more akin to murder and the murderers have removed themselves from all aspects of accountability including answerability, justification for actions and the ability to be punished by third party actors truly outside the system. It is a rigged game.

the-world-is-a-dangerous-place-to-live-not-because-of-the-people-who-are-evil-but-because-of-the-people-who-don_t-do-anything-about-itThe sociopaths responsible for ordering false assessments and falsified drug and alcohol testing as well as those complying with it in the drug and alcohol testing, assessment and treatment industry need to be held accountable.

Those ordering the falsified tests and assessments are essentially putting guns to the heads of doctors.  The labs and rehab centers complicit in this fraud are pulling the trigger.  Simple as that.

You can see some of these letters here:  Letters From Those Abused and Afraid.

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