The Psychiatrist as Patient: Do We Always Get Good Care in Our Hour of Need?

This post is prompted by a meeting I had recently with one of our senior residents. He was seeking my advice about a grand rounds he’ll be giving in the new year on barriers to psychiatric treatment when the patient is a psychiatrist. I’ve touched on this topic before in this blog, with pieces on stigma^1-3 and self-medicating in psychiatrists⁴ . But our conversation got me thinking about a psychiatrist friend of mine who had a bad experience, one that actually rendered him quite rattled. He has a history of major depression and has been stable for quite a long time. Here is what he told me over the phone:

You know, Mike. I’ve just moved to this city to start my new job. First order of business – get a new psychiatrist to take over my care. I asked around and was given the name of Dr. Moore (pseudonym), who sees a lot of doctors in town. I was really looking forward to seeing him. Let me tell you what happened. It didn’t go well, but now I wonder if that’s my fault. You’re a former training director so maybe you can help. The visit started out OK but it went south when he asked why I’d never disclosed my illness to my residency training director. I told him I didn’t think that was necessary because I was well the entire time, taking my medication and seeing my regular psychiatrist from medical school every 6 months. But he kept focusing on the fact that I should have revealed my history of depression even before I began my residency.

When I asked him to explain why he felt this way, he got really sarcastic and kind of belittling. He said, “The ethical thing to do is to be transparent. You should have let the training director know that you have a ‘pre-condition’ so that they could keep an eye on you.” When I asked him what he meant by that (assuming he meant “pre-existing condition”) he really got upset and accused me of playing dumb. He said something like, “Surely I don’t need to explain to you, a psychiatrist, that when a doctor has a history of depression, if it comes back it could affect his work with patients. And that is why when you’re in training you should tell the director so he or she can be on ‘high alert’”

I felt really confused then. And ashamed actually. I am an ethical person. I know my illness well, and so did my psychiatrist at the time. I would have gone on medical leave if my symptoms came back and I was at risk of harming my patients. But this has really upset me. I haven’t slept well the last couple of nights, and that’s also why my wife agreed that I should call you. What do you think? I wonder now if he was right, that I was kind of fraudulent by not coming out about my illness to the training director.

I told him that he had done nothing wrong and that there is no obligation to disclose his personal health history unless there is some impairment at work or a history of impairment in the past. Fortunately, I succeeded in putting him at ease. I made a few phone calls and found him a different psychiatrist with whom he has a very good fit.

MORE: Doctors May Fear Losing Their License for Seeking Mental Health Care

The good news is that he is selectively open about his mood disorder and he reached out to me to gain some perspective. But many psychiatrists in his position, given their privacy or internalized stigma, have told no one about their condition and may not have that option. And this is particularly worrisome if the psychiatrist is quite symptomatic and very sensitive to criticism and confrontation. This type of encounter with someone in authority, like your new psychiatrist, could set off a flood of guilty ruminations and plunging mood.

I invite readers to weigh in on this, either with their own personal stories of being a patient or their professional experiences treating psychiatrists. We read so much about physicians being “difficult patients.” What about when the shoe is on the other foot?

References

1. Myers MF. Stigma and the Ailing Physician. Psych Congress Network website. https://www.psychcongress.com/blog/stigma-and-ailing-physician. Published March 2, 2015. Accessed October 18, 2017.
2. Myers MF. Stigma and the Ailing Physician: Part 2. Psych Congress Network website. https://www.psychcongress.com/blog/stigma-and-ailing-physician-part-2. Published April 13, 2015. Accessed October 18, 2017.
3. Myers MF. Stigma and the Ailing Physician. Part 3. Psych Congress Network website. https://www.psychcongress.com/blog/stigma-and-ailing-physician-part-3. Published May 21, 2015. Accessed October 18, 2017.
4. Myers MF. Depressed Psychiatrists and Self-Prescribing. Psych Congress Network website. https://www.psychcongress.com/blog/depressed-psychiatrists-and-self-prescribing. Published September 30, 2014. Accessed October 18, 2017.