M. Dolores Braquehais, M.D., Ph.D.

Doctors are reluctant to ask for help when they suffer from mental disorders (1–4). Several factors may account for this fact: tendency to intellectualize psychiatric symptoms, greater stigma associated to mental disorders among health professionals, easy access to self-treatment, etc. (5–10) Delay in help seeking causes greater morbidity and mortality among sick doctors and may also lead to malpractice behaviors (10-15).

The first specific programs for physicians with mental disorders (“sick doctors”, SD) were developed in the USA in the late 1970s. Their initial objectives were to identify and to treat SD who were engaged in misconduct as a consequence of their mental disorders, mainly substance use disorders (1,16–21). Similar programs were developed later on in Canada (22–24), in Australia and New Zealand (25–30), and in the UK (31–33).

The Barcelona Integral Care program for Sick Doctors (PAIMM in Catalan and PAIME in Spanish) was created jointly by the Department of Health of the Regional Government of Catalonia (Spain) and the Catalan Medical Association in 1998, and is managed by the Barcelona Medical Association (4,34–38). In 2000, the program was extended to nurses and, since 2011, to pharmacists and veterinarians. All these programs are grouped into the Barcelona Integral Care Program for Sick Health Care Professionals. The main aim of the Program is to assist health care professionals who suffer from substance use disorders and/or from other psychiatric conditions, and help them go back safely to their professional practice. In Spain, “medical associations” and “medical councils/regulatory bodies” are part of the same institution where all practicing physicians need to be registered (Colegio de Médicos). The rest of health care professionals are affiliated to similar institutions.

The Barcelona Program can be defined as a non-persecutory, non-punitive (if mandatory admission can be avoided), voluntary access clinical program that also promotes prevention and rehabilitation. There is a special care for providing fully confidential treatment as the emphasis relies on enhancing voluntary enrollment in the program. Only when malpractice issues are involved, the treatment becomes compulsory.

Taking care of our colleagues is an ethical and moral imperative that helps improve their psychosocial wellbeing and it also prevents malpractice issues due to mental disorders.

References
1.     AMA. The sick physician. Impairment by psychiatric disorders, including alcoholism and drug dependence. JAMA?: the journal of the American Medical Association. 1973; 223(6):684–7.
2.     Bloom M. Impaired physicians: medicine bites the bullet. Medical world news. 1978; 19(15):40–1, 46, 50–1.
3.     Herrington RE, Jacobson GR. Outlook for impaired physicians with appropriate treatment. JAMA?: the journal of the American Medical Association [Internet]. 1982; 248(23):3144.
4.     Arteman A, Gual A, Padrós J, Casas M, Bruguera E, Colom J. ¿Qué hacer cuando el paciente es un colega? Dos años de experiencia del Programa de Atención Integral al Médico Enfermo (PAIME). Adicciones. 2001; 13(1):3–5.
5.     Herrington RE. The impaired physician–recognition, diagnosis, and treatment. Wisconsin medical journal. 1979; 78(3):21–3.
6.     Firth-Cozens J. Predicting stress in general practitioners: 10 year follow up postal survey. BMJ (Clinical research ed.). 1997; 315(7099):34–5.
 7.     Miller L. Helping troubled doctors. BMJ. 2002; 324(S148).
8.     Hughes PH, Brandenburg N, Baldwin DC, Storr CL, Williams KM, Anthony JC, et al. Prevalence of substance use among US physicians. JAMA?: the journal of the American Medical Association. 1992; 267(17):2333–9.
9.     Boisaubin EV, Levine RE. Identifying and assisting the impaired physician. The American journal of the medical sciences. 2001; 322(1):31–6.
10.     Davidson SK, Schattner PL. Doctors’ health-seeking behaviour: a questionnaire survey. The Medical journal of Australia. 2003; 179(6):302–5.
11.     Herrington RE, Benzer DG, Jacobson GR, Hawkins MK. Treating substance-use disorders among physicians. JAMA?: the journal of the American Medical Association. 1982; 247(16):2253–7.
12.     Skipper GE, Campbell MD, Dupont RL. Anesthesiologists with substance use disorders: a 5-year outcome study from 16 state physician health programs. Anesthesia and analgesia. 2009; 109(3):891–6.
13.     McLellan AT, Skipper GS, Campbell M, DuPont RL. Five years outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ British Medical Journal. 2008; 1–6.
14.     Redfern N. Morbidity among anaesthetists. British journal of hospital medicine. 1990; 43(5):377–81.
15.     Jacyk WR. Physician at Risk Committees Re-evaluated. Canadian family physician Médecin de famille canadien. 1986; 32:345–7.
16.     Brown RL, Schneidman BS. Physicians’ health programs–what’s happening in the USA? The Medical journal of Australia. 2004; 181(7):390–1.
17.     Carr G. Is the Mississippi Recovering Physician Program seeing more issues related to physician stress and burnout? Journal of the Mississippi State Medical Association. 2003; 44(2):39–40.
18.     Isaacson M. Seeing the invisible. The Journal of the Arkansas Medical Society. 2010; 106(11):252–3.
19.     Talbott GD, Gallegos KV, Wilson PO, Porter TL. The Medical Association of Georgia’s Impaired Physicians Program. Review of the first 1000 physicians: analysis of specialty. JAMA?: the journal of the American Medical Association. 1987; 257(21):2927–30.
20.     Shore JH. The Oregon experience with impaired physicians on probation. An eight-year follow-up. JAMA?: the journal of the American Medical Association. 1987; 257(21):2931–4.
21.     Conner SL. Comparison of impaired physician programs nationwide. Maryland medical journal. 1988; 37(3):213–5.
22.     Arboleda-Florez J. The mentally ill physician. The position of the Canadian Psychiatric Association. Canadian journal of psychiatry. Revue canadienne de psychiatrie. 1984; 29(1):55–9.
23.     Puddester DG. Canada responds: an explosion in doctors’ health awareness, promotion and intervention. The Medical journal of Australia. 2004;181(7):386–7.
24.     Brewster JM, Kaufmann IM, Hutchison S, MacWilliam C. Characteristics and outcomes of doctors in a substance dependence monitoring programme in Canada: prospective descriptive study. BMJ (Clinical research ed.). 2008;337(a2098):a2098.
25.     Khong E, Sim MG, Hulse G. The identification and management of the drug impaired doctor. Australian family physician. 2002; 31(12):1097–100.
26.     Schattner P, Davidson S, Serry N. Doctors’ health and wellbeing: Taking up the challenge in Australia. MJA. 2004;181(7):348–9.
27.     Engs RC. The drug-use patterns of helping-profession students in Brisbane, Australia. Drug and alcohol dependence. 1980 Oct;6(4):231–46.
28.     Gold N. Doctors get sick, too. Australian family physician [Internet]. 1980; 9(5):337–42.
29.     Riley GJ. Understanding the stresses and strains of being a doctor. The Medical journal of Australia. 2004; 181(7):350–3.
30.     Jurd SM. Helping addicted colleagues. The Medical journal of Australia. 2004; 181(7):400–2.
31.     Oxley J, Brandon S. Getting help for sick doctors. BMJ. 1997;314:1–6.
32.     Kmietowicz Z. New helpline set up by doctors for doctors. BMJ (Clinical research ed.). 2002; 325(7369):854
33.     Oxley JR. Services for sick doctors in the UK. [Internet]. The Medical journal of Australia. 2004; 181(7):388–9.
34.     Bosch X. Catalonia makes plans to help addicted doctors. Lancet. 1998; 352(9133):1045.
35.     Bosch X. First impaired physicians therapy program appears to be successful in Spain. JAMA?: the journal of the American Medical Association. 2000; 283(24):3186–7.
36.     Bosch X. New group to look at helping the sick doctors of Europe. Lancet. 2001; 358(9294):1707.
37.     Bosch X. Spanish doctors careless of own health, says report. The Lancet. 2000; 355:2146.
38.     Bruguera M, Gurí J, Arteman A, Grau J, Carbonell J. La atención de los médicos hacia el cuidado de us propia salud. Resultados de una encuesta postal. Medicina Clínica. 2001;117(13):492–4.