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

Specific programs to treat doctors who suffer from mental disorders and/or addictions (Physicians’ Health Programs, PHPs) seem to provide the best available measures for protecting patients, recovering physicians’ careers and their psychosocial wellbeing (1). First PHPs were developed in the USA since the late 1970s in order to identify and treat physicians who had had misconduct behaviours as a consequence of a mental disorder, mainly, substance use disorders (2). The US Federation of PHPs offers state programs (44 states are full members, as membership is voluntary) and meetings, where issues concerning physicians’ health are discussed (2). Similar PHP were developed later in every Canadian province (3), in Australia (4), and the UK (5).

As the major objective of these programs is to warrant safe practice, they are mainly devoted to providing mandatory treatment when practice problems are involved. Counseling and other preventive actions are also offered to physicians in trouble, mostly for those enduring stress problems (burnout) related to the maintained exposure to work-related distress (6) or with difficulties concerning the work-home balance. However, the emphasis on warranting safe practice may prevent physicians who suffer from any kind of psychiatric illness from asking for help, as they may fear the professional implications of their demand.

This handicap lead to the emergence of new PHPs models, such as that developed in Spain, the Integral Care Program for Sick Doctors (PAIMM in Catalan and PAIME in Spanish). Since 1998, Spanish PHPs (7) have been developed in each Spanish province sponsored both by Public Health Departments and Regional “Colegios de Médicos” (in Spain, these institutions act both as Medical Councils and Associations). Confidentiality of patients entering the program is reinforced with special measures to protect the patient’s identity (i.e. the real name of the doctor is only disclosed when there is a threat to oneself or others).

The creators of the Spanish PHP decided to move from a punitive perspective to a non-judgmental one and mandatory actions are only reserved for those cases where practice difficulties or evidence of malpractice issues are involved. A recent study (8) has shown that promoting voluntary help seeking among doctors with mental disorders is possible. A retrospective chart review was conducted on 1363 medical records of physicians admitted to the inpatient and outpatient units of the Barcelona PHP from February 1998 to January 2012. The sample was divided into three time periods: 1998-2004, 2005-2007 and 2008-2011 (477, 497, and 389 cases, respectively). Voluntary referrals grew from the first period (81.3%) to the latest (91.5%) while the mean age at admission decreased from the first period (54.2 years) to the last period (44.8 years). Other findings were also significant. Adjustment disorders increased their prevalence during these years while inpatient treatment progressively represented less of the overall clinical activity. Altogether, these results suggest that enhancing voluntary help seeking among doctors may be feasible in PHP perceived by users as non-punitive and where treatment becomes compulsory only when practice problems related to mental disorders are identified.
 
In summary, we should look forward to finding new ways of achieving a balance between warranting a safe practice and taking care of our colleagues in trouble. New therapeutic models, such as that provided by the Barcelona PHP, where sick doctors feel not judged but helped so that they can go back to their professional activity and recover their integral wellbeing should be fostered in all countries.

References

1. Carinci AJ, Christo PJ. Physician impairment: is recovery feasible? Pain Physician 2009; 12:487-491.

2. DuPont RL, McLellan G, Carr G et al. How are addicted physicians treated? A national survey of physician health programs. J Subst Abuse Treat 2009; 37:1-7.

3. Brewster JM, Kauffman M, Hutchinson S et al. Characteristics and outcomes of doctors in a substance dependence monitoring programme in Canada: prospective descriptive study. BMJ 2008; 337:a2098.

4. Jurd SM. Helping addicted colleagues. Med J Aust 2004; 181:400-2.

5. Oxley JR. Services for sick doctors in the UK. Med J Aust 2004; 181: 388-9.

6. Kumar S. Burnout in psychiatrists. World Psychiatry 2007; 6:186-9.

7. Bosch X. First impaired physicians therapy program appears to be successful in Spain. JAMA 2000; 28: 3186-3187.

8. Braquehais MD, Valero S, Matalí JL, Bel MJ, Montejo JE, Nasillo V, Arteman A, Padrós J, Bruguera E, Casas M. Promoting voluntary help seeking among doctors with mental disorders? Int J Occup Med Environm Health 2014; 27: 435-443.