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.
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