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Many Psychiatrists Self-Prescribe, Study Says
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Many Psychiatrists Self-Prescribe, Study Says

Research News

ROBERT SIEGEL, host:

A new study from a professor at the University of Michigan looks at how frequently psychiatrists prescribe medication for themselves. It finds that many are writing their own prescriptions to avoid the stigma associated with being a doctor with a mental health problem.

Alix Spiegel has the story.

ALIX SPIEGEL: Several weeks after Robert Klitzman's sister died on 9/11, the respected New York psychiatrist took to his bed. He was overwhelmed, he says now, by intensely painful symptoms.

Dr. ROBERT KLITZMAN (Co-Founder, Columbia University Center for Bioethics; Director of the Ethics, Policy, and Human Rights Core of the HIV Center, Columbia and the New York State Psychiatric Institute): You know, my eyes hurt and I just didn't feel like moving. And I - just to move my muscles, to move my arms, to get to the bed felt like a huge effort. I felt like I was sick physically.

SPIEGEL: Klitzman assumed that he was suffering from a bad flu. But his psychiatrist friends who came to visit usually came to a different conclusion. They would gently suggest that Klitzman was experiencing depression, a diagnosis, he says, that he invariably dismissed.

Dr. KLITZMAN: I just felt that's completely off the table of what's involved here.

SPIEGEL: But then days in bed stretched into weeks and then into a month, until finally, Klitzman could come to know other conclusion. He was smack in the middle of a major depression. And once you recognized this, he says, it was hard for him to believe that he had been unable to see it before.

Dr. KLITZMAN: And I was surprised that I hadn't seen that in myself - that I hadn't recognized that the sort of gazed with which I look at my patients, I didn't look at in myself.

SPIEGEL: According to a recent study published in the journal, Psychotherapy and Psychosomatics, an alarming percentage of psychiatrists like Klitzman do end up treating themselves.

The study's author, Professor Richard Balon of Wayne State University, asked 830 psychiatrists in the state of Michigan if they ever treated their own depression. Sixty-eight percent of the psychiatrists responded, and as Balon explains, he was disturbed by what they said.

Dr. RICHARD BALON (Professor at the Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine): One out of six said, yes, I did treat myself in the past. And that was surprising for me.

SPIEGEL: One out of six - because depression affects cognition, Balon thinks it's highly dangerous for psychiatrists to try to treat themselves this way, particularly, he says, since 15 percent of people in major depression attempt suicide.

Ironically, Balon says, the psychiatrists indicated they decided to treat themselves because they were concerned about the stigma associated with mental illness and were afraid that a record of psychiatric treatment would follow them.

Dr. BALON: About 40 percent of people - they are worried about the presence of permanent insurance records.

SPIEGEL: And according to Doctor Spencer Eth, a former chair of the American Psychiatric Association's Ethics Committee, these fears are sadly justified.

Dr. SPENCER ETH (Medical Director of Behavioral Health Services, St. Vincent's Catholic Medical Centers-New York): Absolutely. And, you know, we can call this stigma, but it's more serious and the repercussions are far more severe than just embarrassment.

SPIEGEL: Eth points out that several state licensing boards require psychiatrists to provide a history of mental illness. And psychiatrists who acknowledge they've been treated can face investigations and even rejections. Then, of course, there are the malpractice issues.

Eth talks about his own experience in one recent malpractice inquiry.

Dr. ETH: The medical board received a complaint about this physician having an improper interaction with a patient, something the physician adamantly denied. But in the course of the medical board looking at the complaint, they asked the physician, have you ever been in treatment for a psychiatric condition?

SPIEGEL: Had he?

Dr. ETH: She had. But this is - should be confidential, privileged health care information. But if you answer dishonestly to the medical board, then, of course, you are - that's fraud and that jeopardizes your license. If you answer honestly, then all of a sudden, your own personal psychiatric history is going to be investigated; that's why they are asking the question.

SPIEGEL: Eth says one way psychiatrists get treatment on the down low is by paying out of pocket, so no record exists. But they still have to answer honestly when confronted directly. Eth does think that a psychiatrist's mental health can, in extreme cases, affect patient care. But he points out that the vast majority of people who experience depression have only mild to moderate symptoms that in no way affect their ability to work - which is why Eth feels that licensing and malpractice boards should not ask for mental health histories.

Dr. ETH: If you want to design questions that truly reflect some kind of danger situation, then you would ask, have you ever been hospitalized for a psychiatric condition?

SPIEGEL: Eth says one reason this is also important is because studies have indicated that psychiatrists suffer from depression at a significantly higher rate than other doctors.

Dr. ETH: It's a very lonely profession, unlike other medical professionals, psychiatrists tend to have solo practices. They don't work with a nurse or a secretary, and they hear about people's problems all day. And there is kind of a depressing effect from the nature of the work.

SPIEGEL: Clearly, Eth says, psychiatrists should be able to benefit from the same kind of care they give to others. This, ultimately, was the case with Robert Klitzman, the psychiatrist who lost his sister on 9/11. Klitzman got care, got medication, and got better - well enough to write his book about the perils of doctors becoming patients.

Alix Spiegel, NPR News, Washington.

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