Albuquerque Journal July 12, 2010 -- When Dr. Patrick Hudson set out as a young plastic surgeon, he made a few errors that don't seem to bother him now, but then seemed like major professional failings.
"You think you're the only one who's ever made this mistake and who's ever done this," he says. "I felt terribly alone. Terribly alone. And one of the things that I've tried to encourage and would like to encourage more is to allow physicians, especially new ones, not to feel alone."
Hudson, now working as a psychotherapist, is one of an increasing number of mental health resources for New Mexico doctors. Many doctors, experts say, struggle greatly to balance their work and home lives and suffer extreme stress from perfectionism; they also face a number of deterrents to seeking help.
Suicide rates show how stark the need is. Male doctors are 1.4 times as likely to commit suicide as other men, and female doctors are 2.3 times as likely to do so as other women, according to a 2004 analysis in the American Journal of Psychiatry.
That is partly because doctors have ready access to lethal drugs and precise knowledge of how to end their own lives, Hudson says.
Interestingly, the statistics show about an even split between male and female doctor suicides. In the country as a whole, men who commit suicide outnumber women 4 to 1, according to a 2005 World Health Organization report.
There's no consensus about which specialties are worse -- psychiatrists have the highest rates, according to a 1980 study in the Journal of Clinical Psychiatry, but much of that data is more than 40 years old.
Hudson emphasizes that doctors are no more or less susceptible to mental illness than anyone else. But doctors tend not to seek help until their problems manifest in ways like suicidal thoughts, marital strife or drug abuse.
"My feeling is that I'd like to catch those folks before that happens," Hudson says.
Balance, perfection
Hudson started working as a psychotherapist in 2009, specializing in work with other doctors, in part because he knows the strain of learning to practice medicine.
He says it's difficult to learn how to choose the right antibiotics every time, notice certain swelling and complications after surgery or be sensitive to remarks patients make in the office.
The twin pitfalls of being a doctor are a poor work-life balance and perfectionism, says Dr. William H. Brady, medical director of employee and occupational health services for Presbyterian Healthcare Services.
Brady, a former medical director of Los Alamos National Laboratory, began a Presbyterian's "Physician Wellness" coaching program in January. He says he has had six individual coaching clients so far.
Doctors' stress has roots in medical school, he says, where students live in delayed gratification: The system is built as a series of tasks, one after the other, so it never feels finished.
"There's always this hurdle to get past," he says. "When you're in practice, you find that there are still demands on your time. You never get there."
Brady says his clients have shifted their lives -- creating a better harmony between family and work -- and seem happier for it. He says he believes current medical students, including his daughter, are taught to be more mindful of the balance.
That's a lesson he says he wishes he had learned long ago.
"I would have been able to spend more time with my family," he says. "I would have been able to spend more time pursuing my love for writing."
Hudson says he wasn't aware of such resources, either, so he dealt with the stress of perfectionism alone.
"The culture of medicine is to be perfect at all times," he says. "Who wants to go see a doctor that doesn't want to be perfect?"
When a patient dies or a procedure goes wrong, a doctor needs to grapple with the incident itself, in addition to the legal wrangling of often fruitless malpractice lawsuits, Hudson says.
Hudson says doctors who are trained therapists are especially valuable to other doctors because they know the terrain well and can see how perfectionism works.
Therapy benefits almost anyone, says Jon Thayer, executive director of the New Mexico Monitored Treatment Programs, which treats medical professionals. The trouble is getting a doctor to sit for it. "The stigma of being a patient is sometimes difficult for a doctor," he says.
But after pride, doctors' biggest obstacle to seeking help is confidentiality.
Getting counseling
Hudson says doctors fear publicly acknowledging mental health problems because of possible repercussions for their insurance rates and medical licenses.
While the New Mexico Medical Board, which oversees medical licenses, takes care not to trample doctors' rights, its most pressing concern is patients' safety, says Lynn Hart, executive director.
"It's important to work with (the doctors)," she says. "We don't take it immediately from an adversarial standpoint."
Doctors can report major mental health problems to the board themselves. The board also accepts complaints from third parties, including other doctors.
In an investigation, Hart says the board subpoenas records, interviews witnesses and sends doctors for an evaluation with Thayer's program.
"We're not in the business of taking their careers away," Thayer says. He says the vast majority of doctors whose licenses are suspended eventually show enough improvement to return to practice.
Thayer says that for doctors without major problems his group can offer confidential services -- no name required -- and referrals to counselors who will also be confidential. Hudson says his therapy is also confidential.
Brady says he keeps his coaching confidential, though he doesn't believe his coaching would alarm the medical board anyway.
For help
For doctors seeking counseling, the following numbers and websites should be of help.
New Mexico Monitored Treatment Program: 271-0800. Offers confidential services and referrals.
Patrick Hudson: 842-5300, www.abqmd-psychotherapy.com. Offers confidential counseling.
On the job: Health care employers like Presbyterian Healthcare Services and Lovelace Medical Center offer confidential mental health services for doctors.
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