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Judy Woodruff: They dedicate their lives to saving others, but they can't always save themselves. Doctors are at a higher risk of suicide compared to other adults. And it turns out physicians frequently decline to seek treatment for their own depression. Patrick Terpstra of Newsy, it's an online and cable news network, has our report. It's the focus of this week's segment on the Leading Edge of science and medicine.
Anna Hardison Severn: I can remember getting the call. As soon as she called and told me that he was, that he had disappeared, I think I just knew.
Patrick Terpstra: North Carolina physician Mitchell Hardison was a popular family doctor with a secret.
Anna Hardison Severn: All of these guys are doctors in this photo. And even though they were my dad's closest friends, he wouldn't have talked about that with them.
Patrick Terpstra: He was depressed, his daughter Anna says.
Anna Hardison Severn: The stigma around mental illness and medicine is so strong that I don't even think he would admit it to his closest friends.
Honestly, I don't even really know if he admitted it to himself.
Patrick Terpstra: Hardison killed himself three years ago. He was among medical doctors who take their own lives at a higher rate compared to the general population. A landmark 2004 Harvard study found male physicians were 40 percent more likely to die by suicide, and female physicians were 200 percent more likely to take their own lives. Research shows long work days, constant sleep deprivation, a sense of guilt and a fear of showing weakness are factors.
Dr. Alex Hellman: I am a killer. That's a fact.
Patrick Terpstra: Anesthesiologist Alex Hellman felt like his actions contributed to a patient's death after he replaced a breathing tube.
Dr. Alex Hellman: There's always a sense and a question of like, well where's the justice in this situation? There's only one way to make this situation right. And that answer was suicide.
Patrick Terpstra: His wife stopped his suicide attempt. He thought the emotional pain was just part of the job.
Dr. Alex Hellman: I got tons of education on how to prevent disasters and accidents. I had no education on what to do if and when one happens to you.
Patrick Terpstra: In recent years, groups such as the American Medical Association have stepped up their fight against physician burnout and depression, now recommending that hospitals offer new resources, like 24/7 confidential counseling. At the time, only Dr. Hardison's family knew he was sick.
Anna Hardison Severn: He was 100 percent positive that, if he came forward and said he needed help, that there would be a reprisal of some sort.
Patrick Terpstra: Hardison's daughter says her father had fallen victim to a medical system that he felt discouraged him from seeking psychiatric care. Hardison worried if he got treated for his depression, he'd have to disclose it when he renewed his medical license with the board. At that time, North Carolina asked whether doctors had been treated for mental issues on their application for a medical license or renewal.
Anna Hardison Severn: Since the medical board deals with your licensing, there was a fear that if you sort of admitted that you needed help, it would undermine who you were as a doctor, and they would start digging into things that hadn't even been done incorrectly, and that would just result in, like, smearing your name or losing your license, or, you know, just possibilities like that, that were terrifying.
Patrick Terpstra: Katherine Gold at the University of Michigan studies doctor suicides. Her research shows that mental health questions on physician license applications keep doctors from seeking counseling, while failing to actually identify unstable and unsafe doctors.
Dr. Katherine Gold: Just having a mental health problem doesn't necessarily mean that there are any behavioral problems. So, I think boards often conflate the two.
Ian Marquand: The board's mission is very simple. It's stated in statute, basically to protect the public against people who shouldn't be practicing medicine.
Patrick Terpstra: Ian Marquand is executive officer of the Montana Board of Medical Examiners, responsible for licensing doctors. Montana was among 38 states we found that asked doctors about their mental health when they apply for or renew a medical license.
Ian Marquand: With mental health, we don't go into specifics, but we do want to make sure that our providers are stable individuals, again, to prevent any harm to patients.
Patrick Terpstra: Montana's medical application asks about five years of past psychiatric history. But numbers provided by the Montana Medical Board show, out of 22 applicants who reported mental diagnoses in the past three years, none ended up with any impact to their license. Why ask the question, then?
Ian Marquand: That may be a question for the board and our department to review.
Patrick Terpstra: It's a similar story in other states that require disclosure. The head of Wyoming's medical board said, In my 11 years with the board, I cannot recall a single time that the board declined to license a physician or physician assistant on the basis of a disclosed mental health condition.
Dr. Katherine Gold: There's quite widespread concern that many of these questions wouldn't hold up if they were challenged in a court of law, because they're very broad. They don't talk about current impairment.
Patrick Terpstra: The Americans with Disabilities Act prohibits discrimination based on disability, including mental health diagnosis. State boards in Minnesota and New Jersey changed their mental health questions after doctors successfully argued that the questions were too broad and violated their rights under the ADA. Last spring, medical boards across the nation gathered in Charlotte, North Carolina, to talk about this issue.
Dr. Humayun Chaudhry: So this is the nation's state medical and osteopathic medical boards coming together.
Patrick Terpstra: Dr. Humayun Chaudhry leads the Federation of State Medical boards. The Federation advises states on the best practices for licensing doctors.
Dr. Humayun Chaudhry: It does have a lot of meaning when the nation's state medical boards decide to support a particular point of view on anything.
Patrick Terpstra: The group passed 35 recommendations to promote physician wellness. Topping the list, they asked state boards to consider whether it's necessary to ask doctors about mental health at all and to ensure questions focus on current impairment, limiting them to the past two years. We found at least 21 states that ask about three or more years of mental health history. Katherine Gold hopes the report makes state boards go a step further to eliminate questions about mental health.
Dr. Katherine Gold: But I tell you, as long as the states are asking physicians about mental health, you are going to have many, many physicians who don't speak up and don't get help and just get worse.
Patrick Terpstra: After Mitchell Hardison's suicide in North Carolina, the state medical board there removed the mental health questions from physician license renewal applications. Following the Federation vote, the board took the question off the initial license application as well.
Anna Hardison Severn: Honestly, I think he would be thrilled that something about his life helped somebody and horrified that the story is public. And that's almost to me the reason why we have to do it, because he felt like it couldn't be talked about and it shouldn't be something anybody knew. And I don't feel that way.
Patrick Terpstra: For the "PBS NewsHour," I'm Patrick Terpstra from Newsy.
Judy Woodruff: And Newsy has much more on physician depression and suicide at Newsy.com/Unspoken.
