Sham Peer Review and Increased Physician Suicide Risk
by Richard Willner, CEO
The Center for Peer Review Justice
Various stressors have been correlated to physician suicide,
including: personal, financial, and profession.
[i] Anyone who
has
been under pressure from a legitimate review process will
readily tell you that it can be stressful. If the review is a
sham, the stressful nature of the review increases dramatically.
This unnecessary stress may increase the risk of depression and
suicide in the physicians exposed to sham peer reviews.
Generally, suicide results from depression, which is either
untreated or inadequately treated and accompanied by the
“knowledge of and access to lethal means.”[ii]
Interestingly, a study of 47 physicians who were followed for a
30-year period “concluded that long hours, demanding patients,
and ready access to narcotics were not problems for physicians
who did not have preexisting psychological difficulties evident
at college entry.”[iii]
Although the two major risk factors for suicide are mental
disorders and substance use disorders, because most individuals
with these disorders do not commit suicide, other risk factors
are involved, such as “stressful events and predisposing factors
(eg, impulsivity).”[iv]
Certainly, experiencing any peer review can be a ‘stressful
event,’ but a sham peer review poses an inordinate amount of
stress because it is difficult for the provider under review to
use definable defenses in the review process.
For example, in a typical morbidity and mortality conference an
adverse surgical or clinical outcome is openly discussed, and
the provider in question may have considerable answering to do
regarding the care rendered in that case.
In that situation, at least the provider knows the object of the
review, how to respond, and how to improve his or her
understanding to better approach similar situations in the
future.
However, in the case of an adverse sham peer review action, the
provider would not know what was coming, why it was coming, or
how to prepare.
He or she is socked with an adverse action with little to no
ability to honestly be heard. This results in enormous levels of
stress that may be a trigger to developing psychological squeal,
and in the most extreme cases, suicide.
Factors that tend to be protective against suicide include:
“effective treatment for mental and physical disorders, social
and family support, resilience and coping skills, religious
faith, and restricted access to lethal means.”[v]
Effective treatment for physicians has similar barriers as to
the general populations as evidenced in a study involving
medical students, including: “lack of time (48%), lack of
confidentiality (37%), stigma (30%), cost (28%), and fear of
documentation on academic record (24%).[vi]
Herein lies a major problem, as the protective factors are not
as effectively available for physicians.
Practicing physicians with psychiatric disorders often encounter
overt or covert discrimination in medical licensing, hospital
privileges, health insurance, and/or malpractice insurance. . .
[I]t is not known whether medical boards use the information to
covertly discriminate against a physician who was treated or
previously impaired but does not report current impairment.[vii]
An expert panel noted that in some states, “licensing boards
conduct investigations if physicians seek psychiatric treatment,
a process that can lead to sanctioning regardless of whether
there is any evidence of impaired functioning.”[viii]
As the admission of any psychiatric problem could end their
medical careers, many physicians “suffer in silence.”[ix]
According to one surgeon who has suffered with depression, “You
just would rather take a risk with your health than your career.
It’s not like you get a second chance with it.”[x] Sadly, it has
been estimated that approximately 400 physicians die each year
from suicide.[xi] Another sad statistic is the suicide
completion rate for physicians is significantly higher than the
general population.[xii]
If sham reviews could be entirely eliminated and the ability for
practitioners to receive effective treatment without the
negative ramifications noted above, it is possible that the many
physicians who “suffer silently” might be reduced.
However, the present situation is that sham reviews do occur and
the stigma of seeking appropriate psychological and psychiatric
care is real.
Likewise, defending against sham peer reviews and spurious board
actions through the legal system is fraught with many
difficulties at great monetary costs to the victim practitioner.
It is important to understand that addressing the problem of
sham peer review through an organization with vast experience
will afford a level of comfort, reassurance, and hope.
One of the protective factors against suicide comes in the form
of “support.” While the article cited above mentioned support in
the form of “social and family support,” additional support from
an organization that offers genuine solutions to a seemingly
impossible situation obviously comes within the realm of support
that most would need to aid them in coping with the unnecessary
burdens of stress due to sham peer review.
The Center for Peer Review Justice specializes in helping those
Physicians and Surgeons who are going thru the Sham of a Peer
Review or State Board Abuse. It offers excellent Sham Peer
Review defense as well as free excellent advice 24-7.
The Doctors of CPRJ genuinely listen and genuinely help as “No
Doctor is left behind”. The hotline that is answered by a real
caring doctor is 504-621-1670.
[i] American Medical Association Council on Scientific Affairs,
Physician Mortality and Suicide: Results and Implications of the
AMA-APA Pilot Study. 50 Conn. Med. , 37-43 (1986).
[ii] Louise B. Andrew, et al. Physician Suicide. Medscape
Reference. Updated May 26, 2011.
[iii] Claudia Center, et al. Confronting Depression and Suicide
in Physicians. JAMA, Vol. 289, No. 23, 3163 (June 18, 2003).
[iv] Id.
[v] Id.
[vi] Id. At 3164.
[vii] Id.
[viii] Tracy Hampton, PhD. Experts Address Risk of Physician
Suicide. JAMA, Vol. 294, No. 10 (Sept. 14, 2005).
[ix] Lindsey Tanner. Medical Know-How Raises Suicide Risk for
Doctors. USA Today. May 8, 2008.
[x] Id.
[xi] See note 2.
[xii] Id.