PBS高端访谈:医生自杀率引担忧（在线收听）

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.

朱迪·伍德拉夫：他们终生致力于拯救他人的生命，却不能自医。从事医生这个职业的成年人比其他行业的同龄人相比有更高的自杀风险。而且，医生经常会因为抑郁而不会寻求治疗。帕特里克·特波斯特拉是在线有线新闻网——新闻懒人包的记者，请听他发回的报道。本周的焦点之一是科学和医疗的前沿领域。

安娜·哈迪森·塞弗恩：我还记得我接到了电话。她打电话过来说他失踪的失踪的时候，我就知道发生了什么。

帕特里克·特波斯特拉：北卡罗来纳州医生米切尔·哈迪森是一名备受欢迎的家庭医师，但他却有着不为人知的密码。

安娜·哈迪森·塞弗恩：这张照片上的人都是医生。虽然他们是我父亲最亲近的朋友，但他也不会跟他们说这个秘密。

帕特里克·特波斯特拉：我父亲有抑郁症，米切尔·哈迪森的女儿安娜如是说道。

安娜·哈迪森·塞弗恩：与精神类疾病有关的标签让人压力太大，所以我觉得正因如此，父亲无法向哪怕最亲近的朋友们开口。说实话，我甚至不知道父亲自己是否真正接受了这件事。

帕特里克·特波斯特拉：哈迪森3年前自杀了。医生自杀的比率比普通人要高，而哈迪森正是一名医生。2004年，哈佛做了一个里程碑式的研究。该研究发现，男医生自杀的比率比其他人要高出40%；女医生自杀的比率比其他人高200%。研究表明，这个比率之所以如此之高，是因为医生工作时间长、缺觉、有负罪感、恐惧向外界展示自己柔弱的一面。

医生亚历克斯·赫尔曼：我是杀手，这是事实。

帕特里克·特波斯特拉：麻醉师亚历克斯·赫尔曼觉得自己的行为是导致病人死亡的一个原因，因为他撤掉了一根呼吸管。

医生亚历克斯·赫尔曼：医生总会这样的感觉，也经常会问自己这样的问题——这种情况下应该如何判定呢？只有一种方法能让自己好受些，那就是自杀。

帕特里克·特波斯特拉：她妻子拦住了他。他觉得这种情感上的痛苦也是工作的一部分。

医生亚历克斯·赫尔曼：我学过很多防治灾难和事故的方法，但我没学过自己处于这种境地的时候该怎么做。

帕特里克·特波斯特拉：近年来，美国医学会等组织加大力度对抗医生倦怠和抑郁的问题。现在，该学会推荐各医院提供新的资源，比如全天候的秘密咨询服务。目前，只有哈迪森的家人知道他得了抑郁症。

安娜·哈迪森·塞弗恩：他十分确定，如果他坦白表示自己需要帮助的话，就一定会有报复行为出现。

帕特里克·特波斯特拉：哈迪森的女儿表示，自己的父亲是医疗体系的受害者，父亲觉得正是医疗体系让他无法寻求精神护理哈迪森担心如果自己进行抑郁症的治疗，他就必须要公开自己向医委会更新医生执照的时间。那时候，北卡罗来纳州要求申请进行精神疾病治疗的医生提供医生执照或者医生执照的更新证明。

安娜·哈迪森·塞弗恩：鉴于是医委会负责发放医生执照，所以有人担心如果医生承认自己需要帮助的话，就会破坏自己作为一名医生的形象，然后医委会就会调查医生是否有行为失当之处。这可能就会给自己的职业生涯抹上污点，或者丢掉执照，总之后果很严重。

帕特里克·特波斯特拉：凯瑟琳·戈尔德是密歇根大学的医生，他主要研究医生自杀的问题。她的研究表明，因担心申请医生执照会受到影响而造成心理健康问题让医生们无法寻求咨询服务，同时也无法确定会引发安全问题的不稳定医生。

医生凯瑟琳·戈尔德：有心理问题不一定就代表有行为失当之处。所以我觉得医委会总是把这两种问题归结为同一种问题。

伊恩·马昆德：医委会的任务很简单。法令里已经写的很清楚了，医委会就是要保护公众不会受到不符合职业规范的医生的治疗。

帕特里克·特波斯特拉：伊恩·马昆德是蒙大拿州医师考试委员会的首席执行官，他负责给医生发放执照的事宜。我们发现，包括蒙大拿州在内，共有38个州在医生申请或者给医生执照续期时询问他们心理健康状况的州。

伊恩·马昆德：在心理是否健康的问题上，我们不会探究得很详细，但我们必须要保证我们的医务工作者精神稳定，不会对患者造成伤害。

帕特里克·特波斯特拉：在蒙大纳州进行执照申请需要过去5年的精神病历。但根据蒙大拿州医委会的数据，过去3年里进行过精神诊断的22位申请者中，没有人因此在申请执照时会受到影响。那谁会问问题呢？

伊恩·马昆德：这可能就是委员会和我们部门要审查的问题了。

帕特里克·特波斯特拉：这也是其他州要公开的类似情况。怀俄明州医委会会长表示，我在医委会工作了11年，我印象中医委会从来没有因为公开自己的心理健康状况而拒绝给医生或医师助理颁发执照。

医生凯瑟琳·戈尔德：有很多人担心，一旦对簿公堂，很多问题就兜不住了。因为问题很广泛。他们现在谈论的也不是当前的心理障碍问题。

帕特里克·特波斯特拉：《美国残疾人法》禁止其实残疾人，包括精神疾病患者。明尼苏达州和新泽西州的州立医委会改变了他们对心理健康疾病的一些问题。因为在此之前，有多位医生表示，问题太过广泛，违背了《美国残疾人法》赋予的权利。去年夏天，美国各地的多个医委会聚集在北卡罗来纳州的夏洛特讨论这个问题。

医生胡马雍·乔杜里：美国的各个医委会都来了。

帕特里克·特波斯特拉：胡马雍·乔杜里各州医学委员会联盟的负责人。该联盟就如何处理办法执照的问题给各州提了建议。

医生胡马雍·乔杜里：如果各州的医委会决定支持某种观点的话，当然是很有意义的。

帕特里克·特波斯特拉：该组织为了提升医生的健康状况，通过了35条建议。首要的一条建议是：他们建议各州医委会考虑一下是否有必要询问医生的心理健康问题。同时要确保把问题的焦点放在当前的心理障碍问题，而且最多不能超过2年之前的情况。我们发现至少有21个州会问到大概3年甚至3年以上的心理健康史。凯瑟琳·戈尔德希望，这次报告能让各州医委会进一步减少有关心理健康的问题。

医生凯瑟琳·戈尔德：但我想说，只要各州会问到医生心理健康的问题，就会有很多很多医生不愿意开口寻求帮助，情况可能比这还要糟糕。

帕特里克·特波斯特拉：医生米切尔·哈迪森在北卡罗来纳州自杀后，该州医委会就去掉了更新医生执照时的一些心理健康方面的问题。在各州医学委员会联盟进行投票后，医委会也在首次申请医生执照的问题列表中去掉了这个问题。

安娜·哈迪森·塞弗恩：说实话，我觉得如果他知道自己的人生经历会帮助到其他人的话，会很激动。在知道自己的故事公布于众之后，也会很震惊吧。对于我来说，这就是我们做这件事的理由，因为他觉得这件事难以启齿，这件事不是对任何人都能说的出口的。但我并不这样认为。

帕特里克·特波斯特拉：以上就是新闻懒人包帕特里克·特波斯特拉发回的《新闻一小时》报道。

朱迪·伍德拉夫：新闻懒人包还有很多跟医生得抑郁症以及自杀有关的新闻，敬请关注Newsy.com/Unspoken。