Mass. becomes first state to stop asking doctors about past mental illness and drug use – The Boston Globe

Now, in an effort to combat stigma and burnout among medical professionals, Massachusetts has become the first state to eliminate questions about mental illness and addiction providers throughout the health care system. In about two dozen other states, the professional boards that license doctors have stopped practicing. However, Massachusetts goes further: Avoiding questions from credentialing forms used by nearly every hospital, health system, insurer and medical licensing board in the state.

This is a huge step forward, says Dr. James Baker, president of the Massachusetts Society of Addiction Medicine and a physician at a hospice care facility in Haverhill. The power of this new policy is that it opens the door for physicians struggling with depression, anxiety, and substance use disorders to get the help they need without fear.

The questions arise from the idea that medical professionals must hold to a higher standard, and because lives are in the balance if they are under the influence of alcohol or drugs at work.

However, studies have found that questions about mental health history and past drug use have long had an intimidating effect on doctors seeking professional help. In a 2017 survey, nearly 40 percent of American physicians said they would be reluctant to seek treatment for a mental health condition because of concerns about implications for their medical license. In a separate study, nearly half of female doctors said they met criteria for mental illness but did not seek treatment partly for fear of reporting to a medical licensing board.

The push to remove questions about drug use and mental health has gained momentum during the pandemic amid rising rates of burnout and mental distress among physicians. Forty-six percent of healthcare workers nationwide reported feeling frequently burned out in 2022, up from 32 percent in 2018, according to a survey published last fall by the Centers for Disease Control and Prevention. Prevention. Each year, an estimated 300 to 400 physicians kill themselves, and the suicide rate within the profession is more than double that of the general population, according to a review by the American Psychiatry Association.

However, the high-profile death of a doctor in New York in the early days of the pandemic spurred hospital and medical professional associations to address the issue.

In April of 2020, Dr. Lorna Breen, an emergency room doctor at New York Presbyterian Hospital in Manhattan, was shocked by the relentless number of sick patients, many of whom were dying in hospital waiting rooms and hallways, her family said. After working a string of 12-hour shifts, Breen called his sister to say he couldn’t leave his chair at home. Concerned, family and friends took Breen to his childhood home in Charlottesville, Va., where he checked into an in-patient psychiatric unit.

While in the psychiatric unit, Breen repeatedly told relatives that he feared losing his medical license and hospital credentials because he sought mental health treatment, according to family members.

Days after expressing those fears, Breen took his own life.

Those questions contributed greatly to [Breens] death, said J. Corey Feist, Breens’ brother-in-law and co-founder of a national foundation that advocates for the removal of stigmatizing questions from the medical credentialing and licensing process. Much of his self-identity is inextricably linked to being a doctor. … When you threaten to take away that lifelong desire, it can result in suicide.

In recent years, medical boards in at least 26 states have changed the language of their licensing applications to remove questions related to doctors’ mental health changes that affect 673,000 doctors nationwide. country, according to Dr. Lorna Breen Heroes Foundation.

It took more than a year of painstaking work to find and eliminate the language. The Massachusetts Health & Hospital Association has begun collecting credentialing forms from every hospital, health insurer and medical licensing board in the state. Association staff then carefully combed scores of forms that numbered 20 pages or more to identify potentially egregious questions about past treatment or diagnosis of a mental illness or disorder. substance use.

Many of the forms have not been updated in decades and reflect outdated views on the nature of addiction and mental illness, the association found. Some put questions about past mental health treatment and substance use in the same category as questions about criminal convictions. Many hospitals and health insurance plans use a standard form that hasn’t been updated since 2004.

Dr. Steve Defossez, a neuroradiologist at Tufts Medical Center and vice president of clinical integration at the state hospital association, said the questions are a major disincentive to doctors seeking help for mental health and substance use problems. ingredient. In hospitals, such credentialing forms are shared with up to three dozen hospital staff and administrators, from the hospital’s credentialing committee to the board of trustees, Defossez said.

If someone has a condition that’s still stigmatized, there’s no reason to reveal it to the dozens of strangers and colleagues they work with, Defossez said. The alternative is that doctors hide it and don’t get the help they need.

The combination of high stress levels, long hours, and repeated exposure to trauma can cause health workers to burn out, according to doctors’ groups. Throughout the state, there are confidential peer support groups designed for health care workers; and the Massachusetts Medical Society offers a program, known as Physician Health Services, that provides therapy and monitoring to physicians with substance use and mental health problems.

Baker is not ashamed that she sought psychiatric counseling for her grief after losing her 23-year-old son, Max, to a heroin overdose seven years ago. But he resented having to disclose this fact every two years when he renewed his credentials. Usually, he writes an asterisk next to the question and writes in a brief explanation, noting that he sought psychiatric care because of a family tragedy.

What happened to my son was a terrible tragedy, but the fact that I sought care for him should be my private business, Baker said. Those questions do not improve patient care. All they do is prevent physicians from seeking care for themselves.


Chris Serres can be reached at chris.serres@globe.com. Follow him @ChrisSerres.


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