Medical Malpractice

I'm a licensed psychologist in private practice. I see depressed, anxious and/or attention deficit professionals. The other day, James, a 50ish physician, sat staring out the window in my office as he said, "I don't know why I'm here. My colleagues wanted me to see someone. I yelled at Debbie, my nurse, the other day." He looked downcast as he continued, "I'm embarrassed and then there is a part of me that believed she deserved it. She didn't give the right dosage to the pharmacy. Fortunately, they caught the error and called. She could have killed my patient!" With the last line, he spoke with great force, and then continued, "I guess I've been snapping at patients, too. I don't know why. I need to get control. I don't know what good it's going to do me to come here."

Later in the day, Caroline, a 43 year old attorney, sat in the same spot with tears rolling down her face. "I don't know even what I'm ccrying about anymore. I just can't seem to stop once I start. I can't concentrate. I start to work on something, and 15 minutes later I still haven't done anything. I'm just staring out into space. I don't have anything unusual going on. I have the usual concerns, like building my practice, taking care of the kids, paying bills, helping my father with my mom - she has Alzheimer's - but this is the same that most people are going through, isn't it."

My last client, George, a 34 year old dentist, fidgeted with his fingers, tapped his leg, and at times, squirmed. He spoke in short, staccato sentences, "My licensing board told me to get counseling. Someone complained. Said they smelled alcohol on my breath. So, I had a drink at lunch. It takes the edge off. Nothing wrong with that. I'm just not getting to sleep and then it's time to get up. I just need to get it together -it's just a little stressful right now. I can do that."

What do these three people have in common? If you said that they sounded stressed, you would be correct. But, don't they sound a bit more than stressed? Deciding when stressed becomes depressed or anxious is not easy to determine on your own. This article gives you some guidelines to use to determine when you might need to seek help from a psychologist. The general layperson often assumes that if you are a professional and/or well-educated that you don't have stress. Or, worse yet, you should be able to deal with it on your own. After all you are smart enough, aren't you? You may subscribe these myths, too. Yet, professionals often have highly profession-specific stresses.

Physicians have to worry about making the correct diagnosis with difficult cases. Life and death can depend on the correct diagnosis and treatment. Staying current with new findings in the field is time-consuming - something that physicians are short on. Add that to the threat of malpractice and decreasing insurance reimbursements and you have a recipe for stress.

What kind of stress does a dentist have? No one wants to go to the dentist. Conscious and unconscious fear is directed at the dentist daily. Having to hurt someone on a daily basis - even if it is to help them - isn't always easy. There has been research that dentists as a profession experience clinical depression more often than the average lay person. Attorneys - the non-attorney might scoff "Hah, they deserve it,". The public opinion of this profession is unwarranted, but, there it is - extremely negative. Attorneys have one of the highest rates of depression and suicide of any of the professions. They, too, have to keep current in their field. They often deal with angry, bitter people. Their colleagues might be included in that group. "Every one wants a piece of me. I can't seem to please anyone," one attorney told me.

I could go on with each profession's signature stresses; but, I think it is sufficient to write that professionals are like everyone else in terms of stress. The more directly a profession impacts other humans, the more stressful it is. I've been using the word "stress" as though we all have the same understanding of its definition. Stress is the physiological and/or emotional response to internal and/or external changes in our lives.

An example of an internal change is the disease process. Betty, a 55 year old client, related that she just felt down much of the time. She wanted to sleep "all of the time," and she had no energy. Stress? Depression? Turns out that she was suffering from hypothyroidism. Her depression was partially biochemical and partially a reaction to not being able to function normally. This vicious cycle is not as uncommon as we'd like to think. So changes in our bodies is a stress, a change to which we try to adjust. External stressors are more easily identified. Changes which we perceive as negative are stressful in that they trigger a physiological change of fight, flight or freeze responses. We feel tense and hypervigilent as a result of excess adrenaline and cortisol in our systems.

Chronic stress leads to chronic symptoms of

• Fatigue
• hypervigilence
• dread
• sleep difficulties
• irritability

Negative changes in the following areas can result in stress responses:

• Relationships
• Marriage
• Religion or spirituality
• Finances
• Career
• Health

How do you know when you should seek help? Everyone experiences stress responses, don't they? Yes, you are correct; however, when the stress responses become chronic or great enough, then they interfere in everyday functioning. When you can't

• Perform your usual tasks in your profession
• Get along with friends, family or colleagues
• Feel contentment more than discontentment

Then it is time to get help.

The following are a list of symptoms that a depressed person might experience:

• Loss of interest in normal daily activities
• Feeling sad or down
• Feeling hopeless
• Crying spells for no apparent reason
• Problems sleeping
• Trouble focusing or concentrating
• Difficulty making decisions
• Unintentional weight gain or loss
• Irritability
• Restlessness
• Being easily annoyed
• Feeling fatigued or weak
• Feeling worthless
• Loss of interest in sex
• Thoughts of suicide or suicidal behavior
• Unexplained physical problems, such as back pain or headaches

An anxiety ridden person might experience some of the following:

• Restlessness
• Feeling of being keyed up or on edge
• Feeling a lump in your throat
• Difficulty concentrating
• Fatigue
• Irritability
• Impatience
• Being easily distracted
• Muscle tension
• Trouble falling or staying asleep
• Excessive sweating
• Shortness of breath
• Stomachache
• Diarrhea
• Headache

Experiencing one or two of the above symptoms on various occasions does not mean that you are experiencing either depression or anxiety. Different people might have various combinations of symptoms. If you have five or more of any of the above symptoms and you have experienced these symptoms for over two weeks, seek help from a qualified mental health specialist. Treatment might include talk therapy, psychopharmaceutical prescriptions or a combination of both. Talk therapy and medication have shown to have the best results. So if you have experienced a feeling of stress with some of the above symptoms, you might be experiencing something more serious, such as depression or anxiety. Stressed, depressed or anxious, you can manage your life more effectively with help. You don't have to suffer alone - there is hope!