I recently published an essay on physician suicide: “Doctors are killing themselves, and who is taking notice?”  My intent was to bring awareness to this issue and honor a fallen colleague.  I want to continue the discussion.

I realized that year after year, I fill out the medical licensure recertification without much thought. I live in Kentucky and have since I was initially licensure and the recertification questions ask, “Do you presently have any physical or mental problems or disabilities which could affect your ability to competently practice your particular branch of the healing arts or your particular specialty?”

I mark no and think little about it.  Recently I saw a post in a Facebook group querying how to advise a friend and physician who begun psychiatric treatment to answer licensure questions without fear of punitive results. I responded quickly if it hasn’t affected their ability to practice, the answer is no. This person lived in New York, and the question was, “Have you received treatment within the last five years for the use of alcohol or a controlled substance, prescription-only drug, or dangerous drug or narcotic or a physical, mental, emotional, or nervous disorder or condition that currently affects your ability to exercise the judgment and skills of a medical professional?”

Many answers on the forum described that the individual would need to get their practitioner to write a letter on his behalf to the board.  I have thought about this often.

You see, my anxiety is not a secret to anyone who knows me — whether it is my constant movement or the way I smooth my hair and bite my lip — I wear it like a scarlet letter.

My anxiety shaped me.  As a grade-schooler, I cringed when I was appointed hall monitor because the only person who was assured detention was me. I turned myself in every time. I grew to understand that it was a part of me — possibly shaped by my Appalachian ancestry passed down over generations — I mimicked the mannerisms of my mother and grandmother without much thought.  Little did I know not everyone felt the same angst with confrontation or understood the pain of parting with some random item that I had given some arbitrary significance and subsequently stored in the crevices of my gray matter.

When I heard a colleague and past resident of my tiny hometown ended his life, I thought again about what I had learned about licensures.  I recalled my intern year, I was pregnant and dealing with a lot of anxiety, and after much research and urging, I had decided it was best for the baby and me to be on an SSRI.  The research suggested to me that it was best for my baby to be with a well mother. If I had to worry about applying to the licensure — and answering a question such as the one posed in New York and many other states — I wouldn’t have gotten treatment. I know myself and psychiatry, and eventually, I would have ended up needing treatment, but how far would I have had to fall? I can’t fathom that now.

I had only just completed a degree that I had been on course for since I was a second grader who, after acute appendicitis, encountered a surgeon who removed my appendix and the pain went with it. After many years of study and matriculating a year early to medical school, I had finished my courses and fell in love with psychiatry. Long before my intern year, I realized that sacrifice was what was expected, and I felt privileged to be one of a chosen few to give myself to medicine. I felt honored to be able to prostrate myself at the altar of medicine.  I was thankful I had been given the opportunity to be a doctor. After having my hands smacked with retractors in surgery, I felt pride that I was able to be in the room with surgeons who were saving people’s lives, my own comfort was a small price to pay.

What I have realized in the last year is that as I have been filling out my licensure every year, there are others like me who have had to ask for a letter to continue the practice that like me, they have sacrificed for.  What an indignity! Did I need a letter stating I was fit to complete 2 days call after I had been diagnosed with breast cancer?  Did I need a letter after the traumatic end to a second-trimester pregnancy, releasing me to return to work the following Monday?  How about when I returned to work 3 weeks after a C-section? Nope. Those were collateral damages to my personal life, my health, my strength.

Who decides the cost?   In the midst of the chaos, the stress of parenting, and being a good partner, what I did know was medicine.  Medicine brought me solace: I knew how to be a doctor and as a doctor and person my colleagues and I should be able to seek health care without fear of losing the profession we hold so dear.

My colleague Dr. Ray Thornton was in New York at the time of his death. I cannot help but think the laws there could have affected his decisions about when and where to seek care.  I know it would have affected mine. It’s time to change the way we approach the mental health care of physicians in this country.

Courtney Markham-Abedi is a psychiatrist.

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