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Wellness rhetoric and stigmatisation of health care professionals with mental disorders

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Wellness rhetoric and stigmatisation of health care professionals with mental disorders
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   Wellness rhetoric and stigmatisation of health careprofessionals with mental disorders Nicholas D LawsonEditor  –   Tackett’s commentary onstigma and well-being amonghealth care professionals 1 containsa number of stigmatisingstatements about professionals with mental disorders anddisabilities that are common within the literature on this topic,and important to clarify.First, Tackett suggests that ‘addressing students’ prejudiceagainst mental illness might makethem more open to and acceptingof mental illness’ after noting that Schwenk et al .  revealed that ‘prejudice against care seeking isoften worst among the studentsand physicians with severe mentalillness’. 1 This is a problematicinterpretation of Schwenk et al.’sdata. 2,3 Schwenk et al.’s paperssuggest that trainees with moresevere symptoms of depressionthink that ‘telling a counsellor Iam depressed would be risky’ and would avoid seeking treatment ‘due to concerns about confidentiality’. 2,3 This is quiteunderstandable becauseexperimental evidence suggeststhat a history of receivingpsychological counselling makesresidency programmes view applicants less favorably  4 andbecause the treatments offered tothese trainees are often not confidential. 5,6 Trainees withmental disorders do not have a‘prejudice’ against care seeking just for being more aware of thesefacts. Terms like  prejudice   and discrimination   are also morecommonly used to describe beliefsor behaviours enacted by morepowerful groups or individualsagainst those who are lesspowerful.Schwenk et al.’s studies also foundthat trainees with more experience with symptoms of depression wereless likely to agree that ‘medicalstudents with depression aredangerous to their patients’. 2 Thisresult suggests that trainees withsymptoms of depression may beless likely than those without toendorse the belief that people with mental disorders aredangerous, and may be moreempathic and provide better careto patients with mental disordersand disabilities.Second, Tackett claims that ‘whenthe well-being of healthprofessionals is compromised,patients suffer’ 1 and cites asystematic review by Hall et al . 7 examining the relationshipsbetween burnout/poor well-beingand medical errors. Yet Hall andcolleagues found only six studiesevaluating these relationships withobjective measures of medicalerrors. 7 Four of the five studiesmeasuring burnout found noassociations with medical errors.These studies do not suggest that poor well-being or mentaldisorders in providers aremeaningful causes of medicalerrors or adverse patient events.Other studies evaluating theserelationships have used physicians’self-reports as measures of medicalerrors, 7  which are unlikely toaccurately reflect true medicalerror rates. 8  Articles within the medicalliterature on wellness very oftendepict providers with burnout andmental disorders as dangerous orless capable clinicians. They alsoframe mental health stigma asproblematic insofar as it preventsengagement in mental healthtreatment, but not as a socialinjustice that results indiscrimination. 9 By contrast, disability rightsadvocates, who strongly oppose workplace wellness programmes,allege that these programmesprovide ‘cover for discriminationbased on health, weight, income,age, pregnancy, and disability’. 10  Yet, although their concerns areoften discussed in law and policy  journals, they are almost neveracknowledged within the medicalliterature on wellness for healthcare professionals.There are also many reasons to besceptical of defining self-carecompetency as a ‘core professional value’. 1 Educational requirementssuch as these, and for trainees to‘reflect on their own well-being’, 1 are prone to misuse, 11 and could Georgetown University Law Center, Washington, District of Columbia, USA  Correspondence:   Nicholas D Lawson,Georgetown University Law Center, 600New Jersey Avenue NW, Washington,District of Columbia 20001, USA.Tel: 00 1 646 246 6251;E-mails: nick.d.lawson@gmail.com,ndl30@georgetown.edudoi: 10.1111/medu.13732 206  ª  2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education;MEDICAL EDUCATION 2019  53 : 206–208 letters to the editor   coerce participation in workplace wellness programmes, evaluationsand mental health treatment.However, these programmes andinitiatives are rarely scrutinised orstudied for possible drawbacks likethese and discrimination. 10 There are many   other   good reasonsto question the wisdom of  workplace wellness programmes.But it is especially important that the rhetoric used to support themnot exacerbate stigma against providers with mental disordersand other employees withdisabilities. REFERENCES1 Tackett S. Stigma and well-beingamong health care professionals. Med Educ   2018; 52  (7):683  –  5.2 Schwenk TL, Davis L, Wimsatt LA.Depression, stigma, and suicidalideation in medical students.  JAMA   2010; 304  (11):1181  –  90.3 Schwenk TL, Gorenflo DW, LejaLM. A survey on the impact of being depressed on theprofessional status and mentalhealth care of physicians.  J Clin Psychiatry   2008; 69  (4):617  –  20.4 Oppenheimer K, Miller M, Forney P. Effect of history of psychological counseling onselection of applicants forresidencies.  Acad Med   1987; 62 (6):504  –  8.5 Lawson N, Boyd JW. Flaws in themethods and reporting of physician health program outcomestudies.  Gen Hosp Psychiatry   2018;https://doi.org/10.1016/j.genhosppsych.2018.06.002 [Epubahead of print.]6 Lawson ND, Boyd JW. Do statephysician health programsencourage referrals that violate the Americans with Disabilities Act?  Int  J Law Psychiatry   2018; 56 :65  –  70.7 Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare staff  wellbeing, burnout, and patient safety: a systematic review.  PLoS One   2016; 11  (7):e0159015.8 Davis DA, Mazmanian PE, FordisM, Van Harrison RT, Thorpe KE,Perrier L. Accuracy of physicianself-assessment compared withobserved measures of competence:a systematic review.  JAMA   2006; 296 (9):1094  –  102.9 Lawson ND. Structural stigma anddiscrimination against medicalstudents and residents withsuspected mental disorders. Oralpresentation at the EighthInternational Together Against Stigma Conference, 20 September2017, Copenhagen. http://www.againststigma2017.com/images/Presentations/OR-3-Structural-stigma-and-discrimination-against-medical-students-and-residents.pdf [Accessed 17 July 2018.]10 Kirkland A. Critical perspectiveson wellness.  J Health Polit Policy Law   2014; 39  (5):971  –  88.11 Martimianakis MA, Maniate JM,Hodges BD. Sociologicalinterpretations of professionalism. Med Educ   2009; 43  (9):829  –  37. Striving for a culture of well-being, openness, and caring  Sean Tackett Editor  –   I thank Nicholas Lawsonfor his thoughts and theopportunity to clarify the messageof my commentary. 1 I regret theuse of the word ‘prejudice’. I agreethat it is likely that most healthprofessions students with severemental illness who avoid seekingcare do so because of systemicfactors rather than a ‘prejudice’ heor she might have against havingmental illness.The author’s second point callsattention to one recent systematicreview  2 that I used to support thestatement that ‘when the well-being of health professionals iscompromised, patients suffer’. Although this review rightly pointsout limitations among study designs and measures, it alsodescribes that an overwhelmingmajority of studies foundassociations between worseprovider well-being and morepatient care errors. This was trueof studies that used objectivemeasures and those that combinedobjective and self-reportedmeasures. Beyond this review,there is a sizable literaturedescribing the adverse effects of poor provider well-being on otheraspects of patient care and healthsystem function. 3,4 More andhigher-quality research wouldcertainly be useful, but it is hardto find a health care association orinstitution that is not calling forheightened attention and General Internal Medicine, Johns HopkinsHospital, Baltimore, Maryland, USA  Correspondence:   Sean Tackett, GeneralInternal Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave,Baltimore Maryland 21224, USA. Tel: 00 1410 550 1785;E-mail: stacket1@jhmi.edudoi: 10.1111/medu.13750 207 ª  2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education;MEDICAL EDUCATION 2019  53 : 206–208 letters to the editor 

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Oct 16, 2019

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