TUCSON, Ariz., June 12, 2019 /PRNewswire/ -- Moral injury
and risk for suicide may result from physicians' perceptions
of coercion in the treatment methods they receive in Physician
Health Programs (PHPs) and "preferred physician treatment
programs," and independent oversight and ethical standards are
needed, writes psychiatrist Robert
Emmons, M.D., in the summer issue of the Journal of
American Physicians and Surgeons.
Originally intended to help physicians with addictions recover
and return to practice, PHPs are now used for an expansive list of
allegedly impairing mental conditions, Dr. Emmons writes. The
formerly collegial, clinical process has become in many instances
an adversarial legal one. Exclusive referral relationships and
often unregulated financial ties now bind medical licensure boards,
hospital peer review committees, PHPs, and preferred physician
treatment programs into a "medical regulatory-therapeutic complex"
(MRTC).
Compliance with orders for treatment, often in remote, massively
expensive inpatient facilities, is enforced by threat of loss of
licensure. Patients who face civil commitment for psychiatric
treatment have their civil rights assiduously protected. In
contrast, the claim is made by leaders in the MRTC that physicians
knowingly agree to mental health screening essentially at the will
of medical boards when they apply for their licenses.
Leaders in the MRTC deny that the common practices in their
field amount to coercive treatment, although this is the usual
perception of physician-patients referred to a PHP. Physicians who
are disappointed in their expectations of clinical relationships of
trust in what they erroneously suppose to be ordinary treatment
situations are likely to experience feelings of betrayal and moral
injury, which may lead to despair, an expectation of exploitation,
and suicidal thoughts.
In ordinary, non-coercive clinical environments, patients who
receive bad advice or who simply do not agree with evaluators or
treaters can escape by seeking second opinions. In the MRTC,
physician-patients are not allowed to refuse to accept false
positive diagnosis, unnecessary care, unsatisfactory treatment, or
bad-faith practice. Even when practitioners in the MRTC adhere to
their own guidelines for best practices, the discrepancy between
what they think is necessary to protect the public and
physician-patients' expectations of ordinary clinical ethical
standards is enough to create the conditions for moral injury.
While it may be difficult to prove or disprove causal links
between practices in the MRTC and the risk of specific adverse
outcomes, the limited evidence that suggests an elevated risk for
suicide in physicians mandated into these programs is enough, says
Dr. Emmons, to compel immediate action to try to avert catastrophic
and unacceptable events. For any physician mandated into evaluation
or treatment in the MRTC, risk for suicide should be re-evaluated
on a regular basis. Intensive, independent investigation of
practices in the MRTC is paramount when questions about safety and
efficacy arise about a treatment that is imposed upon
unwilling patients.
Ethical guidelines for the use of coercion in the MRTC are
proposed. Meanwhile, "attorneys who represent physicians need to
understand the clinical risks and ethical problems with coerced
treatment and fitness-for-duty assessment in the MRTC before
advising their clients on their responses to mandates from medical
licensure boards and other referring entities," Dr. Emmons writes.
Physicians who perceive mental illness in themselves, or are
alleged to have signs of impairment, should consider seeking
evaluation and treatment outside the MRTC.
The Journal of American Physicians and Surgeons is
published by the Association of American Physicians and Surgeons
(AAPS), a national organization representing physicians in all
specialties since 1943.
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SOURCE Association of American Physicians and Surgeons
(AAPS)