The signifying disconnect

So, as I was prepping class wandering through the internet between classes earlier today, desperately wishing I didn't have anything to do with Hegel on the theory calendar, I came across an interesting post: Doctor: Perhaps We can All Work Towards This on a blog called, simply enough, Doctor. Doctor's post begins as a response to a journal in the New England Journal of Medicine about physician's committing suicide. Bummer, I thought, and read on (because, really, I'm a cold so and so; did I mention how much I like Titus?).

Doctor then talked about an article from the Journal of the American Medical Association, and it was then that something stuck my Hegel-benumbed eyes. First, (and I'm copying from Doctor):

Thirty-five percent of physicians do not have a regular source of health care, which is associated with less use of preventive medical services supporting the observation that the medical profession does not encourage physicians to admit health vulnerabilities or seek help. [Emphasis mine]

Now, I'm going to lay out my assumption about physicians. Assumption: Most can afford health insurance or health care, or have health insurance/care through a job.

So, why do more than one third of physicians NOT have a regular source of health care? After all, these are the people who tell us to have this or that test taken at this or that age, have screening procedure X done every year, or every third year, blah blah.

But more than one third choose NOT to have a source of regular health care. Why is that? Okay, a FEW physicians are no doubt the only health care provider in a rural area, and there's just no one else. But if my assumption holds, then the choice IS a choice, and NOT about lacking money or health insurance.

What is it about? Do 35% of physicians not believe the stuff they insist on about tests and preventative medicine, wellness, and such?

Do they think that being asked if they wear a seatbelt is inane as I do? (Really, I've jumped out of an airplane in flight on purpose, and not because it was falling out of the sky. My seatbelt is the least of anyone's worries. And yes, thanks for asking, I do wear my seat belt. I'm nuts, not stupid.)

Or is the decision not to have a source of regular health care about other things? If so, what?

If so, here's one possibility from the first article Doctor quotes, "Taking their own lives--the High Rate of Physician Suicide" (NEJM), which says,

It has also been noted that physicians tend to neglect their own need for psychiatric, emotional, or medical help and are more critical than most people of both others and themselves. They are more likely to blame themselves for their own illnesses. And they are apparently more susceptible to depression caused by adverse life events, such as the death of a relative, divorce, or the loss of a job. [Emphasis mine]

Maybe it's because they think their peers will be critical and judgmental about their own foibles, perhaps because they themselves are critical? And just don't want to hear the criticism from someone else? They don't want to feel that they're to blame for their own illnesses?

Back to the JAMA article, "Confronting Depression and Suicide in Physicians" (the link is to the abstract), which argues that

It is reasonable to infer that physicians' concern about disclosure of mental health records is widespread, although studies are lacking. Breaches of confidentiality also are believed to harm openness between the physician (as patient) and the treating clinician and may result in needless disclosures to coworkers. Those concerns, coupled with professional attitudes that broadly discourage admission of health vulnerabilities, are likely the driving forces behind physicians' disinclination to seek mental health care.

So, physicians are worried about breaches in confidentiality. Do they know something about the effectiveness of HIPAA confidentiality rules that I don't? Like that they're not respected?

Doesn't this strike you as a bit of a disconnect? Physicians (who tend to tell the rest of us to get regular preventative health care) don't get it themselves, at least 35% of them don't.

Perhaps, they don't get it because they're already critical, and, perhaps, don't want to open themselves up to the criticism of others? And/or, they're worried about breaches of confidentiality. Or there's some other information they have that they're not sharing.

I'm trying to imagine a parallel in my own field: don't encourage your own kid to go to college because college is useless? Maybe a better parallel would be don't subject your work to the scrutiny of others who might be critical because you are?

I don't know. I do know that I see a disconnect between what people in the medical profession SAY and what they DO themselves, and the disconnect is statistically significant, and, according to these articles, significant enough to affect depression and suicide rates among physicians.

Now, I'm reading against the grain here, obviously; Doctor wants his readers to be concerned about physician suicide, and more specifically, wants to encourage his physician readers who are depressed to click on his link to the Physician Suicide Project.

In reading against the grain, to try to understand something else about the community textually represented in this study, I'm not dismissing the articles' or blog's concern about physicians committing suicide. But it does make me wonder why.

I know the stereotypical college professor gets up with caffeine and starts in on alcohol at 5pm, but I have to admit that I don't know any college instructors (at any level) who've committed suicide. (I know one grad student who committed suicide.) I know plenty of college instructors (and grad students) who seem depressed, though. Certainly, anyone without tenure might reasonably be concerned about breaches of confidentiality, especially about depression or suicide attempts.

We're a pretty self-critical bunch, and we, too, experience a serious level of disconnect between what we say and what we sometimes do: I teach Marx, but I have retirement "savings" in mutual funds which invest in the stock market. We're supposed to respect and care about our students, but every instructor in the world has complained about students at some point.

But the disconnect isn't quite the same as it seems in the article above; I think I have a strong sense that what I do is meaningful enough that I want to participate in it, teaching, learning, studying, contributing to understanding, knowledge. And I think most college instructors share that same basic sense that what we do really IS worthwhile and meaningful.

I guess that's where I see the significance of the disconnect I've been pointing to in those articles, and in the blog: if 35% of doctors don't see regular health care as worthwhile and significant, then at least some of them don't see what they do every day as worthwhile or significant.

I don't know if I could get up in the morning tomorrow, and face Hegel again if I didn't think doing so was worthwhile and meaningful, that it mattered. (And that's JUST Hegel! Imagine facing people who haven't been dead for 100+ years if you feel that what you do doesn't matter!)

It sure would be interesting if the researchers who wrote those articles, or if Doctor, himself, were to figure out if there's a correlation between the 35% of doctors who don't get regular health care and the doctors who experience depression or commit suicide.

(Okay, and because I can't resist the irony: Doctor says that physicians are more successful than most when they try to commit suicide.)