Consistency Between State Medical License Applications and Recommendations Regarding Physician Mental Health

Saddawi-Konefka, Daniel; Brown, Ariel; Eisenhart, Isabella; Hicks, K.E.; Barrett, Eileen; Gold, Jessica A.

doi:10.1001/jama.2021.2275

Cited by 24 publications

(26 citation statements)

References 10 publications

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“…Professionalism education often focuses on broad general principles, rather than on what to do when these and other ethical principles conflict and need to be weighed against each other. Education on professionalism should thus address this situation of doctors not wanting to treat unvaccinated COVID patients, probing why doctors nonetheless have duties to care for these patients, how and why psychological and moral conflicts can nonetheless ensue, and how best to address these challenges [45].…”

Section: Ways Of Addressing Resultant Moral Distressmentioning

confidence: 99%

“…This Federation recommends, too, that state boards use supportive or normalizing language about obtaining mental health treatment. But only one state has thus far adopted all these guidelines [51]. Physicians in states in which initial license applications fail to follow such guidelines are 29% more reluctant to seek mental health treatment [52].…”

Section: Ways Of Addressing Resultant Moral Distressmentioning

confidence: 99%

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Needs to address clinicians’ moral distress in treating unvaccinated COVID-19 patients

Klitzman

2022

BMC Med Ethics

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Background Moral dilemmas have arisen concerning whether physicians and other providers should treat patients who have declined COVID vaccination and are now sick with this disease. Several ethicists have argued that clinicians have obligations to treat such patients, yet providing care to these patients has distressed clinicians, who have at times declined to do so. Critical questions thus emerge regarding how best to proceed. Main body Providers face moral tensions: whether to place the benefits to an unvaccinated patient over their duties to protect themselves and their families, staff and other patients, and goals of working collaboratively with patients. Clinicians’ duties to treat such patients arguably outweigh claims otherwise, but these obligations are creating moral conflict and distress for providers. Moral distress has been associated with burnout, post-traumatic stress disorder, and interpersonal and work difficulties. Given ongoing vaccine refusals, these problems are unlikely to disappear in the foreseeable future. Society has obligations to address this moral distress due to principles of reciprocity, and implicit social contracts, as part of which physicians risk their lives in caring for patients for the good of society as a whole. Responses are thus urgently needed at several levels: by hospitals, medical schools, professional societies, governments, media, providers and patients. Medical training on professionalism should address these stresses, probing why doctors have duties to treat these patients, but also how moral conflicts can ensue, and how best to address these tensions. Governments and institutions should thus alter relevant policies and devote more resources to addressing clinicians’ psychological strains. Institutions should also improve organizational culture. Public health organizations and the media described clinicians, earlier in the pandemic, as heroes, committed to treating COVID patients. This narrative should now be changed to highlight the strains that unvaccinated patients cause—endangering hospital staff and others. Conclusions Unvaccinated COVID patients should receive care, but multi-level strategies, involving enhanced policies, education and practice are vital to alleviate ensuing moral distress, and thus aid these clinicians and their patients. Ethical arguments that providers must treat these patients have not considered these obligations’ effects on clinicians, but should do so.

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Section: Ways Of Addressing Resultant Moral Distressmentioning

confidence: 99%

Section: Ways Of Addressing Resultant Moral Distressmentioning

confidence: 99%

Needs to address clinicians’ moral distress in treating unvaccinated COVID-19 patients

Klitzman

2022

BMC Med Ethics

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“…A 2021 review showed that 39 states now ask questions focusing only on current impairment rather than illness, diagnosis, or previous treatment and that 17 no longer require disclosure of mental health conditions. 7 According to the Dr Lorna Breen Heroes' Foundation, as of November 2022, 19 states have medical licensure applications that align with recommendations from the FSMB (https://drlornabreen.org/ removebarriers/ ). However, it is important to note that these data only focus on physicians, and not other members of the health care workforce.…”

Section: Change Is Happeningmentioning

confidence: 99%

Time to Act: Destigmatizing Mental Health Care for Health Care Professionals

Myerholtz

Lamoureux

2023

Fam Med

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“…19 The 'State' of disability inclusion can be measured by systemic barriers to access, which lead to disparate outcomes for trainees with disabilities compared to their non-disabled peers. 20 These barriers are present in several domains, including: admissions, 3,21,22 instruction, 18 process, 16 access to accommodation in medical training and licensure exams, 23,24 lack of knowledge regarding reasonable and appropriate accommodation/ adjustments 3,16 and discriminatory practices for physician licensure. 24,25 In the context of an ableist and historically hostile environment.…”

Section: Deming's Point 3: Cease Dependence On Inspection To Achieve ...mentioning

confidence: 99%

“…20 These barriers are present in several domains, including: admissions, 3,21,22 instruction, 18 process, 16 access to accommodation in medical training and licensure exams, 23,24 lack of knowledge regarding reasonable and appropriate accommodation/ adjustments 3,16 and discriminatory practices for physician licensure. 24,25 In the context of an ableist and historically hostile environment. 15 The need to self-identify a disability will also result in an underreporting of disability and a cadre of trainees who are silently suffering, never truly having full access to our programmes and never reaping the benefits of feeling included in the medical community.…”

Section: Deming's Point 3: Cease Dependence On Inspection To Achieve ...mentioning

confidence: 99%

Disability inclusion in medical education: Towards a quality improvement approach

Singh

Meeks

2022

Medical Education

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The Issue The shift to a more diverse workforce that includes physicians with disabilities has gained considerable international traction. Indeed, disability inclusion is experiencing a renaissance in medical education. However, the philosophy of disability inclusion must be adjusted from one where disabled trainees are viewed as problematic and having to ‘overcome’ disability to one where institutions anticipate and welcome disabled trainees as a normative part of a diverse community. Observations Most trainees with disabilities will enter an unregulated, uninformed system leaving them vulnerable to under‐accommodation, systems barriers and lack of informed support. Further, the perception of the super human good doctor creates disincentives for candidates to disclose their disability, creating structural barriers that the system needs to address. A less often discussed contributor to health care inequities is the inadequate training of health professional educators on disability rights and disability competencies. Indeed, the lack of education, coupled with minimal exposure to disability outside of the hierarchical patient‐provider relationship, perpetuates to stereotypes and biases that impact clinical care. Approach Disability inclusion has not been reviewed through the lens of quality improvement. To close this gap, we examine the state of the science through the lens of disability inclusion and offer considerations for a quality improvement approach in medical education that addresses the global revised trilogy of World Federation for Medical Education standards of quality improvement at all three levels of education, training and practice. Conclusion We propose a vision of systems‐based disability‐inclusive, accessible and equitable medical education using 9 of Deming's 14 points as applicable to medical education.

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Consistency Between State Medical License Applications and Recommendations Regarding Physician Mental Health

Cited by 24 publications

References 10 publications

Needs to address clinicians’ moral distress in treating unvaccinated COVID-19 patients

Needs to address clinicians’ moral distress in treating unvaccinated COVID-19 patients

Time to Act: Destigmatizing Mental Health Care for Health Care Professionals

Disability inclusion in medical education: Towards a quality improvement approach

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