PRESIDENT’S MESSAGE: 
Michael Baron, MD, MPH, DFASAM, FAPA - Spring 2025

Michael Baron, MD, MPH, DFASAM, FAPA

Stigma is Lethal

Stigma is lethal. Stigma significantly prevents physicians and other licensed healthcare workers from seeking help for mental illness. Stigma leads to exclusion, prejudice, and discrimination, and it can even lead to death. The Triad of Confidentiality, championed by Drs. Hengerer and Gundersen, cochairs of the FSPHP Task Force to Support Safe Haven, is one of FSPHP’s initiatives to reduce stigma.
The Triad of Confidentiality includes: 

1. Regulatory Protection: PHP is approved to accept confidential referrals without the involvement of the state medical board.
2. Record Protection: PHP records are protected from discovery in legal proceedings.
3. Application Protection: PHP compliance permits nondisclosure of protected health information on licensure/credentialing/insurance and certification applications.

Stigma is a major reason that physicians don’t get help for mental illness. Stigma can also lead to suicide. The following is a case that ended tragically for one of two residents. The facts are real but are changed to protect identities. Stigma is triggered through many different processes, especially these leading ones: 

• Medical licensing and credentialing applications often require the disclosure of mental health history.
• Seeking help for a mental health condition might lead to breaches in confidentiality, potentially impacting one’s standing among colleagues or superiors.
• Demanding workloads make it challenging for physicians, especially trainees, to prioritize their own mental health care.
• Many physicians internalize negative attitudes about mental illness, viewing the need for help as a sign of weakness or personal failure, causing self-stigma.

At the Tennessee Medical Foundation (TMF), we received a referral for a Post Graduate Year (PGY) 5 resident with only four months remaining in their five-year training program. He was referred to the TMF the day after his arrest for diversion of opioids for his own use. He was in treatment for opioid use disorder (OUD) the day after he was referred. In his eighth week of treatment, and despite heavy lobbying by the PHP, he was terminated from residency with only four months remaining.

So far, his story has a happy conclusion. About eight months after successfully completing treatment, he entered and completed another PGY5 year at a different residency program. His criminal charge was adjudicated with a deferred entry of judgment to avoid criminal conviction. He had State Medical Board actions, including probation. He loves recovery and is very involved in 12-step work. He is now in a successful private practice. The ninth step promises of recovery have come true in his life. A few months after his termination, a friend of his—a PGY4 resident from a different program but at the same institution—was sent home on a Friday for alcohol issues. Over the weekend, he ended his own life. When I told this story at the AMA State Advocacy Summit meeting in January 2025, I heard a collective gasp from the audience. Stigma is lethal.

We will never know the extent of stigma this resident had. We won’t know his degree of negative self-talk. We don’t know what factor the first resident’s termination had on the second resident’s suicide. What we do know is that months prior to the PGY4 resident being sent home and ending his own life, the PGY5 resident who was sent home was terminated. The PGY5 resident was not yet back in another residency. 

Stigma can be lethal in several ways, particularly when it comes to mental health and substance use disorders (SUD). We have seen examples of how stigma causes delays in treatment or leads individuals to avoid care altogether. The following are real-life examples with which we were involved:

• A pregnant physician with an active SUD was afraid to seek necessary obstetric care. She avoided prenatal care due to fear of legal consequences and of having Department of Child Services involvement. This lack of care could have led to serious health complications for both her and her baby. She self-referred to the PHP on advice from a confidant who was a past PHP participant. She accepted our referral for obstetric and SUD treatment. She had no legal or regulatory board consequences and delivered a healthy baby.
• A treating physician dismissed the physical symptoms in their physician patient (our participant) who had a co-occurring mental health condition, attributing the symptoms to their mental illness. This resulted in a delayed diagnosis.
• A physician who was successfully discharged from treatment and released to return to work was very hesitant to begin the employment application process. She had toxic shame and the “why-try syndrome” of hopelessness. This resulted in social isolation and unemployment. She was eventually pushed by the PHP into applying for work and, to her surprise, was hired.

By creating barriers to care, worsening symptoms, and contributing to social and economic hardships, stigma can significantly increase the risk of premature death among physicians with mental illness and SUDs. Healthcare workers with stigmatized conditions may face bullying, neglect, or even harassment, putting their physical and emotional safety at risk. 

Our everyday PHP language can also be stigmatizing. Stigmatizing language can significantly impact our participants’ health, well-being, and even access to care. Changing the words we use to talk about addiction is crucial in reducing stigma. Our lexicon can perpetuate stigma or reverse it. Terms like dirty screen, junkie, druggie, wet brain, and cold turkey are stigmatizing. A shift in language reflects our understanding that addiction
is a chronic, treatable disease, not a moral failing or character flaw.

Stigma has been a part of the healthcare workers’ psyche since long before the entrance of PHPs 50 years ago. A lot of work has been done to raise awareness and reduce stigma over the last 10 years. We are far from done. Confidentiality diminishes the effects of stigma that can be associated with mental health care. The implementation of confidentiality is an integral component of encouraging help-seeking and provides assurance of public safety. 

This work is a call to action to address confidentiality barriers to seeking help.■

Read more on this in the Spring 2025 issue of Physician Health News.