Surgeons with depression and suicidal thoughts don’t get the care they need

When you think of surgeons, you likely picture heroes deftly using scalpels to pull patients back from the brink. But sometimes, as much as surgeons want to save someone, they simply can’t. A new survey finds that some of the men and women doing amazing feats of medicine in the OR don’t think quite so highly of themselves.

Suicidal thoughts could be the result of depression and job burnout. But the most telling factor is that surgeons who think about harming themselves are likely to have made a serious medical error within the last three months. Doctors who made a medical error were three times more likely to have suicidal thoughts. To a surgeon, the repercussions of a medical error might be telling because of the high-stakes nature of surgery. Do errors have a greater emotional effect on surgeons? I think it’s likely.

There’s no doubt that surgeons have very stressful working lives. The amount of stress depends on where they work. If they work in a teaching hospital, having residents be the first responders may offset some of those long, stressful hours we hear about. On the other hand, if you’re a surgeon who works without residents, you have very long busy days that start early making rounds on admitted patients, then going then all day at surgery in the operating room or seeing patients in the clinic, then back on the wards to check up on patients. If you’re on call, you may be up all night doing surgery. And if you work in a small town, you may be on call at the hospital all weekend or even all week long.

If you think surgeons are unfeeling about errors, you’ve fallen for an image. Like us non-surgeons, for the most part, they feel horrible. There’s a saying you hear. They may do thousands and thousands of operations over career. They seldom remember the successes. But they always remember the names of the patients who die or who have the complications. The hardest thing they have to do is take that long, lonely walk down the corridor to the surgical waiting room to tell loved ones that there were complications. You can imagine how they feel when the complications are due to actual errors. But surgeons find they tend to be forgiven by the family if they confess to what happened and aren’t forgiven when they make up story.

And when they’re depressed and have thoughts of suicide, they’re not very likely to get help. According to the survey in the Archives of Surgery, only 26 percent of surgeons with suicidal thoughts sought help from a psychiatrist or psychologist, compared to 44 percent in the general population. Surgeons said they were reluctant to seek help because doing so might affect their reputation or even their license to practice medicine. Among surgeons who had used antidepressant medications within the previous year, about 9 percent had self-prescribed the drugs while one-third had received the prescription from a physician friend not formally involved in their care. The bottom line: surgeons with depression and suicidal thoughts don’t get the care they need.

If I were a patient, I’d find it very difficult to ask my surgeon what mood he or she is in. I would look for signs that my surgeon likes his or her job, is engaged with me when I have an appointment. I’d look for signs of burnout – things like emotional withdrawal, acting like he or she doesn’t care, and not making any effort to connect with me as a patient. If your surgeon seems to be walking around as if under a cloud, it could be that he or she is burdened by a recent error. In that case, do you cancel the surgery? I hope not, because the point of this isn’t to weed out depressed surgeons! I don’t think the onus should be on patients to learn their surgeon’s mood. I think it’s up to us to change the culture of medicine so that it’s considered okay to talk about one’s mistakes and how one feels about them.

I’ve been traveling across Canada giving a talk called ‘Mea Culpa” in which I talk about my own medical mistakes. I’m hoping to set an example for others to follow.

Adapted from a blog post that appeared on White Coat, Black Art.

Brian Goldman is an emergency physician and author of The Night Shift: Real Life In The Heart of The E.R., published by HarperCollins.

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  • http://www.jamesloganmd.com James

    Fortunately, there’s no good evidence that treatment for depression actually decreases suicide rates. Maybe a doctor’s mood is really his own business and not the patient’s or the public’s.

    • Kristin

      Unless depressed surgeons are also less able to do their jobs well–an entirely reasonable proposition, given that depression often goes hand in hand with cognitive distortions.

      Mental illness deserves treatment. Suicide isn’t the only meaningful bad outcome; relational outcomes matter, too. Why suffer more than you need to?

    • Dr. Dredd

      James, why do you say it is fortunate that treatment for depression doesn’t decrease suicide rates?

    • Ben Mullings

      There’s actually plenty of research that psychological interventions have efficacy for reducing depression. Here’s a short list of controlled studies: http://www.psychology.org.au/Assets/Files/Evidence-Based-Psychological-Interventions.pdf

      Then there’s pharmacological approaches and of course combinations of the two, which in many cases optimises the rate of improvement.

  • http://www.ServantLawyership.cm Kathleen Clark

    Dr. Goldman: When you mention that the public may think that surgeons are unfeeling about errors, I thought of what I read recently about a pharmacist who made an error, was prosecuted criminally and had to appear before the pharmacy board. The pharmacist, before testifying in these situations, stated that he was told by his attorneys to show no emotion. This, in turn, enraged some of the family members of the child who died because the pharmacist seemed cold and unemotional.
    I’ve talked to plaintiffs in med mal cases who speak of physicians who seem cold and distant, perhaps because their attorneys told them to show no emotion?
    I’d like to see attorneys who advise their clients such be part of this conversation. Although I am an attorney, I don’t do medical mlpractice litigtion.

  • Elizabeth

    Thank you for this article that continues the discussion on the humanization of physicians and the very real problem of depression in medicine. Attitudes like that of James that a doctor’s mood is only his or her business keep treatable mental illness in the shadows and lead to more harm for the physician, which, even if not in true medical errors, will lead to a less engaged and more easily burnt out doctor.

  • Dr. J

    Dr. Brian,
    The very real fact is that the public has no time nor tolerance for the fallibility of medical professionals. On top of that the regulatory authorities in most provinces ask annually if their members are under care for a mental illness, and if they are their license and livelihood are at risk.

    Why would a depressed surgeon, or any physician for that matter, in this sort of environment possibly out themselves and risk these repercussions? The question isn’t what’s good for their depression, it’s what’s good for them overall. When you look at the whole picture it’s clear that outing yourself as a depressed doctor is not a good idea.
    Dr. J

  • http://www.solacecounseling.com Solace Counseling

    Great article. Depression affects millions of Americans each year, and surgeons none-the-less. If a physician is suffering from depression they may handle their symptoms differently based on their education and experience with depressed patients. Depressed physicians and surgeons should seek professional treatment.

  • s.h.

    James,
    YES a surgeon’s mood IS everyone’s business. A suicidal person is in fact homicidal (think about it). If the person cutting into me and has my life in his/her hands then hell yes it is my business.
    And I am sure a simple search of Pub Med, or other journal database, will show tx for depression DOES prevent suicide.( Never mind my personal and anectdotal experience.)
    No matter the profession, it is important to get help. Surgeons are human too and deserve the same care and compassion we afford any other person. Get help anonymously if need be, but get help.

  • Penny

    That’s really terrible! I can understand why many would be depressed. Most patients feel like attacking the surgeon after an operation I think, because they hurt something awful, sometimes for a few years, so it’s easy for them to believe the surgeon actually caused more harm than cure. I’m sure surgeons don’t get nearly the thank that most doctors do. I think a lot of people also, deep down, feel that “cutting people’s” parts away really isn’t the way to go also, and that it’s kind of archaic and that one day we will react to that with horror as we do when we hear of the days that they used to do bloodletting.

    But I also feel sorry for surgeons in that they and most doctors are surely aware that once your name is in the massive electronic system for having “troubles” they will be labelled as “troubled” for life and even be treated differently. This is one of the ugliest things about the electronic system. It’s totally unforgiving, and since billions of medical records have now been stolen that makes it even worse. It makes it seem as though this entire electronic system was designed “basically to ensure theft” in the first place.

  • s.h.

    Penny:”Billions of medical records stolen”?! Where did you hear THAT?! And where and when did this happen?!

    • Penny

      Hang on while I check my bookmarks…..

      Here it is:
      http://www.corpocracy.info/stolenmedrecords.htm

      Quote:
      “Millions of computerized medical records were stolen shortly after implementation of computerized electronic databases. “Billions” is probably closer to the stolen number now. The following chart will be gradually updated, although this could go on forever. So many are lost or stolen that it’s difficult to keep caught up.
      Many reports are also missing because of medical agencies that refuse to inform patients. If your province or state is not listed here, you may be living in one of those areas that hides the breaches. Most states and provinces have legislation stating that patients must be informed of breaches but these laws are often disregarded. The list located below was derived from information located on the Internet. “

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