Dealing with depression has made me a better doctor

I was a junior doctor when I experienced my first episode. The strange thing is, that despite my medical training (I may have bunked off a few of the relevant lectures in medical school), I didn’t recognize the symptoms.

I had lost my appetite and had lost weight.  I wasn’t sleeping and was irritable, angry and tired most of the time. Most disturbing to me was a feeling (despite being surrounded by work colleagues and friends most of the time) was that I felt emotionally cut off and removed from people. I had also become cynical and decidedly detached from my work responsibilities and, truth be told, had lost all empathy with my patients. Not a good combination for someone working in healthcare.

It took a conversation over coffee with a good friend of mine who is a psychiatrist to make me realize that I was depressed.

Although of course it is obvious to me in retrospect, I had no idea I was depressed at the time. Like many people, I had no clear sense of my mood on a day to day basis. Like most other doctors I just kept on going.

For the last 20 years, I’ve been on the receiving end of medical care from GP’s, psychiatrists and psychologists.  I’ve learnt a lot about mental illness, its treatment and how to look after myself better.

I have also learned a lot about the stigma of mental illness in medicine and how to cope with it. Largely, it has to be said, by keeping quiet about it.

Mental illness is, for many affected doctors, a shameful secret. One that can affect how other doctors perceive your reliability as a clinician and also one which could affect your career.   To admit to not coping in medicine is to be weak, to somehow let your community down, and to go against the macho code of invincibility that we have imposed on ourselves.

What’s ironic about the code of silence is that a significant proportion of doctors have experienced mental health problems. Up to a quarter of doctors will meet the criteria for a depressive illness by the end of their first year in training and other studies suggest that up to 51% of (female) doctors have a lifetime history of depression. Substance and alcohol abuse are common, burnout is common and suicide rates are higher than in other professions. Medicine is not as glamorous as it sounds.

At present, thanks to the medical care and advice I’ve received and the support of family I’m doing well. Most of the time. I’m more mindful of my own moods and more forgiving of myself when I make mistakes. I recognise the warning signs of an imminent crash and feel better equipped to deal with the symptoms when they come. I have learned to say no (and not feel guilty about it) and also to give myself the odd pat on the back and remind myself that I’m doing some good.

However awful I sometimes feel, I know that it will pass eventually. I also know, that on my worst day, I’m still a conscientious and caring physician.

I also firmly believe that my experience of dealing with depression has made me a better doctor; It has helped me understand the healthcare system from a patient’s perspective and also helped me empathize more deeply with patients (as another patient) and to be a more compassionate.

It has made me much more attuned to psychiatric symptoms in my patients (even when may not be aware of them themselves) and to develop a language that allows me to engage them in discussions about their mental health in a non-threatening way. Although I have a better understanding of how an illness like depression can color and skew patient perceptions of certain physical symptoms, I think I am also less likely to over-diagnose psychiatric illness in a patient who’s symptoms don’t easily fit into a neat medical model.

There. I’ve said  it. Whats your story?

Ronan Kavanagh is a rheumatologist who blogs at Dr. Ronan Kavanagh’s Blog.

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  • InsightBusinessWorks

    As a psychologist who now works as an executive coach and consultant, especially in health care, I commend your willingness to tell your story. I have no doubt that facing and dealing with your depression has made you a better doctor; I know from experience that many patients won’t talk to their doctor about symptoms of anxiety and depression. Or if they do have a psychiatric diagnosis, they feel their concerns about medical issues won’t be taken seriously. The mind and body are not and have never been separate; we need compassionate, effective care for all illness and we have a long way still to go. Thanks for your willingness to address these issues!

  • Suzi Q 38

    Thank you for your story. We all have our tough days. I hope that yours get better. Believe that it will.

  • Guest

    Thanks for sharing. I suffered from deep depression during my intern and PGY1 years thanks to too many stressors and no real outlet to manage them. It was when the chief residents spoke to me and told me my work was lacking I finally realized I needed help. Like you, up to this point there was a loss of joy. Along with that loss came difficulty sleeping, over eating, feeling hopeless and actually wishing for injury and death so I wouldn’t have to continue dealing with life. I took time off and started what has become life long counseling. I struggle with the side effects of meds so I have chosen not to take them. It’s amazing how many medical students, residents and physicians struggle with depression but are too fearful to admit it. We are supposed to be strong, hard workers, invincible. At my residency weakness was not tolerated. I hope the environment is changing for trainees.

    • Suzi Q 38

      Yes, we are all only human.
      We have are good and bad days.
      Hopefully the good ones will outnumber the bad.
      Good Luck.

  • chrliechaz

    I’m so glad you shared this. The stigma against mental health issues is so aggravating, since I believe everyone suffers a bout of depression, anxiety or other aspect of it during their life at one point. If society were more accepting and less judgemental we could all deal with it in a more relaxed fashion.

  • SBornfeld

    Well, there you go. Looking through the topics on kevinmd I see all the piling on the health care manager they’ll never meet, and then the very few who will actually comment here for attribution. How sad that in 2013 we still feel compelled not to speak out regarding mental illness. It’s either hidden away or bemoaned when the psychopaths go homicidal.

    Yes, there is general ignorance (“oh, I know just what you feel”), or admonishment to “not let it get to (us)”, not “wallow in self-pity”, etc. etc.

    Thank you for speaking out–for attribution. The general acceptance of the concept of mental illness as “real” has progressed so very slowly (as is the case regarding “mental health parity” laws). You have just made it just a little bit easier for me and others who have suffered from depression to come out of the shadows.

  • Judith Horton-Holm

    As a young person, I had bouts of depression in either Spring or Fall. This continued thru out my life, often skipping years. Eventually. I received medical rx for this which helped greatly, plus I began working as a psych nurse, which helped on the acceptance level. It can be a very painful condition and can make you feel isolated and different. But , if one can understand , there is treatment AND MOST IMPORTANTLY, it is a sickness like any other, and is part of the human condition.

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