It was only day one, and I was covered in blood halfway to my elbows from doing chest compressions in the operating room. The room was filled with doctors, nurses, and other OR staff. Empty bags that once contained life-saving blood, plasma, and platelets lay scattered across the floor. She was young, not the kind of patient you would ever suspect you’d be sweating over as you frantically recall what you learned in your basic life support (BLS) training. Once the decision was made to stop the resuscitation attempts, I found myself in a sort of daze. As we cleaned up, I recall being told of various grief support groups offered at our hospital if I needed to talk. Still in shock, I heard their suggestions, but like many others, I figured I could handle it on my own.
I wanted to be a surgeon, and I feared seeking help or talking about the effects of patient death was a sign of weakness. I told myself, “there’s no room for weakness in surgery.” I knew that vascular surgery was a high-stakes specialty and that over the course of a career, I would sadly have many patients die in the OR.
Now, as I sit on my couch, confined to my 550 square foot apartment due to the Covid-19 pandemic, I am beginning to wonder how I can better prepare myself for handling such situations throughout the course of my training, and avoid becoming another burnout statistic.
According to Dr. Dawn Coleman of the University of Michigan, physician burnout is defined as a “mental state characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment.” Presently more than 50% of physicians practicing in the U.S. suffer from burnout. Burnout has been linked to a decline in quality of care, decreased patient satisfaction, and increased medical errors. For the physician, burnout has been shown to sever personal relationships, lead to substance and alcohol abuse, and, more importantly, depression and suicide.
Current statistics show that male physicians are 1.4 times more likely to commit suicide than the general male population. Female physicians commit suicide at a rate of 2.2 times higher than the general female population. In a 2018 survey conducted by the Society of Vascular Surgery, 30% of 872 respondents met the criteria for burnout based on the Maslach Burnout Inventory (MBI), a validated measure of burnout. The MBI-Human Services Survey for Medical Personnel utilizes three scales assessing: emotional exhaustion, depersonalization, and personal accomplishments. Of those surveyed, 37% screened positive for symptoms of depression in the past month, and 8% indicated suicidal thoughts during the prior 12 months.
In the world of medicine, we are often too proud to admit when we are struggling or when we need help. This too often leads to medical students, residents, and physicians pushing issues under the rug or “self-medicating.” A national study published in 2015 found that 12.9% of male and 21.4% of female practicing physicians met alcohol abuse/dependence diagnostic criteria. It seems, however, that the problems may begin as early as medical school. A 2012 survey of 3,389 medical students found 17.5% suffered from burnout, 18.1% met criteria for alcohol abuse/dependence, and 25.2% described symptoms of depression. Of this survey population, a staggering 26.6% fell into all three categories.
It’s time for health care professionals to acknowledge our vulnerability and allow others in. We often share our highs, but battle alone, behind closed doors with our lows. Even as I sit here on my couch writing this piece, I recall how embarrassed I was to admit that I needed to talk to someone to help me process this patient’s death. I was able to confide in one of my classmates, who like myself, had chosen a career in surgery. Just talking over the experience and how I had felt since lifted a weight off my shoulders. To my surprise, my classmate then began to tell me about a traumatic experience he had while on our intensive care clerkship. I feel that my willingness to be vulnerable enabled him to shed his cloak of invincibility and sort through some of his emotional baggage as well.
If we all just take some time each week to gather our thoughts, sort through our emotions, and talk to a friend, family member, or colleague, we can flatten the curve and avoid becoming another statistic. To be a catalyst for change, I offer myself to anyone who needs to talk. If you’re the family member or friend of a physician, make yourself available to just listen and be supportive. Even doctors are not impervious to the words of the late Bill Withers, “We all need somebody to lean on.”
Victor H. Hatcher Jr. is a medical student.
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