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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