Don’t poop where you eat: Mental health services for young physicians


Imagine you are an ambitious new worker at a powerhouse institution. Your job performance is soaring, but you frankly work like a dog. Your weeks top out at 80 hours, you get maybe a single 24-hour block of time off every 7 days, you work weekends, and you often work up to 30 hours straight in one stint, sleep at work, and eat exclusively from food options in the building.

You rarely see the sun, your mother currently has to take care of your cat for you, and you are home so infrequently you cancelled your Internet and cable. You start doing too many drugs to stay awake, drinking too much alcohol to try to sleep afterwards, and starting to think about suicide. You are depressed.

So you request a meeting with a coworker you hardly know but that seems like they’d be good at talking, and say, “Hey, let me tell you my feelings. Have you write down my deepest darkest secrets, and store them on the public shared drive with my name, birthdate, social security number, and ‘please do not read!’ on it?”

This is story of mental health resources for the 29 percent of resident physicians who are depressed.

The reality of health insurance for anyone is the network. The network defines who you are able to see for care, and who will accept you as a patient to be seen.

For residents, who are predominately hospital-employed, and who often purchase health insurance through their employer, their network is also their place of work. That is, the physicians a resident is able to see for their personal health care — including mental health, gynecological exams, sensitive medical issues such as HIV — are often restricted to the same hospital that resident works at. It is not an unreasonable fear for residents, then, to not seek care when it comes to stigmatized mental health.

While privacy protection acts like HIPAA are real, they are difficult to trust when you know every single one of your co-workers and ancillary staff (nurses, attendings, etc.) have a password into your private file. Further, unrelated medical care (for example, an ER visit during work hours from a needle-stick accident) allows completely HIPAA-compliant access by one of your coworkers into all of your records.

There is a saying, “Don’t [poop] where you eat” — that is, to keep personal and professional separate. For many residents whose health care is limited only to their place of work, there are often no other options. Of depressed first-year residents, over half cited “perceived lack of confidentiality” as a barrier to treatment.

With suicides, depression and burnout on the forefront of news in medical training, a mandate for hospitals to offer medical staff health care networks not affiliated with their place of employment would be a positive step in residency health.

Amy Ho is an emergency physician.  

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