Why can’t doctors be depressed? They encounter challenging and emotional situations every day, and they are robbed of the emotional intelligence training necessary to handle them properly.
The 32-year-old single mother of two who was recently diagnosed with metastatic breast cancer and given a prognosis of four months to live. The 13-year-old daughter who suffered her first seizure while swimming alone in her home pool and now lies paralyzed in the hospital. The 75-year-old grandfather who suffered a stroke and now can no longer recognize his wife and children.
These events can be traumatizing, yet we as physicians are rarely reminded to show our emotions. To admit that we are suffering. To ask for help.
Showing your emotions becomes a liability, admitting that you are suffering reveals weakness, and asking for help can feel burdensome. With this combination of experiences and pressures, it is no surprise then that there is such a high rate of physician suicide in the U.S.
During our medical training, aside from one or two lectures on general wellness, we do not complete course work addressing ways to deal with these emotionally charged events. Naturally occurring anxieties about inadequacy, fear of failure, and self-imposed expectations of perfection tax what little energy remains to deal with these emotions. In our training, we are taught how to take care of others, but not how to take care of ourselves.
We are thrown into the chaotic environment of medicine and left to learn for ourselves how to cope with the accompanying emotions. Without healthy habits to manage our experiences, some reach towards alcohol and drugs. Others seek solace by escaping this world.
With emotionally taxing interactions, a low emphasis on proper coping mechanisms, and an extensive knowledge about how our bodies stop functioning, it is no wonder that 300 to 400 physicians commit suicide every year. But the problem is rooted earlier in the educational system.
A JAMA article published in December showed that 1 in 4 medical students experienced depression or depressive symptoms during their training, of which, only 16 percent sought medical care for their symptoms. That leaves 84 percent who did not. Even for students who study depression, are knowledgeable about the warning signs of the illness, and have access to mental health resources, only a fraction reached out for help.
To their credit, many schools now offer free counseling services to curb this problem. However, if only 16 percent of the individuals who are trained in spotting the signs of depression seek help, why do we think that these optional services will solve the problem? They won’t. We need a more proactive approach.
After the suicide of one of their former residents, Stanford’s general surgery residency implemented a wellness program they call “Balance in Life.” One of the components is a mandatory weekly meeting with a psychologist to discuss any issues the residents might be facing in their personal or professional lives.
The meeting is during protected educational time and does not take away from the resident’s patient care responsibilities. If anything, it improves it.
With an issue that revolves heavily around stigma, the solution lies in programs that are opt-out instead of programs that are opt-in. The key is not simply having counseling available, but encouraging students to experience it and decide its effectiveness for themselves.
Stigma causes shame and limits agency. However, staying in a program that everyone starts out in is less shameful than joining one by yourself. Thus, opt-out programs can lift the burden of shame by preventing people from being singled out.
Mount Sinai medical school is currently creating such an approach after the suicide of one of their fourth-year medical students. In addition to reshaping their curriculum to become less focused on grades and exam scores, they are implementing a yearly mental health checkup.
With a general screening program, they are likely to catch those who fear reaching out for help. Furthermore, they normalize the appointment and in turn start breaking down the mountains of stigma surrounding the issue.
A great deal of energy is being poured into physician wellness and burnout prevention — and mental health is intrinsically tied to these solutions. But we must be proactive. We tell our patients to take care of their health and come in on a regular basis. Why not do the same for ourselves?
Michael Grzeskowiak is an internal medicine resident.
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