How do we create the medical culture that is conducive to physicians’ health?

On June 30th, a physician entered a hospital in New York City with an assault rifle. He killed one person, a physician, and wounded six others. He then set himself on fire and shot himself in the chest, dying by suicide.

I, nor anybody else, knows this man’s motives or what was going on in his head. But one detail in the story stuck out to me.

According to CNN, before the physician opened fire, he yelled: “Why didn’t you help me when I was getting in trouble? Why didn’t you help me?”

I think something all of us could agree on is that this man needed help. And we can also conclude that he didn’t get the necessary help. Unfortunately, for physicians, not getting adequate help seems to be the norm and not the exception to the rule. Not only because it’s not available, but because they fear the repercussions from seeking out what they need.

I want to use this particular, tragic story to address a bigger issue in general: caring for the mental health of physicians.

First, let’s look at the numbers.

According to US News and World Report:

One-third of physicians report experiencing burnout at any given point. This is 15x more likely than professionals in other lines of work.

Medical students have a rate of depression that is 15 to 30 percent higher than the general population — which ultimately leads to poorer performances with patients.

Physicians have a divorce rate 10 to 20 percent higher than the general population.

45 percent of primary care physicians say they would quit if they could afford it.

And 300 to 400 physicians die by suicide each year. To put that into perspective, that’s about three medical school graduating classes worth.

So what’s going on?

The US News and World Report article cites “the culture of medicine” as the main culprit. But, what’s that? First, it’s dealing with high-stress situations and death on a regular basis with no time to reflect, mourn, or even slow down. Also, it’s a lack of autonomy over one’s schedule or time — physicians are constantly being pressured to see more patients in less time and produce better health outcomes. That’s an impossible situation. It results in sleep deprivation, absence from family activities, and an inability to engage in any self-care. It is a culture where physicians have low autonomy but high responsibility. And that is an extremely problematic combination.

Why don’t physicians get help when they are struggling? US News and World Report says it’s due to fear. We often penalize physicians by denying them privileges or licenses if they’re being treated for substance abuse or depression. Their source of livelihood and sense of identity would be stripped from them. There is also a sense of stoicism and pride with regards to one’s own health that goes, “I can’t be seen as unhealthy because I am a physician.” Because of this, many try to self-medicate.

There are well-intentioned interventions that promote meditation, exercise, or group therapy among physicians, but these aren’t feasible because, as mentioned before, doctors do not have time for this. And that paradigm puts the burden of wellness on the physician when the source of the problem is structural.

Questions:

Although stoicism can be beneficial in medicine (in an emergency you’d want a doctor that’s calm and collected), is the tough-it-out, take-the-abuse mindset an inherent trait in the field of medicine, or is that something which we have created and which we are now suffering from?

If it’s not inherent, how do we create the medical culture that is conducive to physicians’ health? How do we make a culture where asking for help is supported and encouraged?

Jamie Katuna is a medical student.  She can be reached on Facebook.

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