I will always be a vascular surgeon.
But let’s be clear; I no longer practice vascular surgery.
Despite a busy practice, happy patients, local awards, and the respect of my peers, I quit. I gave it all up. All of the education, all of the endless training, all of the time, hard work, and, yes, all of the salary — I turned my back on it.
I am a recovering patient with constant suicidal ideation. I’ve stood on a bridge wanting to jump. I’ve walked to the top of my hospital’s medical tower and only turned around when a nurse called me. I knew if I stayed in medicine, I would eventually kill myself.
Was I burned out or just not resilient enough? I had a good work-life balance. I didn’t have EHR overload. I had a good relationship with my hospital administration, and felt respected. I even worked on self-care. I ate well. Hell, I did yoga!
What drove me out? Rather than burnout, it was depression. Severe depression, to be precise. So does my story help other doctors? Does it relate to the average physician who might be suffering day in day out? I am writing to show that a brush with mental illness should be an alarm for any physician. But I am also writing this to make our profession at least consider mental health issues as a possibility, rather than the taboo subject that it is. That message makes it relatable to all.
Burnout is very relatable for most physicians, even those who don’t experience it.
Physician wellness is now a massive industry with wellness conferences, wellness curricula in medical schools and residencies, and wellness has even entered the “C-suite” with health systems adding chief wellness officers to their organizational charts.
Does mental illness in medicine get the same attention? Undeniably no. And this is because of one very unavoidable reason: the repercussions of disclosing mental illness could irrevocably affect a physician’s career.
The fear of losing privileges, credentialing, and licensing keeps physicians mum about their conditions. Mental illness goes unchecked in those who keep silent. That is what happened to me. Allowing the demon to grow in my mind for years without confronting it gave my worst self-hate a place to flourish.
Do doctors keep silent about burnout?
At your average medical conference, when a speaker asks how many doctors feel burnout, they are met by a sea of raised hands. Burnout is the hot topic. It’s acceptable, even normalized. But we know that burnout can lead to severe sequelae, including depression, substance abuse, and suicidal ideation. Do severe burnout sufferers share details of such dire conditions? Do they participate in resilience workshops? Mindfulness exercises? Does it matter?
They may even diligently attend all of the wellness drills, yet keep their severe symptoms hidden. They might tell others, “It’s just burnout,” an explanation that provides sufficient cover for their more ominous symptoms. They’ll more readily blame the system rather than anything inside their brains. “It’s the administration.” “It’s this damned EHR.” “It’s the long hours.”
Why is burnout treated differently? One answer may lie in the fact that although a diagnosis for burnout technically exists (Z73.0), it is considered an occupational condition rather than a medical one.
Furthermore, without any classification of burnout in the current version of the DSM, one can plausibly deny that burnout is a true mental illness. Thus authorities are none the wiser if a physician discloses burnout. This is a refuge for presumably the majority of burnout sufferers. Most burned-out physicians would even balk at the idea of burnout being considered a mental illness. “I’m not mentally ill. I just hate my job!”
I no longer care about how burnout or depression gets classified because I no longer practice. I have no job to lose. I do, however, care about how burnout is treated among its worst sufferers. Regardless of etiology, I know what it feels like to feel that desperate, that hopeless, that alone. So I argue that burnout treatment should have a mental health component, regardless of DSM or ICD status. In addition to the personal resilience arm and the structural/organizational improvement arm, I propose a mental health arm of burnout recovery.
Am I splitting hairs? As long as people are getting treatment for burnout, does it matter if we call it mental health or not? For the majority of burned-out doctors, probably not. Resilience and mindfulness exercises suffice. But for that subset who are suffering those severe effects of burnout, I guarantee you one thing: all the yoga in the world will not fix their ill.
Ideally, we would approach all doctors broadly with a focus on mental health, burnout or not. Imagine gathering a small group of doctors in a room. You tell them to talk about mental illness. Nobody speaks. Those with mental illness will certainly clam up, while those without mental illness have nothing to say. Instead, if you tell the group to talk about mental health, it at least provides a forum to discuss things that have otherwise been considered taboo: feelings, emotions, yes, mental health.
If we treat doctors, emphasizing mental health, we can, for the moment dodge the specter of mental illness disclosure. More importantly, it gets the doctor talking. Untreated mental illness may be the biggest risk of all, more so than burnout. I have two decades’ worth of untreated depression to support this claim. Treatment only comes to those who seek it. Talking about mental health as opposed to illness, may give a suffering physician an avenue to speak to someone — anyone. It lets the affected physician know they are not alone.
That is the hope that all doctors can talk about their mental health, whether they have burnout or not, mental illness or not. Just get people talking. For now, I’d be happy if we addressed the mental health of burnout. Even if we just talk about it.
Leonard Su is a vascular surgeon and founder, Vocementium.
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