Physicians and the psychological trauma of COVID-19

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In April 2020, Dr. Lorna Breen, an emergency medicine physician from New York-Presbyterian Medical Center, came to the University of Virginia Medical Center, not as a physician, but as a patient. She had been working at the height of the COVID-19 epidemic in Manhattan, and was staying with her family in Charlottesville when she committed suicide. Her father described her as a hero killed by COVID-19, another casualty in the war against the disease.

The psychological toll the virus has taken on my colleagues is great, but we are not ready for the second wave of casualties — we are still waiting for the first storm to pass. COVID-19 is to the American health care system as Hurricane Katrina was to New Orleans. New Orleans was an unstable city long before Katrina hit. It took a massive natural disaster to bring New Orleans into the public eye. Katrina drew America’s attention to the city’s endemic poverty, racism, and our government’s inept response to the catastrophe.

New Orleans was constructed on a piece of land between two lakes, under sea level in the middle of the path of America’s hurricanes, protected by levees. America’s health care system is constructed between state and federal governments, under insurance and pharmaceutical companies, in a system that profits from Americans being unhealthy. Katrina hit New Orleans with such force that the levees failed and the city flooded; the deluge of COVID-19 patients into America’s hospitals has turned the nation’s attention to our existing endemic disparities in care, overworked and underpaid workforce, and our government’s inept response. But in the case of COVID-19, the levees are physicians and not concrete walls.

Physicians start becoming levees in medical school. Along with the Hippocratic Oath, we may take out hundreds of thousands of dollars in loans and begin years of studying, testing-taking and clinical rotations that take us away from the people and hobbies that once gave us the emotional strength to excel. Residency then brings greater responsibility, longer hours, a steeper learning curve, and more personal sacrifice. Despite debt and personal stress that compounds endlessly, we prop up America’s hospitals with great resilience.

Unlike our inorganic concrete levee counterparts, physicians are human and susceptible to illness; particularly mental illness. Medical students enter training with similar rates of depression and anxiety as their non-medical peers, but reach rates up to 56 percent, far outpacing them. Resident physicians suffer from depression, burnout, suicidal ideation, and suicide attempts more than other age-matched college graduates. An estimated 300 to 400 physicians commit suicide annually, and female physicians are 1.6 times more likely to die by suicide than males. This is an unsurprising truth to us female physicians, all too familiar with the added stress of workplace gender disparities in medicine.

Despite this, practicing physicians and residents reluctantly seek care. Physicians face heightened concerns related to personal and liability insurance from disclosing mental health diagnoses and discrimination from their peers in the medical system, resulting in a physician workforce rife with mental health needs. Studies show surgeons are up to three times more likely to consider suicide, yet less than 30 percent seek psychiatric help. In true physician form, we readily counsel our patients to seek psychiatric care but are reluctant to seek it ourselves, even if our ability to safely care for our patients and ourselves is compromised without it.

Fearful of professional repercussions, we physicians who do seek care can find the experience exceptionally guilt-ridden and isolating, needing reassurance that asking for help is acceptable and does not imply weakness. I fear for my colleagues who are suffering from untreated mental illness, unable or afraid to seek care. Dr. Breen reportedly had no history of mental illness, and was described as gregarious, outgoing, and extroverted. I can describe many of my colleagues the same way – but are they levees about to break?

As COVID-19 devastates America and the world, I hope that fundamental change to our health care system results from its horrific exposé. Without COVID-19, the pressures placed on physicians are already immense. In the age of COVID-19, these pressures are proving to be insurmountable. Being a physician is difficult, but it does not have to be deadly. Physicians deserve proper stigma- and repercussion-free mental health care as much as they deserve proper personal protective equipment. By definition, a hero is the offspring of a god and a mortal; if we physicians are to be known as heroes, we deserve to have our human mental health care needs met.​

Sarah Bridge is an emergency medicine resident.

Image credit: Shutterstock.com

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