The pedestal that’s killing doctors

Doctors are often called “heroes” – a surprisingly uncomfortable label. Physicians are already tired of being held to a higher standard than the average person; raising the pedestal is problematic. While doctors are compassionate individuals who care about bettering lives and curing illnesses, we are also human. At the end of a standard workday, we would like to live normal lives. Unfortunately, the hours are longer, and we are never permitted to “turn off” being a doctor, with dire consequences:

Approximately one doctor dies by suicide every day in the United States – the highest suicide rate of all professions.

Announcements about suicides of medical students, resident doctors, or fully licensed physicians are a regular part of the culture. While physician suicide rates are double the rates of suicide in the general population, physicians were not originally uniquely predisposed to suicide; the increased suicide risk starts in medical school. The cause is a mixture of unhealthy work conditions and toxic medical culture, both of which treat doctors as superhuman.

How many other professions expect their employees to work 24+ hours on-call regularly and to work around 80 hours in an average week? Compassion fatigue is almost inevitable. When I share these hours with people who don’t work in health care, they don’t believe me; it sounds like an exaggeration, even though it’s an exactitude. Plus, minor mistakes, uncertainties, and tardiness are criticized more in doctors than in the average person; we are expected to be infallible.

Why are doctors treated like health care robots with lower sleep requirements for normal functioning than the average human? Why are doctors punished when they make mistakes during a state of total exhaustion – mistakes they would not have made if the system didn’t expect them to be awake when they needed to be resting?

From the medical student to the fully-fledged doctor, we are exhausted every step of the way – physically and emotionally. The consequence of this is often dark humor behind closed doors. Classmates joked in medical school that they wished to receive a cancer diagnosis, a septic infection, or get hit by a car before their on-call shift, to get some guilt-free rest. These jokes are a thin veil for some truth, as the suicide rates of physicians clearly demonstrate.

Yet, our challenges are met with a lack of compassion, and we are told to solve our burnout with resilience. Physicians who are struggling get dismissed with the statement, “being a physician is a privilege”; doctors should be grateful even to have such a prestigious job despite difficulties. The “suck it up, buttercup” mentality is widespread.

Beyond the work environment is the expectation that doctors be martyrs, angels, conformists, and remain professionals 24/7.

Signs that a doctor is on vacation are met with disdain and jealous remarks about “rich doctors,” though some colleagues finance their vacations by adding to their 6-figure line of credit debt. Some may feel the need to hide their vacations because of contempt expressed towards doctors seeking respite.

Doctors are also attacked for using social media like average people. For example, a prominent MedTwitter celebrity physician was criticized for making humorous TikTok videos; humor and satire are policed even in personal time. Thankfully, the MedTwitter community defended him, with thousands deploring the censorship of doctors.

Not all physicians receive this level of community support. Even when off work, doctors are commonly criticized for being political, for doing anything edgy or humorous, and conformity and 24/7 professionalism are expected. A now-redacted journal article was widely criticized for labeling female physicians as “unprofessional” for posting vacation bikini photos on social media or for taking a stance on controversial issues such as gun control or abortion – outside of work. Everything a physician does outside work is watched and at risk of being taken out of context, reported, and possibly leading to discipline.

Can you imagine life as a doctor without being berated for tardiness that is usually out of your hands, for small and ultimately inconsequential errors, for not having all the answers all the time, for being a regular person on social media, and for deigning to take a vacation?

Even within the medical community, there is a shocking amount of stigma and lack of compassion for colleagues. I have witnessed the hypocrisy of one colleague who posted on social media about the atrocities of physician suicide, then outcasted an isolated and depressed colleague. Another doctor working in mental health has made insensitive, tone-deaf remarks about how awkward it is if a doctor openly admits having a mental illness such as depression.

We need not just display performative caring in medicine when we want to virtue-signal. We don’t need more resilience training, which is thrown at us so much that it has become insulting. We need real change within the standards of the profession, and until then, we need genuine community care.

“Shouting ‘self-care’ at people who actually need community care is how we fail people.”
– Nakita Valerio

Colleagues are fellow humans who need and deserve support and compassion outside their role as a health care robot. Instead of “performing” caring with empty-hearted tweets sharing articles on physician suicide, pay attention to your colleagues:

  1. Verbally acknowledge that you notice someone has been struggling and offer to listen if needed; the gesture alone can be significant and lead to a constructive discussion.
  2. Include colleagues in friendly workplace discussions or out-of-office social gatherings, as social isolation can exacerbate mental illnesses while a sense of community can make symptoms more manageable.
  3. De-stigmatize mental illness and normalize discussions of mental health in your circle at work; when people do not need to hide their problems, they are more likely to seek help to resolve them instead of bottling up their feelings until it kills them.

Medical students, residents, and fully licensed physicians are subjected to expectations that are inhumane. We are expected to be superhuman, angels, martyrs, and robots – but we are just human. Let us be human.

Patricia Celan is a psychiatry resident.

Image credit: Shutterstock.com

View 5 Comments >

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories