The culture of silence works against medical professionals’ wellness

This excerpt is adapted from Stress in Medicine: Lessons Learned Through My Years as a Surgeon, from Med School to Residency, and Beyond.

I will never forget the moment when I learned that a longtime physician friend had taken his own life. My friend was younger than I, had been in practice for five years, and was married with a loving family. The last time I saw him, we shared funny stories, and he was excited to show me his new car. He appeared and sounded well. There was no indication that he was having a difficult time.

Six months later, I was driving home after a long day in clinic when I received an urgent call from a mutual friend who shared the news. I was shocked and in complete disbelief. My friend was a wonderful person, full of potential, with so much more to give to the world.

Medical professionals face uniquely challenging pressures. Our work itself is extremely demanding, and always has high stakes for those we care for. External circumstances that impact our work carry uncertainties that add more stress. Constantly feeling targeted as the financial solutions to greater health system issues compounds our burden.

While some choose to talk about their struggles openly, many stay silent and suffer in solitude. There is reluctance to share for fear of being judged negatively in some way. This culture of silence is harmful, and it works against medical professionals’ wellness. It is time that we address our difficulties head-on.

The struggle is undeniable—and so is the stigma 

Many say physicians are a privileged group, that we are fortunate to have had the opportunity to go to school and achieve, to earn the money we do, and to live comfortably. In these same conversations, however, professional and personal struggles, sacrifices, resilience, and grit in our commitment to care for others are rarely acknowledged in any meaningful way.

Instead, we are represented as currency on political balance sheets with concerns for public opinion seemingly leading all decisions. Publicly funded health systems often devalue our work with every fee that gets cut, with every resource that gets restricted, with every demand for us to do more with less, over and over and over again.

All the while, counterparts in the private sector work in financial models with relatively less oversight since they are not funded by public money. The uncertainty that our best interests will be protected justly by the very systems we serve continues to build and becomes harder to shake.

A 2019 article in the Canadian Medical Association Journal notes that “suicide is an occupational hazard for physicians” and that it is “the only cause of mortality higher in physicians than in non-physicians.” The article goes on to note that “increased suicidal ideation begins in medical school,” and it says, “In a recent meta-analysis, the prevalence of suicidal ideation among medical students was 11.1 percent. In analyses subdivided by time, 7.4 percent of students reported suicidal ideation within the past two weeks, and 24.2 percent within the past year.”

It’s clear that medical professionals are struggling with a host of unique challenges. Yet stigma often discourages us from seeking professional help for mental health concerns. The stigma is often due to a lack of facts and understanding. In our world of medicine, however, we are introduced to mental illness as part of formal curriculum in our undergraduate medical education. We know the facts of these conditions, as well as the associated challenges they may bring. As colleagues with knowledge and insight, we must encourage one another to seek support.

We need to protect each other

When we talk about physician wellness, our innate culture of silence about professional and personal challenges works against us. Remaining silent will not help physician well-being. It will not help reduce physician overwork and burnout. It will perpetuate physician disconnection and poor mental health.

Unless medical students, residents, physicians, and surgeons share our challenges and experiences with fellow colleagues, support one another, and remain united in our voice, external factors will continue to diminish the value of the work we do, and in turn, impact our wellness. However, to speak your truth can be challenging. You are amongst highly accomplished colleagues where sharing your most difficult and painful moments may bring fears of being judged as weak, incapable, difficult, or rebellious as examples, any or all in combination. The reality is that we all face significant challenges at one point or another—we just don’t talk about them.

When you choose not to share, dismissing challenges and the associated stresses can become a pattern of avoidance. As you avoid these challenges, your stress will continue to build, as complexities continue to evolve in the interim. Over time, stress can manifest physically, emotionally, cognitively, or behaviorally.

When stress feels manageable and causes little disruption in your daily life, social supports such as friends, family, colleagues, and other social networks can be helpful in getting you through. When stress feels overwhelming and does begin to interfere, however, you may benefit from seeking professional support from a mental health provider.

Openly sharing our challenges is essential for well-being for ourselves, our families, our patients, and the health systems within which we work. Commit to speaking up, either to your peers, mentors, family, friends, or mental health professionals. Speaking out isn’t a sign of weakness. In fact, it’s the first step toward developing mutually empowering frameworks that may actually serve to improve our health system overall.

Reject the culture of silence

Along with challenging our culture of silence within medicine, we must openly reject the stigma surrounding mental health concerns and be supportive of those who seek help. We should not be afraid to reach out to trusted relationships for the kindness, understanding, and social supports we need.

Feeling heard and supported builds interpersonal relationships, which ultimately improves your personal wellness—and transitively, that of your patients.

Nina Ahuja is an ophthalmologist and author of Stress in Medicine: Lessons Learned Through My Years as a Surgeon, from Med School to Residency, and Beyond.

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