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Doctors’ Mental Health: Don’t Wait Until It’s Too Late

Discussion in 'Hospital' started by The Good Doctor, May 6, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

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    One of our most talented residents committed suicide during my psychiatric training. I remember relaxing with him in a VA hospital call room several months before his death, laughing together at some of the idiosyncrasies of our unit attending.

    He opened up to me about his doubt in his choice in psychiatry and how he was considering a transfer into internal medicine. Having made the opposite transition just months before, I shared how happy I was in my new program.

    He was truly a star: incredibly accomplished yet friendly and kind.

    Listening to him discuss his post-college research, I felt both intimidated and slightly embarrassed to share my own decision to “work abroad” pouring pints of Guinness in an Edinburgh bar.

    During that call night, he asked if we could speak again sometime about his possible career transition, and I agreed enthusiastically.

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    Several months later, while on my honeymoon, I received a gut-wrenching email from the residency program. A few nights earlier, this co-resident had returned home after a dinner with his father and overdosed on a large amount of medication. He was in a coma, and it was touch-and-go.

    It’s odd, the little things you remember about someone when tragedy occurs. I recalled accidentally sharing some stale crackers with him during that call night and thinking how politely he ate them anyway. I also worried that I hadn’t responded to his inquiries with enough support or encouragement or maybe said the wrong thing. And like many of my co-residents, I thought how terrible I would be as a future psychiatrist if I couldn’t even sense when my friend struggled to this degree.

    Eventually, his family was told he had a very poor chance of meaningful recovery and chose to remove life support.

    We had lost one of our own, truly a death in the family. We gathered for a group memorial with his therapist and psychiatrist, who expressed their own powerful grief at the loss of their patient and future colleague. I remember admiring their composure and their willingness to face all of us and openly voice their sadness and regrets.

    This story is not unusual. I am heartbroken to read again about a fellow physician who has died by suicide. Though trained to treat depression, anxiety, PTSD and burnout, I am unable to prevent such devastating loss. How do we intervene at the most vulnerable time of a physician’s life, when death appears the only option to escape their intense pain?

    Most physicians can describe a similar loss of a mentor, colleague, or trainee. Rates of suicide among physicians have been estimated as 40 percent higher than the general population in men and a shocking 130 percent higher in women compared to their non-physician peers. We need to face the reality that becoming and working as a physician is a high-risk endeavor.

    Rather than present treatment only when individuals are clearly suffering, we need to begin with the prevention of severe anxiety, depression, and burnout. Not only will this improve the lives of our health care providers, but it will also prevent medical errors and decrease physicians leaving clinical medicine due to burnout, creating a healthier general population as well.

    I have been in practice long enough to be offered numerous “physician wellness” options, such as lunch-time yoga and snacks in the break rooms. I’ve received a bag of candy during “Doctor Week” and many cheerful emails thanking me for my dedication and compassion. Though well-meaning, these approaches do little to lessen the massive problem of physician burnout and suicide.

    Physicians seeking mental health treatment face many barriers, including time, shame, and fear of retribution at work. Additionally, medicine’s culture of normalizing elevated stress and distress as part of the physician identity, and encouragement of competition among its members rather than support and cooperation, leads to an epidemic of hidden pain and isolation.

    What if we considered a reframe? Having just completed a group coaching program with other female physicians, I am convinced of the transformative power of communion in this space. In this proactive, future-oriented program, we were able to safely speak of our challenges at work, in our relationships, and with ourselves in a safe and confidential environment. I could not have anticipated what a relief it was to hear other physicians reflect on my self-doubt, sense of failure, and feelings of disappointment in their career trajectories.

    Coaching has been utilized in the corporate world for decades but only recently has been investigated to target the growing rates of physician burnout, including a recent study at the Mayo Clinic. After receiving a mere 3.5 hours of professional coaching over a 6-month period, the physicians in the study were much more likely to report decreases in emotional exhaustion and burnout and increased quality of life and resilience. In short, coaching worked — and in fewer hours than it takes to renew CPR training.

    I have become a strong advocate for physician coaching, not in competition with psychotherapy, but as a starting point to lower risk of future distress.

    All physicians deserve the opportunity to grow and support each other, as the women in my program have done. We can no longer wait until a doctor shows visible signs of mental illness or substance abuse to intervene. Often, they never do. They keep pushing forward, putting themselves last and feeling ashamed that they are struggling.

    If we want strong, resilient physicians, we should consider a standard coaching program for all, just as smart companies worldwide provide coaching for their executives. Every physician is a leader, and they all need support as they navigate their high-risk careers safely and with compassion.

    It is powerful to recognize that others in their field, despite the appearance of constant competence and equanimity, each have their own struggles. If the brightest and most compassionate youth continue to choose a career in medicine, we need to prepare them properly to survive. We can do better for our doctors, and we certainly must.

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