With the recent high profile suicides in the news, many physicians are thinking about the importance of treating the whole patient, the role of empathy in medicine, and how best to observe the way a patient may be feeling emotionally in addition to how they are faring physically. Depression is dangerous and insidious, and we often feel that we must be on high alert to identify it in those we treat.
But what do we do when we ourselves are suffering from mental issues? Says Dr. Ami B. Bhatt, cardiologist and director of the Adult Congenital Heart Disease Program at Massachusetts General, “Using an objective lens is what we do best, but it is also our shield. To turn that lens on oneself is terrifying.”
In 2017, a group of over 200 physicians responded to a survey question that read “Have you ever been depressed as a physician?” Ninety percent of the respondents stated yes! Yet when asked what treatment they pursued only 33% chose any kind of professional help. Nineteen percent coped by turning to self-destructive behaviors or self-prescribing medication, while 10% actually did nothing and just continued to suffer in silence. Many had tried multiple treatments. but a large number did nothing at first, for months or even years until they finally decided to take action, sometimes that action was self-harm. Professional help was not generally at the top of the list, or even seen as an option by a large group.
Due to the punitive nature of so-called physician treatment programs, and the presence of mental health questions on licensing, hospital privilege, and insurance credential applications, many doctors avoid seeking the necessary care. Some may not even feel they need care at all. Since the majority of doctors are overworked, exhausted, and discontent, they often don't see themselves as mentally unhealthy. They've accepted their depressed state and pretend that it's not as bad as it feels.
Denial, avoidance, and distraction are popular tactics among depressed doctors. Workaholism is the most popular (and lucrative) method of physician self-distraction. Obsessing about patients off the clock, complaining about work among peers online and at work. Internist and author, Dr. Shola Shade Ezeokoli says, “My friends and I would take online PHQ-9 [Patient Health Questionnaire] tests that showed we were severely depressed, and we would laugh and go back to work.”
Physicians do face unique circumstances in their careers that can easily lead to depression, sleep deprivation, unusual hours, board investigations, continual exposure to suffering and death. Doctors may also experience depression for the same reasons the general public does, such as marital/family problems or the death of a loved one. Yet even in these cases, the already high stress levels a physician may be experiencing at work make common depression triggers that much more likely to push someone over the edge.
Unfortunately, too many doctors still suffer from incorrectly treated or entirely untreated depression. There is a real fear amongst physicians of seeking treatment in a medical environment which often stigmatizes or punishes physicians who are open about their mental health struggle. Many doctors experience occupationally induced depression, but even those who have non–career-related personal factors that may be a cause of depression seem more likely to suffer than the general population, likely to the enormous levels of stress and self-sacrifice required by the career field.
Most dedicated practitioners, if they are brutally honest, need to be concerned about their emotional and mental health. Dr. Bhatt wisely states “As we raise the next generation of caregivers, we need a societal shift in the paradigm of our view of the physician. This is an important chapter in our story, the story of American medicine. What we choose to do next and how swiftly we do so will define whether, in the future, medicine will become an automated transaction or whether it will regain its place as a dedicated calling. This will only happen if our society reinvests in supporting the healers among us.”
Emerald Coast Medical Association understands the unique stressors of medical practice. Having peers to support you who share your passion and drive can help relieve some of the emotional burden of being a care provider. We have a close-knit group that provides a network you can trust to encourage and help you in hard times. We encourage all local practitioners to join us and get involved in our thriving community. We are stronger together.
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