In my second year of medical school, I attended a reading by Dr. Abraham Verghese, a physician, writer, and humanist. He had just written a book, The Tennis Partner, that was about his friend and then-medical student who lost a slow battle to drug addiction and mental illness. The book was about how their relationship developed—and how he found out about his friend’s problems, then failed to act on it. The reading was poignant because of his obvious emotional involvement, and because the topic hit close to home.
How many of you know medical students, residents, and doctors-in-practice who have been depressed? Who have thought about harming themselves or tried to numb their pain with alcohol and narcotics?
Studies have shown that physicians have a far higher rate of depression, substance addiction, and suicide than the general population. Medical students start out with similar mental health profiles as their age-matched peers. During medical school, one in four medical students become clinically depressed. One in ten entertain thoughts of suicide. Despite their ready access to healthcare, physicians-in-training seek help with lower frequency than other young professionals.
Researchers have come up with various hypotheses to explain these findings, including social isolation during training and greater tendency towards perfectionism. In a New York Times op-ed, surgeon-writer Dr. Pauline Chen discussed the problems with the “survival of the fittest” mentality that is prevalent in the medical profession. While in training, who wants to be the “weak” person who seeks help? Who wants to admit they want more support than someone else, or burden others with time off or shifts to cover?
I faced this issue myself in my second year of residency. My mother died after a long battle with cancer. She had fought it for years with surgery and aggressive chemotherapy until finally she was in remission. Then, during my internship year, we found out that the cancer was back. The last few months of her life were filled with terrible suffering. She fought despite the pain because she wanted to make sure my then-16-year old sister was OK. Finally, she agreed to enter hospice care, but she never quite made it home. She died in the ICU, at age 54.
As much as my family was prepared for her death, and as much as it was welcome because it put an end to her suffering, it was a very difficult time for us. Coming back to work was much harder than I expected. Every cancer patient or critically-ill patient reminded me of my mother and her last days. I cried after every shift. I was on an emotional rollercoaster: things would seem to be getting better, then an issue with my family, or a patient, or a patient’s family, would set things off, and the rollercoaster would come crashing down.
My experience is a pretty specific example of grief and bereavement, but I think the lessons I learned are applicable to other physicians who are coping with their own challenging situations. I share them with you now:
1) Accept the support of family and friends. This may seem obvious, but I made the mistake of shutting people out and burying myself in errands and busywork just to keep occupied. Thankfully, those closest to me didn’t allow me to isolate myself, and I learned that losing ourselves in our training is never a good solution. It may temporize the pain, but will only serve to alienate us from those who care about us.
2) Ask for help. This could be as simple as letting your school, program or hospital know of your need for time off. In my case, I didn’t tell anyone in my residency when my mother got sick. I wish I had, because I would have been able to spend more time with her in her final months. When she died, I even resisted taking time off. In retrospect, I came back to work too soon. I thought I was being strong and wanted to prove—most of all to myself—that I could do it. But the result was traumatizing to me, and I probably ended up delivering less than ideal patient care. There is really no shame in admitting that we need help, whether it’s help for specific things like covering shifts, or if it’s referral to a counselor or support group. Both Dr. Verghese and Dr. Chen wrote about how silence is what leads to deadly outcomes. “Physician, heal thyself” is a mantra that fosters bravado, not compassion.
3) Recognize and help address challenges that others around us are facing. Prior to my experience, I hadn’t realized how prevalent depression and addiction are in our profession. The Tennis Partner describes a very plausible scenario that could happen to any of us. After all, if one in four of all physicians-in-training are depressed at some point in their training, it’s likely that a couple of our friends or colleagues are having problems at this moment. As physicians—indeed, as humans—we have a duty to make sure that those around us are OK.
So do your part. On a personal level, reach out to your friends. If you suspect they are in trouble, reassure them that you’re there for them and that it’s OK to seek help. Make use of student support services in your medical school or hospital. Start your own support groups if none exist. In my residency, I helped to start the Emergency Medicine Reflection Rounds (EMRR) where residents meet to discuss personal reflections and give advice and support for each other. EMRR has been successful so far, and the feedback we’ve received reinforces the importance of establishing and fostering community.
Medical training is not an easy process, but we are not alone. We can each do our part to preserve humanity, promote wellness, and approach each other, and our patients, with respect and compassion.