Quick thoughts on Physician depression and suicide. Re: Why Do Doctors Commit Suicide?

I read a blog post this weekend: Why Do Doctors Commit Suicide?  Anytime I see another physician talking about physician depression and suicide I have mixed feelings. I am sad to see this situation effecting so many others.  However, talking about it also brings us one step closer to finding a real solution for a positive culture that allows great physicians to flourish and best serve their patients.  Talking about it is the first step.

400 doctors suicide every year. That’s a little more than one doctor a day. Doctors are also TWICE as likely to suicide than non-physicians and female doctors are three times more likely. We heard these statistics recently during a lecture on depression and they are again repeated in the above post. I was so shocked to hear these numbers, but when I think of our culture I’m not entirely surprised.

In addition to this, recent studies have shown that doctors with poor work-life balance and burnout have poorer patient outcomes.

If you’re feeling sad/exhausted/inadequate, you’re not alone – I think we all do or have at some point. Talking about that is important to validate the feelings of ourselves and our peers.  You’re not a bad doctor because you don’t know every answer at any given moment ever, with or without food, sleep or using the bathroom. 

Are we able to admit at this point that there is an issue? If so, what do we do?

All fingers point towards an overhaul of the culture. Yet we continue to hide our feelings of inadequacy, we hold ourselves to an unattainable level, and then expect these things from the students/residents under us, perpetuating the cycle. We use our own personal experience of this negative experience as evidence to perpetuate the situation.

How often have you heard, “Well, when I was a resident we did ____ and survived.” or “If I hadn’t been forced to give up that year of my life, I’d never have been as good of a doctor”. Can you truly say that? You definitely learned during that experience, but why could you not have also learned all that information in a less intense, more supportive situation and with more sleep/self-care?

A few recent opinion articles argued that with the new hour restrictions, the interns know less information, are less efficient and/or aren’t available for training. I argue that 1) we haven’t adequately changed the way we are teaching to compensate for the restrictions AND 2) they likely still gain the same level of knowledge and efficiency over time. They are still held to the same standards to hold a job, and have to pass the same board exams.  Also, the hour restrictions are only during one year of training.

While it may take more effort and time for training, it is also less damaging and more sustainable in the longterm. Fostering self-care in physicians as residents may spill over to the rest of their career. Confronting these issues may actually save the lives of some physicians, as we are losing 400 a year to suicide.

400 doctors a year! Consider how many people were in your med school class and residency. That’s a lot of much-needed doctors. Plus this doesn’t count how many doctors quit practicing or quit residency because of burnout (sorry, I don’t have those numbers off hand). 

There are many things that go into being a good doctor. There are many paths too and they don’t all involve 96 hour work weeks and never admitting exhaustion or lack of knowledge.

We are not super-people, we are just people who wanted to help others and have been given knowledge and training to do so.

Posting this now, I still feel like I’m a bad doctor for saying these things (I’m not lazy, I swear. I work a whole bunch of hours more than most all careers and am studying in my spare time, just like everyone else). I know that the doctor guilt I feel for talking about these issues won’t go away anytime soon, but I accept it and I’m posting this anyway.

Why? Because I truly believe that we need to talk about it and that the current medical culture is not healthy for doctors or the patients we serve. There, I said it.

I wrote about this awhile back: Dr. Guilt and the Physician Burnout.  As always, I know this is controversial stuff and I appreciate your kind opinions. There is definitely no specific right answer, I just want to talk about it and get the conversation started.

 

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