Tuesday, September 9, 2014

MiM Mail: Physician depression and suicide

Dear Mothers in Medicine,

Long time reader here and new resident now (2 months in and there's no lookin' back). I was struck by the recent heartbreaking op-ed onphysician suicide in the New York Times. It was especially poignant to me because I'm at the same place in my training as the residents who took their lives. Each night I go home and think about my patients, but I also find myself worrying about my friends and colleagues from medical school in more grueling and less understanding specialities than my own. I know intern year is rough for us all, and I hope they are doing okay. And I'm terrified because I'm a female physician who's struggled with depression in the past (not currently) and I know the grim statistics on female physician depression and suicide rates.

What have you done when you've seen colleagues struggling? How do you handle your own struggles in a field that often overlooks the deep mental and emotional toll this work takes on a person?

- J the intern


  1. I read that article too. More and more articles like that are out there these days. I too have struggled with depression from time to time - never taken medicine because I convince myself I'm fine at the time but in retrospect I can see it very clearly - I'm different, more withdrawn, hate writing, everything seems really really hard and all I want to do on weekends without kids is curl up in bed with endless novels (This happened a lot after my divorce). I did all right in medical school but I wish I would have plugged into counseling earlier in life than I did - waited until two years out of residency on the verge of divorce. There were many opportunities for free counseling during residency that friends plugged into and found helpful but I never did - there didn't seem to be any time.

    In retrospect I would have found the time.

    Good luck to you J the intern find the good in medicine it's out there don't let the bad drown it out. I think I've managed to do a pretty good job of that but there are bad days for sure. Close friendships with co-residents and now partners is a key factor in my sustenance. When you can vent and share about the frustrating and gridlocking aspects of the system - residency, medicine in general - it helps a lot.

  2. I talk about it. When I read that piece and saw the "me, too" moment, I remembered a dinner one night with a bunch of women from my residency - after the second bottle of wine was opened, we started sharing stories and I realized I wasn't the only person who had cried on rounds. Every one of them had. Now - almost 30 years after that night - I try to make space for those conversations with my partners and my learners. And yeah, I wish I'd found therapy before I did, too. Regular therapy appointments, massages, time with friends - it all helps, and it took me way too long to realize I had to make time.

    Paradoxically, going to work in a hospice program made it easier to cope with the grief and guilt and emotional wear-and-tear of medicine. We have conversations about loss all the time, and the normalization really helps.

  3. Use the Employee Assistance Program (or equivalent) at your institution and get the free counseling. They usually have nighttime hours for those of us with longer workdays. And spend a little time NOW at the beginning of your training thinking about your personality and what makes you tick. You need to come up with some self-care go-tos for when you're feeling bad. For me, I journal, I take walks, etc. Experiment with some types of self-care when you can and see what works for you.

    Eat as well as you can and sleep as much as you can.

  4. This is a topic very close to my heart - thank you for raising it. It troubles me greatly, even angers me, that we work in a system that does so little to support their staff. I have long heard many stories of how well supported pilots and the military are, and feel strongly that healthcare workers require the same. Compassion fatigue, burnout, vicarious traumatisation - all catch phrases bandied about to try to describe the feelings we often deal with, but at the end of the day, call it what you will, we need to have a more open culture that doesn't blame the doctor for 'not coping' but rather acknowledges, and more than that, actually teaches healthcare workers how to recognise, avoid, deal with the repercussions of the work we do. The very qualities that make us good doctors place us at risk of burnout. If only we could all have a 'me too' moment, perhaps there would be less of us feeling isolated in what is otherwise a wonderful profession. I've never had depression, but like Gizabeth, have found myself withdrawing, finding everything too hard, lost my interest in other things and generally feeling despondent. I try to reach out to junior doctors, to help them know such feelings as you describe are normal, to accept the gravity of our work places us at risk, and especially to new mothers trying to pretend that pregnancy, breastfeeding, sleep deprivation and longing for their little one must be hidden in order to soldier on and prove how clever/hardworking/committed they are to their jobs. For me, I try to recognise when I'm reaching too frequently for a glass of bubbly, when I'm snappy with the children, or my husband, that my buckets are full and I need to take a step back. I second using EAP - something I failed to do, but wished I had. I hope with more conversations like these, we will hear less stories like those.

  5. I think we need to acknowledge the elephant in the room that nobody wants to talk about: Sometimes doctors treat each other like garbage. It's not just that we're overwhelmed and sad by all the emotionally wrenching things that we see with our patients from day to day. It's also that we work with some pretty malignant co-workers some of the time. I can't tell you how differently I feel after working a week with a resident who treats me like a person vs. one who... doesn't, but it is palpable. Yet, it's somehow only socially acceptable to say that we have sadness because of our patients rather than sadness over how we're being treated by our colleagues. Thankfully since becoming a resident I've been lucky to work with mostly wonderful people, however I know -- having survived medical school -- that won't always be the case, and I dread those rotations.

    1. Wanted to add that the solution isn't just to "get counseling," it's to perpetuate a positive culture in your hospital where it is not ok to like that.

    2. Absolutely! A million times yes! The power hierarchy, the negative culture, being spoken to in a way that a person down the street would never do, the silent treatment, the disapproval. As a hard working, competent, loyal, committed doctor, who puts the patient and the hospital over and above myself, I can not fathom why I have to accept that being devalued is part of the culture of medicine. It doesn't happen in every program, but it's still pretty much endemic to medicine. It's a big part of my recent decision to move programs. Sadly, it's not just medicine. I think the legal profession fights the same culture.

    3. Oh, and I'm sure we've all worked with the competitive colleague, the boss pleaser, who keeps information to themselves and never misses an opportunity to stand out, all the while trying to make you look bad. What is with that? Aren't we all here for the same purpose - to help and nurture? Doesn't that include each other?


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