significantly under-estimated number. To put that in perspective, the University of Louisville School of Medicine( U of L SOM) has roughly 620 medical students. If 400 physicians die of suicide per year, that’ s like losing almost 65 percent of the SOM students to suicide, a preventable cause of death. When physicians die, patients also suffer because they lose their trusted doctors. There are thousands and thousands of patients who lose their physicians to suicide each year. These are bone-chilling statistics and should spur us to try to solve this problem better.
Though physicians are proficient at recognizing and treating depression and anxiety in our patients, physicians are often underachievers when it comes to recognizing, acknowledging and seeking treatment for depression for themselves and colleagues. Physicians are intelligent, successful and sometimes egotistical healers who often have a hard time admitting to and recognizing vulnerability in someone besides their patients. A physician may feel that he / she needs to maintain a façade of physical and emotional machismo at all times, even if slowly falling apart on the inside. Many of us feel the need to shrug off our depression and insecurities, keep a smile on our faces, and never let anyone know that we are struggling. For the sake of our own health and our patients’ health, this is unacceptable.
The National Institute of Mental Health reports that the lifetime risk for depression in the general population is around 12 percent in males and 18 percent in females. In a review article on depression and suicide in physicians-in-training, Drs. Bright and Krahn of the Mayo Clinic note that rates of depression in medical students and residents are higher than the general population, ranging up to 30 percent. After residency, the risk of depression in physicians is still high but more comparable to the general population, with rates of depression in male physicians being 13 percent, and 20 percent for female physicians. However, as physicians are far less likely to admit to being depressed, these numbers are grossly under-estimated.
Untreated depression in physicians can lead to significant risks including minor and major medical errors, erratic behavior, and interpersonal conflict in the workplace. It can wreak havoc on both a physician’ s personal and professional life. Simply put, unrecognized and untreated depression in physicians is dangerous for patients, and significantly decreases doctors’ quality of life.
Even without depression as a complicating factor, physicians have stressful lives that can cause significant psychosocial stress. Each stage of training and practice has its own set of challenges. Medical students are required to absorb and retain exorbitant amounts of information throughout medical school. Most medical students and physicians are, by nature, high-strung and tend to have perfectionist“ type-A” personalities. That alone increases their risk of significant anxiety and depression. Often, medical school provides these bright, achievement-oriented individuals with the first venue in which they fail or at least struggle to stay afloat. I remember feeling terribly overwhelmed and depressed through parts of my
Headshot of Dr. Drew for the 2017 GLMS Mug Book
own medical school career and wondered if it was really worth continuing my medical education. I know I was certainly not the only one who felt that way.
Residency provides a new set of challenges for physicians-in-training who“ magically” went from having relatively minimal responsibilities as fourth year medical students to literally having patients’ lives in their hands as interns. The stress of the new responsibility of relatively independently caring for REAL patients, particularly at 0200 when a patient is crashing and when supervising attending physicians are often at home, is frightening. The fear of making a medical mistake that could cause harm to a patient or even cost a life is very real and can invade one’ s much-needed sleep. The work hours, while better than they used to be, still keep residents away from their family, friends and other support systems. As a result, they often miss out on the social aspect of their lives outside of work, not to mention necessary and rejuvenating sleep. I’ m not an attending physician yet, but I hear that it has its own set of challenges that I will learn about in exquisite detail after I finish residency.
If mental health problems are acknowledged, still there are significant barriers to seeking treatment. Barriers may include fear of“ getting in trouble,” fear of losing clinic / hospital privileges, inadequate time to seek professional care, and minimal time for self-care. We encourage good self-care, including proper nutrition, exercise, socialization, spirituality / religion, etc. in our patients, but it is something that many physicians ignore in their own lives. One is never the same after witnessing some of the incredibly sad situations
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