This piece is part of in-Training Mental Health Week.
Most medical schools across the United States have free counselors, wellness seminars, group talks and other resources available to students. Students are encouraged to seek help from administration if they need it, whether for classwork, work-life balance or stress. Despite the maelstrom of lectures, plenaries, meetings and extracurriculars, there are people willing to help students at every step. Administrators are accommodating of students in a way that is not always as present during undergraduate education or in the workplace. It’s not difficult to see why — medical school is likely the hardest thing a student will do in their life and the support is direly needed.
There is another reason wellness is now stressed so heavily in medical schools, and it is one that is not often talked about — physician suicides. As many as 400 physicians commit suicide each year. That is equivalent to four medical school classes who take their lives every single year. Physicians suffer from depression at approximately the same rate as the general population, but commit suicide at nearly twice the rate as the general population. Doctors also commit suicide at higher rates than any other professional or academic group.
The studies investigating physician suicide rates suggest that while a significant number of doctors suffer depression, many do not seek treatment because of the stigma associated with it. Medical students may find this shocking. Health professionals should know better than anyone that depression and related mood disorders are diseases. We study these diseases in medical school, attempting to understand the chemistry, biology and anatomy of our brains to better understand what can go wrong. Why does the stigma still persist in a field that really ought to know better?
One answer is our constant pursuit for perfection. Matriculants to medical schools are some of the brightest men and women in the nation and medical school is one of the most stressful times in our lives. An ungodly amount of material is thrown at us, and we are expected to memorize all of it for a single eight-hour exam at the end of our preclinical years that will determine what we will do for the rest of our careers. Want to be a neurosurgeon but only scored a 210 on Step 1 because you were sick and your dog died? Sorry.
The overwhelming amount of work and stress doesn’t end after medical school. Residents work long hours and many times are helpless as their first patients suffer and die. Hospitals have recognized how overwhelming residency can be and have capped work hours to 80 hours a week. This change is meant to reduce resident errors and to prevent long work hours from taking a toll on doctors’ physical and mental health, but residents may end up working longer hours anyway to prevent the wrath of their attending physicians (because they worked longer hours when they were residents and kids these days are lazy and entitled) and or to keep caring for someone, because patients don’t get better on a timetable.
Residency programs offer counseling, wellness seminars and activities just as medical schools do, but medical students and residents often rely on the excuse, “Who has the time for that?” Two hours spent in counseling is two hours less studying, or sleeping, or spending time with a partner or family. It’s not surprising that these well-meaning interventions leave many doctors falling through the cracks anyway.
Between residency and becoming an attending physician, seeking help seems to become even more taboo. Osler wrote in his 1906 address “Aequanimitas” that, “in the physician or surgeon no quality takes rank with imperturbability,” and physicians across the nation seem to have taken this to heart. They work long shifts well into their careers, at both hospitals and in private practice, to treat as many patients they can. Any sign of weakness is not just a failure of self; it is considered failing the patient.
For the sake of their patients doctors put away their personal problems, not to mention the heartbreak they experience seeing many of their patients die. For their patients’ sake, doctors feel guilty taking lunch breaks or leaving after their shifts are over because while they are gone, the patients are still in pain and their families are still worried. Seeking help for themselves means admitting defeat or weakness, and thinking they can’t do right by their patients because of their own shortcomings can be the worst feeling in the world.
Does it seem like doctors should stand up for themselves? After all, they can’t do right by their patients if they’re not taking care of themselves too, right? If you think this, remember why you are in medical school. We’re all here because we’re answering a calling. Once we enter the workforce, it can become very similar to a hostage situation where the doctors are both the kidnappers and the mediators. “If you don’t get everything done on this shift, the patients in 301, 302, and 303 are gonna get it!”
Even post-training, doctors’ lives are riddled with stress. Shame and fear of losing one’s career has created one of the many ironies of working in health care, putting a doctor in the position of not being able to receive care themselves. Remember the immense pressure you are under as a medical student. Imagine that pressure when patients’ lives are on the line. Now remember that most doctors cannot or will not seek help if they are depressed, if they feel overwhelmed, or if they need a day off. Imagine your classmates and future colleagues suffering in silence rather than let down their patients or jeopardize their careers. Imagine that they might one day succumb to those pressures and become one of the many physicians who commit suicide. This is a problem that needs to be rectified immediately, beginning with our medical school classes. Wellness seminars will only take you so far, and it is time to open up a dialogue concerning the pressures we will face and the steps we can take should any one of us consider taking our lives.