Your patient is a 35-year-old male. He seems well put
together, tailored clothes and perfectly ordered hair with just a shade of tiredness
under his eyes. His chief complaints are chronic fatigue, sleeplessness, irritability,
heart palpitations, and occasional suicidal thoughts. Or, they would be his chief
complaints, if he ever reported them. He says he’s fine, loves his job, and has
an excellent work life balance.
He lies.
But about what? Doctors are said to be the worst patients,
and that’s frequently true. Physicians don’t like going to other physicians for
a diagnosis on themselves. Sometimes it’s just stubbornness, but there are other,
legitimate reasons that a doctor might not go to another for assistance with
personal health. Fear of losing his job or medical license is a good one.
In his book Hot Lights,
Cold Steel, Dr. Michael Collins recounts his days as a resident at the Mayo
Clinic and the ways he dealt with a lot of difficult cases. The Mayo Clinic is
one of the best in the country, and it’s often the go-to destination for the
strange and severe. Throughout the memoir, Collins tends to critically ill patients
with his supervising doctors and struggles with how he himself is supposed to
cope with the trauma. The cases are varied and extreme. A young boy fractured
his femur and shattered the lower portion of the same leg comes under Collins’s
ministrations, as does a young woman with bone cancer in her leg, requiring a hemipelvectomy,
the amputation of the entire limb and half her hip. More experienced surgeons at
the Mayo Clinic advise Collins, though it’s never stated explicitly, to
distance himself somewhat and, in essence, repress the feelings of sympathy
that might impair his ability to do his job properly. Collins himself expresses
multiple times that he isn’t sure if this is the right approach, but ultimately
doesn’t have any better solutions.
For some doctors, this can work, but it isn’t healthy for
them, and it’s not the best way to relate and communicate with patients on a
human level. Being a physician means having to care about people and put such
emotion on a consistent basis. What about the physicians who can’t do this, who
can’t repress and just go on? They are out there in the profession, and they
are more numerous than most people think.
According to an NPR report from 2018, roughly 300 to 400 doctors
kill themselves every year, and, depending on which study is consulted,
physicians have a higher suicide rate than any other profession, that of 28-40
per 100,000. Women physicians, in particular, are more likely to commit suicide
than their male counterparts, though research and studies have yet to come up
with an accepted reason as to why. Actual numbers for physicians suffering from
depression, suicidal thoughts, or sheer burnout syndrome are unknown, much less
any other mental health condition. These things have to be reported, and for a
lot of doctors, having such visits to mental health professionals on their records
can disqualify them from positions. For one doctor featured in an article by
the Washington Post, a note of mental health problems would eliminate him from
contention for his license to practice medicine.
In some subspecialties, such discrimination is necessary.
Trauma surgery is a good example. When a patient’s life can be measured in
minutes, hospitals have to play it safe and hire the surgeon who’s more robot
than human, who can compartmentalize and deal with the horror, because that’s
his job to do so. However, few doctors live and work in such adrenaline-junkie
environments, and the selectiveness is less understandable for many other sectors
of the medical field. Society seems to try very hard to insist that the stigma
surrounding mental health is antiquated and must be done away with, yet that
supposedly outdated standard is still applied to the medical community.
Thankfully, some medical boards are beginning to move away from the question of
past mental illness and are more focused on current impairment.
It is an uncomfortable truth to admit that the doctors who
take care of us, who try their best to end a patient’s suffering and make them
well again, are only human. Patients want a hero. They want iron men (or women)
who have the answers and provide order to chaos. To be the best physician,
though, a practitioner needs empathy. They can comprehend their patient’s pain,
and they can be affected by the stresses of the job, just like anyone else. The
question that plagues the medical community is how best to end the stigma around
mental health for physicians and provide the help and support that a lot of
them so desperately need.
Quiz Questions:
1.
Where did Dr. Collins do his residency?
3.
What unspoken advice did the senior surgeons give
Dr. Collins to deal with the job?
4.
What is the suicide rate for physicians?
5.
Which subspecialty can you make an argument for
not wanting physicians with serious mental health concerns and why?
6.
Name the one quality that separates good doctors
from the very best.
DQ: What are some ways that the medical community can aid
doctors in dealing with mental health concerns, whether they come from the job
or from other areas of their lives?
Links:
https://www.youtube.com/watch?v=3lda4KyXbLE
Ooof, the fear of needles came out with this one. I really apriciated your presentation but you definatly pulled no punches. I have no desire to work with patients directly, only because I don't have the gut for it. I admire your dedication and hope you can reach your goals.
ReplyDeleteAs for your topic proper, the mentoring system can only go so far before the bad habits perpetuated by the previous generation become too ingrained. The first step would be to normalize seeing a professional or talking with someone who is prepared to shoulder the burden. Mental health in any profession is a balance, because nobody is normal by all standards.