Some memories are engraved in the psyche of doctors. The sound of the locator. The return home half asleep with the hazy memories of a call. The strangest objects found in human orifices (a cockroach in the ear). The largest number of hours spent awake without interruption. Bringing our first baby into the world, watching our first patient die. All of these are rites of passage. I’ve found that it’s easy to talk about the funny memories, but the disturbing ones are more difficult. Even with the closest of friends, recounting the hardest moments feels like transmitting a burden to them.
My shifts in the pediatric emergency room during my three-year residency were a walk through all the stages of desolation for me: a 15-year-old patient needed a rape kit. A 3-year-old baby tested positive for methamphetamine, which her father used. A man dipped the feet of his 6-year-old son in boiling oil. I once had two children die within six hours of each other. After each death, I wiped away my tears, took the file from the next patient, and continued with my consultation. The culture of medicine discourages doctors like me from crying, sleeping, or making mistakes. And what is worse, we are even punished for seeking mental health care.
Even before the COVID-19 pandemic, mental health issues were an occupational hazard for physicians. A systematic review and meta-analysis published in 2015 in The Journal of the American Medical Association found that, broadly speaking, the 29 percent of medical residents suffered from depression or depressive symptoms. To contextualize, from 2013 to 2016, eight percent of Americans age 20 and older suffered from depression within a two-week period. In a study published in August 2019, 16 percent of emergency room doctors met the criteria for a diagnosis of post-traumatic stress disorder (PTSD). The pandemic seems to have made things worse: A survey conducted in the fall of 2020, which was presented to the American Psychiatric Association, suggested that until 36 percent of doctors on the front lines of care suffered from PTSD.
Among physicians, there are also a high risk of suicide compared to many other professions. It is estimated that Between 300 and 400 doctors commit suicide in the United States each year., about a doctor a day. Last year, authorities at a hospital in New York confirmed that two doctors in his residency program had committed suicide a few months apart.
During their residency, doctors don’t sleep, go hungry, are told all the time they’re not good enough, and work a torturous hundred hours a week while racking up six-figure debt. Resident physicians typically work weekends and holidays, often with only four days off a month. In general terms, the regulations of the Accreditation Council for Postgraduate Medical Education it does not allow medical residents work more than 80 hours a week on average over a four-week period, but some residents feel they must lie on their time sheets to avoid scrutiny.
In the cutthroat culture of medical education, it’s OK to embarrass students in public; The practice of quizzing residents or medical students with quick questions in front of their colleagues and patients is called “pimping.”
Despite grueling experiences, doctors who seek mental health care are often stigmatized and hindered by the medical profession. Until last spring, the medical boards of 37 US states and territories they asked questions that could require a physician seeking a license to practice medicine to report any mental health treatment or illness. These questions can be invasive and too general.
Checking those boxes might seem like a risk to everything we’ve worked on for years. It can cause personal medical history to be reviewed by the medical board, psychiatric and drug testing to be conducted, and even medical license to be reviewed, suspended, or revoked, all under the guise of determining our professional competence. Questions have a chilling effect on doctors. In a 2017 article, around 40 percent of doctors said they are reluctant to seek mental health care because they were concerned that their chances of obtaining or renewing their medical license might be jeopardized. On a 2016 survey of female doctorsNearly half said they believed they met the criteria for a mental illness but avoided seeking medical care, in part out of fear of licensing and de-licensing boards.
When doctors work up the courage to seek help, they may have to do so in the very hospital where they work, where they can be recognized by patients and colleagues.
Glen Gabbard, a clinical professor of psychiatry at Baylor School of Medicine, has spent much of his career treating physicians. He explained why his medical patients have a hard time admitting they need care: “You’re supposed to know everything in a life-threatening crisis. You can’t hesitate,” he explained.
Gabbard noted that one of the ways doctors ask for help is through a quick consultation outside the office. A friend may stop you in the hospital cafeteria and ask for a quick prescription for Prozac. Doctors are not only the worst patients, we also tend to have little time and sometimes we give our colleagues terrible care. According to Gabbard, these consultations are sometimes rushed, and some psychiatrists tend to rely on the medical knowledge of their colleagues.
All of this has contributed to creating a kind of underground market for mental health care. There is an unwritten rule: if you have to seek mental health care, you have to be discreet. Look for a therapist outside of your city that documents only the minimum in your history, pays only in cash and does not let your insurance company be charged. Make sure you don’t leave any traces.
As we enter the third year of the pandemic and approach one million Americans dead, it is time for the American healthcare system to recognize the consequences for its doctors and what it owes them. The last two years have been characterized by violent attacks against health professionalsaccompanied by strenuous working hours, sicker patients, limited payments of occupational risk premiums and family sacrifices. A survey conducted in the second half of 2020 revealed that around one in five doctors were considering leaving the practice within two years. Perhaps the saddest thing is that the doctors we often lose are just the ones we need: the kind ones you want to hold your mother’s hand, the attentive and meticulous ones who call you on their day off.
The quickest and easiest remedy to this problem is to remove questions about the mental health of the physician from state license applications and hospital accreditation forms. This would require a fundamental paradigm shift for the medical community. Other solutions include more time off for doctors, comprehensive paternity leave policies, and adequate compensation for occupational hazards.
A former colleague advised me not to write this essay. My palms feel sweaty as I do this. But I’d rather be the confessing doctor than the one drowning the memories of dead children in bourbon bottles or fentanyl syringes. This essay is not brave; it is foolish, but necessary. It is time for all of us to accept that we doctors are worthy of the same compassion that we give to our patients.
We, as doctors, are witnesses of the most bitter and glorious moments of humanity, so it is natural that we feel deeply moved and sometimes dismayed by it. Acknowledging this vulnerability is not a weakness. It makes me a better doctor. It’s what allows me to hold a patient’s hand under the fluorescent light of a sterile hospital at midnight, or gently brush coagulated blood from a strand of hair from a baby.
I don’t have all the answers, but I can’t continue to watch my colleagues suffer. That doctors dare to show their humanity must be above the coldness and indifference of the forms of a medical institution.
Seema Jilani is a pediatrician, humanitarian aid worker, and Fulbright Scholar.