A POST I WISH I DIDN’T HAVE TO WRITE
This piece is weighing so heavily on me today.
It’s called “What I’ve learned from my tally of 757 doctor suicides” and it ran in The Washington Post on 1/13. A colleague of mine sent it to me last night. (This issue has actually been on my mind for the past few months — ever since I myself heard about a local doctor suicide and the circumstances surrounding it.)
The author of the piece was inspired to dig into the issue of doctor suicides about five years ago, when she attended a memorial service for a doctor who had died by suicide — the third doctor suicide in 18 months in her local community.
Since then, she has been on a crusade to understand this phenomenon better. Distressed medical students and doctors at all phases of practice began to contact her to share their experiences of stress, exhaustion, shame and guilt in the wake of errors, and a culture that often prizes “gutting it out” and being strong and stoic.
As it turns out, first-year medical students start out at LOWER risk of suicide than the general population, but this risk spikes during medical school and residency, and never returns to the lower baseline (Privitera et al 2017). There’s some variation in risk depending on specialization, but the fact that doctors are at greater risk for suicide is something most people don’t want to talk about.
From the article:
+ One million Americans lose their doctor to suicide each year.
+ Male anesthesiologists are at greatest risk.
+ Doctors who kill themselves often appear “happy” and well-adjusted on the outside.
+ Malpractice suits can be absolutely devastating and can set some physicians on the path to suicide.
+ “Assembly line” working conditions that focus on productivity and force physicians to see very complex patients in short slots can create a pressure-cooker situation, pushing some doctors to their limit.
+ Many doctors fear that their mental health treatment will not remain confidential, preventing them from accessing needed support.
Does any of this resonate, even a little bit? You may not be able to imagine getting to the point of taking your own life, but it’s so important to see the signs of chronic stress, overwork, posttraumatic stress and depression long before it reaches that point.
5 ways to tell if you, someone you love, or a colleague may need more support:
- You feel disconnected from your practice, lack patience and empathy, and have trouble accessing the passion and satisfaction you used to have for being a physician. These are signs of burnout and can spiral into depression and even suicidal impulses when left untreated, especially when accompanied by passive thoughts of death (e.g. “I wish I’d fall asleep and never wake up” or “My family would be better off without me.”)
- You’ve experienced a trauma at work. Maybe you made a mistake and a patient died, or you lost a patient and can’t stop thinking about what you could have done differently (even if others around you aren’t blaming you). Maybe you’re up at night, or you can’t shake feelings of dread, guilt or shame. Let someone help you with this. Time alone will not necessarily heal what you’ve experienced.
- You are facing financial or legal problems. If there’s an active malpractice suit against you, you may feel hopeless, scared, and/or unable to talk about this with friends or colleagues. You may fear the loss of your ability to provide for your family. You are human and humans make mistakes, but this essential truth can get lost when there’s a legal proceeding going on.
- You are abusing substances. This could take many forms ranging from mild to severe. It could be occasional alcohol binges that create conflict in your marriage, or a flat-out addiction that you’re hiding from the people you work with and the people you love. Secrets are destructive. Substance abuse is a common way that people manage overwhelming emotions, but there are so many other ways. Since abusing substances lowers inhibition, it can create a scenario in which a person acts impulsively to take their own life in a moment of despair or fear.
- You know that you want or need therapy, but you’re afraid your care will not be confidential, so you’re putting it off. Therapists are bound by HIPAA. If you are worried about your records being confidential within the system in which you work, find a therapist in private practice whose records are not connected in the same EMR. Pay cash for utmost privacy. Don’t delay needed treatment because of this fear — talk through your doubts or anxieties with your therapist in the first appointment.
This post is not meant to substitute for professional mental health treatment. If you are suicidal now, reach out for help immediately. The national suicide hotline is 1-800-273-8255, or you can visit https://suicidepreventionlifeline.org/ to access the online chat. If have concerns about someone you know or love, talk to them directly or involve someone you trust in coming up with a plan.
And if you’re not worried about suicide right now, but you are struggling with chronic stress, burnout or relationship issues, please get in touch with me so we can explore next steps. Don’t let worries about confidentiality or the thought that you “should” be able to power through on your own prevent you from getting the help you need and deserve.
Send me an e-mail at dobbinlmft at gmail dot com or check out the rest of my website for more information about how I work, my rates, and the types of services I offer.
It might sound strange that you could be hurtling toward burnout and not know it, but it happens all the time.
Burnout is a bit of a tricky phenomenon. You might be so conditioned to stress that you don’t realize you’re at your limit until you’re already over the edge, ready to give up on your career or run away from home (I’m only partly kidding here).
This is because a lot of us are really good at ignoring early signs of overwork and chronic stress. We set aside our own needs as unnecessary or unrealistic, or incorrectly attribute how we’re feeling to some other issue (“I’m sick again…must be the kids bringing home a ton of germs,” or “I can’t stand that patient — so entitled and demanding.”) You may actually be getting sick a lot because you are carrying around an unhealthy amount of emotional stress and your immune system is compromised. You may be ready to fire your patient because your fuse is short and your empathy supply is running dangerously low, both warning signs of burnout.
Burnout is characterized by three main criteria (thanks to UR’s Dr. Michael Privitera for breaking it down so well in his July 2017 article “Physician Burnout as an Individual and Public Health Issue”).
The examples are written in terms of what physicians or other health care professionals might encounter, but the basic criteria are the same regardless of your profession — and can even show up in the context of home if family life is what’s burning you out:
- Emotional exhaustion: procrastination of important patient/client interactions (i.e. returning phone calls), self-isolation, irritability, low mood, “short fuse.” The people in your life, including patients, family members and/or friends, are beginning to notice a change in you and might even comment on it.
- Depersonalization/callousness: distancing from patients during appointments, decreased listening & compassion, more cynicism and sarcasm when discussing patients/clients (i.e. when staffing a case or consulting with another provider)
- Decreased efficacy: low confidence, worries about ability to perform work tasks, perceived poor decision-making (which in time will become *actual* poor decision-making), decreased ability to engage in the thinking and problem-solving necessary to the job — e.g. sorting through the facts of a case, making accurate diagnoses, considering all possible differential diagnoses, and making a sound care plan.
It snowballs. At first you’re tired, physically unwell, increasingly unpleasant to be around. You start to lose perspective and so-called difficult patients become harder and harder to tolerate — you just don’t have the bandwidth. You start to question your abilities and as symptoms get worse, your cognitive functioning deteriorates. You’re so overloaded, your brain lapses into “habit memory,” and does a less effective job at synthesizing facts and information. You’re more prone to mistakes, sometimes very costly ones.
Burnout is treatable. Here are three things you can do today to start shifting out of burnout and into a more energetic and empowered space:
- Recognize what is within your sphere of control. When we are feeling lousy, it’s easy to focus on all the stuff that we can’t change (e.g. the intense demands imposed by the EMR) while ignoring very real, very powerful things that ARE within our control (e.g. how much energy you put into your notes; putting the phone away when you get home on nights you’re not on call; your mindset — what you think and how you feel about yourself).
- Make one small change to your routine. Choose one thing that’s under your power and consider shifting it. Is your Netflix habit keeping you up too late? Is the midday vending machine trip causing you to crash 30 minutes later? It may sound overly simplistic, but if you can identify one thing that’s interfering with your sleep or diet and cut it out or modify it, you may unlock some additional mental clarity and energy. Do not underestimate the power of one small change. You need to start thinking about easy ways to conserve or bolster your energy.
- Stop seeing self-care as an unrealistic or pointless exercise in self-indulgence. Ideally, self-care should be integrated into your life in a seamless way, without a side of guilt. Many other cultures do this SO MUCH BETTER THAN WE DO. And there’s a lot about the subculture of medicine that perpetuates unrealistic expectations and the value of “gutting it out.” Get creative here! I can’t tell you how often I hear people say that they can’t make time for therapy or a therapy group (which I see as one of the highest forms of self-care) but when something is important enough to you there is ALWAYS a way. True self-care may not be super comfortable or blissful in the moment…exercise, therapy, writing/journaling time, a few hours carved out to make art or music…these activities require you to push past the initial resistance, but it’s in service of a larger goal of a fulfilling, productive life.
As always, please reach out if you would like to come in for a session and strategize what burnout prevention would look like for you. And if you might be interested in joining a transformative therapy group in 2018, complete an interest form here 🙂 HINT: group is always transformative!