Many people are surprised when I tell them that I have clinical depression and anxiety.
“But you’re a successful doctor!”
Yep, that’s actually a big part of it.
Physicians have a higher incidence of mental illness than the general population, and also take their own lives at a higher rate. As many as one-third of medical students and residents screen positive for clinical depression, and approximately one-third of practicing physicians have received an official diagnosis. One survey found that up to 85 percent of physicians experienced some sort of mental health issue. Physicians also commit suicide roughly two times that of the general population, the highest rate of any profession. There is a significant loss of altruism reported among medical students when starting medical school compared to finishing it. The motivation of going into medicine to help people diminishes almost before it starts.
Why would that be? There are many reasons. Medical training and practice themselves play a huge role in these higher rates. While many people in different professions work at least 80 hours per week (which is the upper limit for students and residents), the pressure of working a 30-hour shift (also the longest allowable shift for students and residents, but can be longer for some practicing physicians) while trying to keep your patient alive can be extremely detrimental to your psyche. At the end of such a shift with no sleep, an individual’s reaction time is roughly equivalent to a legally drunk individual (even before Utah changed that level). Physicians are responsible for many auto crashes driving home after such long hours.
There is also the historical culture of medicine, that of the self-sufficient cowboy riding in on his trusty steed to save the day. Admitting weakness is shameful; seeking help is absolute heresy. Thankfully this view is waning, but still remains quite prevalent. This is compounded by the nature of medical care itself—death is still often seen as failure, even when considering that everyone dies and quality of life tends to be more important to people than quantity of life. With life being as fragile as it is, any small mistake by a physician can lead to this failure (i.e., death), causing at best significant emotional anguish and at worst a lawsuit. Such defeat can be psychologically crippling, and considering that the majority of all malpractice suits do not make it as far as trial, much of this suffering is unnecessary.
Many continue to see mental illness as a moral failing, a sign that perhaps you aren’t worthy to be practicing medicine. Fear of losing one’s medical license is a large impediment to many physicians seeking care. Two-thirds of states ask very specific questions about prior treatment for mental illness on licensing applications, leading to over 60 percent of physicians with suicidal thoughts in those states to avoid seeking treatment. Some states (including Utah) have changed the question to ask about current global impairment from a physical or mental health concern, alleviating much of this concern among physicians.
These extreme problems are leading to many physicians leaving the profession early, meaning worsening access to care for all of us and increasing health care costs. As (yet another) discussion of repealing the Affordable Care Act (aka Obamacare) proceeds based on recent court rulings, and with one in four Americans claiming health care costs as the biggest issue they face, it is paramount that we provide as much assistance to physicians for their own well-being so that they can better take care of yours.
Kyle Bradford Jones, MD, FAAFP, is president-elect of the Utah Academy of Family Physicians.