BusyMamaMD

It was 5:00am and pitch black except for the dim parking garage lighting.  I sat in my car, breathing in and out slowly, trying to will myself to get up and go into work.  I wanted to cry, but I was beyond crying.  I was too defeated, too exhausted.  I didn’t remember the last time I saw the sun.  My routine was work, sleep, work, and sleep.  My husband and I barely saw each other and it seemed when we did, we were fighting.  I was too tired to do anything and he spent a lot of time alone.  We had moved to this town not knowing anyone.  It had been 6 months since I had seen the rest of my family.  I was a resident; a physician in training and trapped in a life from which I could not escape.

I knew I had to walk into work and put on my happy, energetic face.  I had a long list of patients to see, notes to write, surgeries to perform, presentations to make, and things to study.  I was not allowed to be too tired or sad or even less than perfect.  No one expects anything less than perfection in medicine.  I was overworked, but complaining would label me as a whiner.  They would say I was not a team player.  I could not admit I was depressed.  No, I had to march on; pretending like everything was not crumbling around me.

Why didn’t I quit?  I did not have to be a doctor.  Here’s the catch.  I did.  By the time one is a resident, he or she has racked up a considerable amount of debt.  The average medical school tuition is 35,000-50,000 a year for four years.  Since medical school is a full time job, most students also take out loans for living expenses.  Most of us needed loans for housing, utilities, car payments, food, clothing, and well, everything.  Then, the interest just keeps growing throughout residency training.  I had over $200,000 in student loan debt.  What would I do if I quit?  I was not qualified to do anything else other than medicine.  So, I trudged on.

I survived, but many medical students and residents do not.  Suicide is too common among physicians in training.  We talk about “burnout” and “stress relief” and “meditation.”  That’s not the issue.  The system is the issue.  Residents are overworked, underpaid, trapped, and held to unrealistic expectations.  When someone is depressed, it is taboo to talk about it.  People are taught to suck it up and push through.  People are taught they cannot make a mistake.  It is time we start talking about this.

Between 300-400 physicians commit suicide every year (Guille 2015).  Physicians in training, such as residents and medical students, are at the highest risk.  Research has shown that suicidal ideation increases at least 4 fold during the first three months of intern year (Guille 2015).   In the United States, 28% of residents experience a major depressive episode during training, compared to only 7-8% of similarly aged individuals in the U.S. general population (Mata 2015).  It is estimated that 23 percent of interns had suicidal thoughts (Guille 2015).  Medical students are not immune either.   It is estimated that 27% of medical students are depressed and over 11% had suicidal ideation. (Rotenstein 2016).   This is unacceptable.

We as physicians need to end the cycle.  I believe duty hour restrictions are a good idea and an idea that should apply to attending physicians as well.  Where does it state that a doctor needs to work inhumane hours in order to be a good physician?  We need to be kind to one another and our trainees.  Mistakes happen.  We should learn from them and not place blame.   Debriefings and meetings after poor outcomes need to be educational and not punitive.  Tuition is out of control and needs to be addressed.  We need to erase the stigma of physician mental illness.  Every hospital credentialing form or licensing application asks questions about depression or treatment for depression.  Why?  This leads people to avoid seeking the help they need.  A lot of changes need to be made, but first and foremost awareness is needed.  The medical community and community at large needs to understand that physician, especially physician-in-training, mental health is a huge issue and one that deserves our attention.  We are losing a doctor a day to suicide.  We need to heal the healers.

References

Guille, C., Zhao, Z., Krystal, J., Nichols, B., Brady, K., Sen, S.  (2015).  Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns: A Randomized Clinical Trial.  JAMA Psychiatry, 72(12):1192-1198.

Mata D.A., Ramos M.A., Bansal N., Guille C., Di Angelantonio E., Sen S. (2015)

Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis.  JAMA, 314(22): 2373–2383.

Rotenstein, L.S., Ramos M.A., Torre M., Segal J.B., Peluso M.J., Guille C., Sen S., Mata DA.  (2016). Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis.  JAMA, 316(21):2214-2236.