Depression
by Diksha Mohapatra.
As medical students, we are hearing more about the high rates of depression in school or clinic. Physicians do, in fact, have higher rates and degrees of depressive symptoms and mental health distress than the general population. About 28% of residents experience a serious depressive episode during residency training as opposed to 7-8% of similarly aged Americans (1). Why would physicians have unique circumstances that lead to depression? They go through bullying, hazing, sleep deprivation, medical board investigations, and witnessing immense patient suffering (2). Along with the unique risk factors, they can also experience others, such as failing marriages, social isolation, spousal death, financial distress, childhood trauma, family history of depression, and others (2). However, physicians who are proactive about prioritizing their mental health can better care for patients and maintain their resilience despite their circumstances. Addressing barriers like how mental health is included in credentialing and licensing questions will lead to benefitting physician mental health and ultimately benefit patients, as well (3)
To gain more perspective from podiatric physicians, I interviewed both Dr. Monara Dini (MD) and Dr. Chuck Starrett (CS) who graciously agreed to shed more light on their experiences.
Interviews
Q1: Did you ever feel stronger than usual sadness or fear of making mistakes?
MD: “Yes. Fear of making mistakes with certain diagnoses’ and surgery.”
CS: “No, because I practiced well within my capacity and level of training. I didn’t take risks.”
Q2: Did your physical health, relationships, and ability to sleep soundly ever become difficult?
MD: “Yes. Difficulty focusing and increased irritability with colleagues and patients.”
CS: “No. I teach now in order to reduce the charting, electronic records, and documentation.”
Q3: Did you or do you feel like the long hours, trauma, or sleeplessness affect your healthy coping mechanisms?
MD: “Yes, same as above.”
CS: “No, I was fine in my residency and practice.”
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Self-treatment strategies that are often implemented are self-distraction (focus on patients’ conditions as their job and ignoring their own), self-soothing (binge-eating easily accessible foods), and self-care (mistaking rest, vacation, addictive exercise leading to injury). Some even take the task of self-care as an unsuccessful action and eventually feel worse (2)
Q4: Do you feel that there is a culture of stigma and lack of self-care in the field of healthcare that prevents you and others from seeking help?
MD: “Yes, there is a culture of selflessness when it comes to being a physician.”
CS: “No. There is a stigma of mental illness. People pretend it does not exist. There is a lack of expertise to help someone even if we do find someone who may need help. We are not well-equipped. We don’t know who to seek help from or how to help a colleague if we ourselves are not dealing with anything.”
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Although physicians usually seem to follow their own advice about smoking and other risk factors for mortality, they may choose not to address their possible depression. Unfortunately, depression is also a risk factor for myocardial infarction in male physicians, and, more generally, can cause immune suppression, increasing the risk of infectious diseases and cancer (4).
Q5: Did you ever feel like, if you were to get emotional help, that it would affect your career?
MD: “Not sure, but if I had time, I would seek it.”
CS: “It is a small profession, so everyone knows everyone’s business. Like someone, I knew who was in the daycare business and was approached to bring in a child who had diabetes. No other daycare felt like they could deal with the child appropriately, and it is like taking on a risk for some higher up. For example, what if the child has a problem? Do you have expertise in this? Are you familiar with handling insulin?”
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In fact, that is often an issue. Physicians might be concerned about confidentiality, time constraints, stigma, cost, and fear that their illness will be documented (5).
Q6: Do you feel that depression in first-year doctors depended on their training program (e.g. longer hours, etc.)?
MD: “Yes. Long hours, criticism and pressure of being perfect.”
CS: “Sleep is good for mental health, and I didn’t notice a problem. Support from colleagues and a decent medical director helps to prevent it. Feeling comfortable in a team is important; to feel like you are a contributing member of a team.”
*****
The situation is only becoming more problematic. Younger physicians are now training in an environment that is more complex than that of older doctors; the medical system now has technology that takes a lot of time and runs at a ferocious pace.6
Q7: Did you ever feel burnt out in your professional career? Please elaborate.
MD: “Yes. Need frequent vacations to avoid being burnt out.”
CS: “I never felt burnt out, but the job can perhaps feel monotonous. Colleague never worked 48 hours at a time, because they took Wednesday off, for example. Taking a day off would help tremendously.”
Q8: Do bad reviews or a lawsuit preoccupy you? Please elaborate.
MD: “Absolutely. I aim to please so any negative feedback is disheartening.”
CS: “Not at all, because I refused to look at reviews. I know that reviews will bum me out. I am confident in what I do, and I practice podiatry, not the law. My focus is always on podiatry.”
Q9: Do you know any peers in medical school, residency, and/or colleagues who have had thoughts of suicide and/or made attempts? Please elaborate.
MD: “No.”
CS: “No, not that I know of. However, I may have been blind to it.”
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Even though it is not always spoken about, the suicide rate in male physicians is about 1.41 times higher than the overall male population in the U.S. As far as the female physicians, the risk is 2.27 times greater than the overall female population.7
Q10: Have you noticed podiatrists who are overworked, exhausted, and/or unhappy to the point that the mood has become normalized?
MD: “Yes.”
CS: “Reduced reimbursement, insurance complaints, EMR, and a variety of other things like that affects most of the podiatrist I know. They like the profession, but the intrusiveness of the insurance carriers and the government can get to them when we discuss our work at meetings.”
Q11: Do you feel that the system does not recognize or want to see when podiatrists are in need of mental health services?
MD: “I don’t think any medical professional seeks mental care due to lack of time and stigma associated with being mentally unwell.”
CS: “They are ready to help, but people are probably cautious to reveal things about themselves to indicate they have a weakness or a chink in their armor.”
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Depression is a risk factor at the same rate in both groups of people, physicians who passed away by suicide were less likely to receive treatment for their mental health conditions than the general population who also passed away by suicide (8).
Q12: Have you or a fellow podiatrist’s depression been so severe that you/they have contemplated leaving the career?
MD: “No.”
CS: “No, but people have left the career just because they realize they’re perhaps simply not suited for it.”
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According to Dr. Thomas L. Schwenk of the University of Nevada School of Medicine, Reno, through his research, he found that residencies would have healthier environments if they developed programs that helped residents process their traumatic experiences (9). Although podiatrists, as is evident, depending on their residency choices and other decisions, seem to have less of an issue, there is still research to be done on the topic.
For now, to ensure better outcomes for physicians and patients, there are many steps that can be taken, such as more openness about depression from those who have experienced it, and the medical board improving the ease at which physicians can address any mental health distress.
by Diksha Mohapatra
School: California School of Podiatric Medicine
Cited:
- Mata, D. A., et al. Prevalence of depression and depressive symptoms among resident physicians a systematic review and meta-analysis. JAMA. 2015; 314(22). doi: 10.1001/jama.2015.15845.
- Wible, P. L. “Doctors and Depression: Suffering in Silence.” Medscape. 11 May 2017. Retrieved September 22, 2019, from https://www.medscape.com/viewarticle/879379.
- Moutier, C. Physician mental health: an evidence-based approach to change. Journal of Medical Regulation. 2018; 104(2): 7–13. Retrieved from https://afsp.org/wp-content/uploads/2018/11/Moutier.-Physician-Mental-Health-and-SP-JMR-2018.pdf.
- Andrew, L. B., et al. “Physician Suicide.” 1 Aug. 2018. Retrieved September 22, 2019, from https://emedicine.medscape.com/article/806779-overview#showall.
- Bright, R. P., Krahn, L. Depression and suicide among physicians. Current Psychiatry. 2011; 10(4): 16–30. Retrieved from https://www.mdedge.com/psychiatry/article/64274/depression/depression-and-suicide-among-physicians/page/0/1.
- Oaklander, M. “29% of Young Doctors Are Depressed: Study.” Time. 8 Dec. 2015. Retrieved from https://time.com/4140497/medical-doctors-residents-depression-mental-health/.
- Schernhammer, E. S., Colditz, G. A. Suicide rates among shysicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry. 2004; 161(12): 2295–2302. Retrieved from http://mwia.net/wp-content/uploads/2012/07/SuicideRatesAmongPhysicians.pdf.
Gold, K. J., et al. Details on suicide among U.S. physicians: data from the national violent death reporting system. Gen Hosp Psychiatry. 2013; 35(1): 45–49. doi: 10.1016/j.genhosppsych.2012.08.005
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