In the last 30 years, taboo subjects have successfully been normalized into (Western) culture and conversation. We can now talk about cancer, menopause, erectile dysfunction, s.e.x., and increasingly, mental illness and addiction, largely without fear. As long as it doesn’t apply to us as doctors. Imagine that instead of hiding our issues in the shadows of fear and shame, we could normalize physician mental health, to offer protection and support: as an essential part of being a thriving healer.
Imagine if it was not just accepted but expected for every physician – from med student to retiree — to engage in mental health self-care, prevention, and early intervention. The current barriers preventing too many physicians from accessing mental health support have to change if we are to address the global epidemic of physician suicide, mental illness, addiction, and burnout. This article explores how we could normalize physician mental health to the benefit of all.
“Improving mental health and wellbeing starts with the self, extends to physician peers, and must involve major changes in the medical workplace,” according to Dr Emily Slat MD and colleagues in a recent article on physician wellbeing.
As doctors and medical students, we find it easy to talk about physical and mental pathology with colleagues and friends – if it doesn’t apply to us. We, as a profession, do not like to discuss our own vulnerabilities. Yet, being human, vulnerable we are.
The prevalence of depression or depressive symptoms has been estimated at 27% among medical students, 29% among resident physicians, and with a similar pattern attending-level physicians. Physicians have higher rates of other psychiatric illnesses, including anxiety disorder, alcohol, and prescription drug use, compared to the general population. Tragically, suicide rates are higher among physicians compared to the general population, particularly among women doctors.
Imagine if it was not just accepted but expected for every physician – from med student to retiree — to engage in mental health self-care, prevention, and early intervention.
This is what we mean when we say “normalize physician mental health”.
However, the reality is far from normalized. That’s why Physicians Anonymous exists.
Simply, we decided to form a doctors-only anonymous peer-support movement because many doctors in distress are too fearful to get help. While things are improving, fears and internal stigma remain obstacles to physician wellbeing. Commonly cited fears include a negative impact on career and reputation, licensing and credentialing issues, malpractice insurance, and health record discovery.
We would prefer it if Physicians Anonymous was not needed. That mental health awareness, discussion, and optimization was the norm, so that no doctor needed to fear being named and shamed. If we knew that it was safe for any doctor to “come out” as a human being with a vulnerability, then our organization could happily close its virtual doors. Until the systemic causes, and barriers to getting help for the resultant stress responses are addressed, we intend to be there for our sisters and brothers in medicine.
While this may sound like turkeys voting for Thanksgiving, we would much rather live in a world where anonymity was not a necessity for physicians to engage in mental health support.
The solution, we think, is twofold and simple:
1. Embed and normalize mental wellbeing in medical training and continue it throughout medical careers – much like CME
2. Remove barriers to physicians getting help.
Easy? Perhaps — with the right levers: a unified approach across medical education, medical regulators, insurers, employers, and professional bodies.
With a pincer movement of 1 and 2 above, we believe we could not just normalize physician mental health, but resource it sustainably so that it becomes embedded in medical culture – a far cry from the macho invincible “I can’t show weakness” culture of modern Western medicine.
Starting with, for example, the American Colleges and AMA, a set of principles based on common values could be drawn up, and a charter signed.
Politicians would be wise to support it. Hospitals and employers will only see improvements in productivity, reductions in costs, and less malpractice.
These charter principles could include:
We’re sure there are more and better ideas. We hope that a few smart and passionate policy and politics medics might come forward to finesse these.
Until then, we offer our members a solid starting point.
Imagine a world where no doctor needed to fear sanctions or discrimination for struggling mentally, particularly when the modern practice of medicine is so fraught with conditions causing moral distress.
In this article we have presented our first attempt at a charter for charter for physician mental health, offering protection, investment, and values-based principles to embed and normalize mental wellbeing from med school to retirement.
So if you want to kill yourself, I am begging you, please please please don’t do it. You think you might be better off dead, at least that’s what Paul used to say. But even though you might not love yourself, trust me, there are people who love you. Even those people you think don’t love you, they do. I did.
And those people who love you will suffer beyond belief, for years. Your mother, your father, your brothers or sisters, your spouse or partner, your kids, your good friends. You will take a little bit of their soul with you, and that little bit of soul will be replaced with dark and sad grief. So please don’t do it.
Reach out to your loved ones, and be honest. Trust me, they will help you. You are loved in more ways than you can imagine, because you are one unique lovable bright spot in this world. So stay with us and shine on us.
(Note: Paul is a made up name)