February 20, 2022 - This pandemic has magnified the constant stress my Emergency Room (ER) colleagues and I have dealt with for years. Physicians have one of the highest rates of suicide of any profession. Male doctors die by suicide at a rate that is 40% higher than the general population. Female doctors die by suicide 130% higher than the general population (See Kalmoe).
We ER docs have an extremely high expectation to perform perfectly when dealing with life and death decisions daily. Obviously, we have to remain calm, be strong and decisive when caring for our patients.
The irony is doctors also believe they cannot, and must not, reveal having any stress, or their own reputation and career will be at stake. Throughout medical school, we are encouraged -- even trained -- to ‘never let them see you sweat’ and be ready for anything. We put patients' concerns ahead of ourselves, often to our own detriment. We are faulted for showing vulnerability and therefore do not ask for help.
We doctors, face stress and grieve at work, and especially during this pandemic many of us have tried to remain isolated from our homes and our support systems to protect family members, and this adds to the anxiety and depression. While we try to compartmentalize all the suffering we see as emergency physicians, we are human, and it affects us all.
Emergency medicine, in particular, is incredibly stressful and known for high burnout rates. Emergency physicians feel we need to be superhuman while on shift, but many friends and colleagues have admitted to me during this pandemic that the hardest part of the day is when they finish their shifts and they are alone, processing the day's pressure, stress, and grief.
The toll our days take on us may not manifest until later down the road. But sadly, for others it can be too much to bear. Emergency physicians are mourning the loss of one of our best and brightest from suicide, Lorna Breen, MD, who left us in April 2020. I fear there will be many more tragedies, unless we break the stigma of mental illness and end the idea that for a physician, seeking treatment is taboo.
Physicians in all specialties are reluctant to reach out for mental health help, even in the best of times. Many of us fear that seeking treatment could jeopardize our career. Questions from some hospital credentialing and medical licensing boards can be worded with sweeping statements that could imply that receiving treatment for a mental health condition would be an impairment that affects our capacity to practice. This approach may go beyond the intent of the Americans with Disabilities Act, and it is understandable that physicians are reluctant to answer these types of loaded questions.
Physicians, just like everyone else, face normal pressures such as a difficult divorce, family issues with children acting out, or the death of a loved one, any of which could reasonably require a little help in the form of counseling or medication. It is unreasonable to expect a physician to absorb and handle these issues themselves while others can seek counseling or care. And it's even worse that we would feel forced to ignore or downplay these stressors during a pandemic.
It is tragically ironic that we are vocal advocates for the mental health needs of our patients while we forgo treatment ourselves and must hide our own human frailty.
The status quo must change. The American College of Emergency Physicians and many other medical associations are fighting to protect the health professionals responsible for millions of lives.
My fellow physicians should be able to seek appropriate mental healthcare without fear of reprisal. Credentialing authorities should encourage physicians to prioritize their mental health. Doctors are human, too. We should be able to get the same mental healthcare as anyone else, without feeling like we are risking our jobs.
Thankfully, this past year the American College of Emergency Physicians and the Dr. Lorna Breen Foundation worked with congress to enact the Dr. Lorna Breen Health Care Provider Protection Act (HR 1667) which was passed in the House and Senate unanimously (a miracle in itself). It's aimed to help “improve mental and behavioral health among health care providers” (See Wild) and to to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care professionals (See Breen Heroes).”
The same goes for you. While I’m going to outline the many ways, I have found to relieve, even harness stress, there are times when the chemical imbalances in our brain and body require professional attention or pharmaceutical intervention. And there is absolutely nothing wrong with this. The worst thing you can do is ignore the problem.
Kalmoe MC, Chapman MB, Gold JA, Giedinghagen AM. Physician Suicide: A Call to Action. Mo Med. 2019;116(3):211-216.
Wild, S. (Rep), HR-1667, Dr. Lorna Breen Health Care Provider Protection Act, presented to President on Mar. 11, 2022.
Dr. Lorna Breen Heroes' Foundation, About the Legislation, https://drlornabreen.org/