Note: A friend read this post and found it depressing. She was kind enough to express her concerns. I took it down, re-read it and tweaked it a little, but I decided to repost it pretty much intact as a sort of record of one aspect of being a medical professional.
I’ve been slacking here in the Underground the last few days. The de-wooificator is on the fritz…the guy at the shop said something about it needing more vitamin C or something.
Most people have busy lives with conflicting responsibilities and needs. Over the last few months, many of my patients have been laid off from their auto industry jobs and don’t know how they are going to make do. They have been putting off medical tests to save money. Home foreclosures here are at record levels, with home values dropping by up to 20%.
I have a number of elderly patients whose families are struggling to take care of them while meeting their own food, housing, and medical needs–and I don’t work in a particularly impoverished area. It’s the economy, stupid.
But of course, it’s really all about me, because this is myblog. My average work week is about 60 or so hours. This leaves little room for things to go wrong. The last few nights I’ve gotten a lot of pages, and because of my allergies, I haven’t been able to fall back to sleep. Sitting up in the kitchen at four in the morning drinking hot tea and reading the paper, knowing that I will be working from 8 a.m. until 9 p.m. keeps me a little on edge.
So I felt a little bad when I was short with one of the residents the other day. He called about a sick patient in the E.R., wondering if I would be admitting him. Unfortunately, part of that decision hinged on what insurance the patient had (we have a system at the hospital for admitting uninsured patients so that no individual doctor will go broke taking care of them). The intern was not feeling particularly helpful when I asked about the insurance status, and he hung up on me. I in turn was not feeling very charitable and wrote his superior about his behavior.
Stress is metastatic–it spreads from its point of origin and can affect an entire extended network of people. In my work, though, I can’t let a bad night interfere with how I do things. Most doctors train under stressful conditions, partly to accustom them to taking good care of patients no matter how they might feel themselves. This usually works.
Sometimes it doesn’t. Physicians suffer from depression at similar rates to the overall population, but rates of suicide (at least as far as the data can tell) are significantly higher. The rates are higher in female than in male doctors. (JAMA. 2003;289:3161-3166.) (Am J Psychiatry 161:2295-2302, December 2004).
From the statistics available, doctors do not abuse drugs significantly more than others, but when they do, it is usually prescription drug abuse. (JAMA. 1992 May 6;267(17):2333-9.). Doctors may or may not drink more than others–the stats are murky.
When a doctor “goes bad” the consequences are unique. They affect a web of patients that may include thousands of individuals. Most patients experience a loss when their physician dies, but I wonder how they feel when their doctor kills themselves. Thankfully it is still relatively rare for doctors to abuse drugs, kill themselves, or suffer from disabling depression. The good news is, statistics show that doctors’ rates of depression mirror the population at large, and the increases in stress-related phenomena aren’t that large. But much more research is needed, especially into the statistic reflecting higher rates of suicide among female physicians.
People may complain about the rigorous nature of doctors’ training (and the training has been modified significantly over the last 10 years), but from my experience, it weeded out people who couldn’t continue to put their patients first, and taught me how to continue to take good care of people despite personal adversity.
I may be accused of “back-in-the-day-ism”, but during weeks like this, with my kid sick, my wife coming down with the same thing, and my not having slept more than a few hours a night, I am thankful that my training made sure I would be able to handle this life. I think most of my colleagues would agree, that despite the hours and the stresses, it is an honor and a privilege to be a physician. I wouldn’t trade it for any job in the world.
Very good post. I have been in the unfortunate position of having had a physician in the past that did take his life. I wrote briefly about it. It haunts me to this day. He couldn’t possibly know the ripples he created in that one single, final act on this earth.
I think of the pain he must have been in. Yours is a demanding profession. It takes and takes without meaning to deplete you. You must carve out a recharging area of your very own to turn to. Whether it’s a darkened room for a time…a walk down a wooden path, something. You need to guard yourself from the weight and responsibility.
I have a friend now trying to juggle his depression and his practice. It is a normal reaction when a break is much needed and your seeing no relief in site. Best to you.