Physician Health & Wellbeing — COVID-19 and Beyond
More Resiliency is Not the Answer
P
hysician suicide has received greater attention due to an acute rise in rates during the COVID-19 pandemic. But this is not a new problem — physician suicide has been on the rise for 150+ years though it has remained medicine’s best kept secret until recently. Although more than one physician dies by suicide every day, institutions are only now facing criticism for their responses, or lack thereof, to this mental health crisis and their roles in perpetuating a culture of silence.7 Physicians are dying at a rate two times higher than the general public and suicide is now the #2 cause of death among resident physicians.1 This year, we will lose at least 400 physicians to suicide in the US — the equivalent of two full medical school classes.1 It was heartbreaking to learn that one of our own, in our community, had died by suicide — an intern only seven months into residency. I couldn’t help but to wonder what we — as a system and a community — had done to this young, driven resident to take away his will to live? Like many physicians practicing medicine for decades, one leader at our institution chose to question his resiliency. “[He] had a different idea of what medicine is and when he got here, he just couldn’t handle it,” he stated. It was clear — none of us were immune to this toxic culture and the silent epidemic. They believe the higher suicide rates are a result of millenials not being By Bindi Parikh, MD
20
Winter 2021
resilient enough, often citing their own experience in “surviving” harsher residency conditions with no duty hour policies. However, many fail to consider the higher patient volumes and greater complexity of medical management today as a result of advancements in medicine. Patients are older, sicker, and face far different complications than they once did. Medical protocols and documentation have become more time consuming than they once were. Although the practice of medicine has clearly evolved in recent decades, the culture has not. The culture of medicine has hinged on the principle that being exposed to greater stress builds better, more resilient physicians. However, research has shown that when humans are exposed to uncontrollable stress, they tend to give up and this response is maintained even when opportunities to escape that stress are presented to them later — a concept
known as learned helplessness, which can render individuals vulnerable to mental illness in the future.2 Although duty hour rules were established to prevent medical errors made by overworked physicians, many programs violate these policies and continue to overwork residents. In fear of retribution by program administrators, residents often never report these violations and therefore, only some programs get cited for these violations. After the death of Dr. Deelshad Joomun in 2018 at Mt. Sinai St. Luke’s Hospital, one resident reported “her program had a resident meeting — not to address the death, but to discuss an upcoming survey by the ACGME [and] what they should and should not include on the surveys, advising them not to air their dirty laundry out in public.”3 Unfortunately, it is common practice for programs to coach residents on how to fill out these surveys — at times, justifying survey results by blaming poorly worded questions and misunderstandings. This results in the silent suffering of medical residents who are pressured to continue working in an abusive environment due to a state of learned helplessness. Prolonged exposure to this toxic environment can erode one’s resilience and mental health, too often leading to a tragic ending as it did in the case of Dr. Joomun. These silencing behaviors by residency programs reflect an unwillingness to acknowledge the systemic problems contributing to resident mental illness. Without acknowledgement by
MetroDoctors
The Journal of the Twin Cities Medical Society
