‘Any man's death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee.” Those moving words are just as relevant today as they were almost four centuries ago when John Donne wrote them.
We have a crisis in medicine—physicians are dying by suicide at twice the rate of the general population in the United States, averaging more than one per day. (New York Times. Sept. 4, 2014; http://nyti.ms/2oU0Y43.) Emergency physicians are part of this group because almost two-thirds report burnout, depression, or both. (Medscape. National Physician Burnout & Depression Report 2018, Jan. 17, 2018; http://wb.md/2E58ouW.)
Solutions to this crisis will need to come from all stakeholders in health care (hospital administrators, health insurance companies, professional organizations, government, the legal system, patients, etc.), but it is also clear that physicians are not availing themselves of mental health care. Reasons for not getting help include skepticism of depression as a real disease, doubts about antidepressants, and fear of the stigma associated with getting psychiatric help.
I was plagued by all those faulty reasons when I felt burned out and clinically depressed back in the 1980s. I did my best for months to pull myself up by my bootstraps with exercise and other recommendations. When those efforts failed, I saw a psychiatrist, opting initially for psychotherapy, which also failed. So I tried a new medicine called Prozac (fluoxetine), the first SSRI, which within a few days lessened my depressive symptoms and at two weeks had freed me of depression altogether. After a few months on the medication, I stopped taking it and have never needed it again.
My concern about being stigmatized turned out to be unfounded, even 20-30 years ago. I have reported my depression on every job and credentialing application, and experienced only one instance of discrimination. That happened when my application to join the U.S. Army Medical Corps was initially rejected by an Army Strong screening physician, but his decision was quickly overturned by wiser superiors. I served my eight years in the Army and have my honorable discharge proudly framed in my home. Today I get job offers daily.
Treat Each Other Better
My treatment experience made me a more empathetic physician. Emergency medicine cannot be optimally practiced by a physician who is burned out or depressed because there is too much cognitive work and multitasking involved. The long-lasting solutions to burnout involve systemic changes (not blaming the victim), but the immediate solution to depression is to get professional help.
If you think you might be depressed, screen yourself with the mnemonic In SAD CAGES. (J Emerg Med 2012;43:786.) If you meet the criteria for depression, get help as soon as possible so patients are not put at risk. Evidence shows that SSRIs will make you more resilient and better at multitasking. Needless to say, taking your own life is the worst choice of all.
As a senior emergency physician with 35 years of experience, I want to call on all of us in emergency medicine to treat our colleagues better. There remains too much hindsighting, scapegoating, and throwing emergency physicians under the bus by those in positions of power. We continue to be plagued by unscrupulous contract-holders who feel entitled to profit excessively from our work. Burnout likely will remain a problem until due process protections become a standard in the health care industrial complex or, failing that, through some form of unionization.
Until we get better workplace protections, emergency physicians need to remember that we are all in this together. I am reminded of one of the few people who survived a jump off the Golden Gate Bridge. He said he had decided that if anyone said something to him as he walked from his house to the bridge, he would turn around and go home. Unfortunately, no one said anything, and he jumped. As soon as he jumped, he realized every problem in his life was fixable except that he had just jumped off the bridge. Luckily, he survived. John Donne was right; please don't wait till the bell tolls. A simple kind word or gesture could make all the difference to one of your colleagues.
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