An elephant in the corner

I was grateful for this essay published in the New York Times last week, just before National Suicide Prevention Week.   The author cites some important statistics, the most important of which is that physicians are more than twice as likely as non-physicians to commit suicide.  He also cites the suicidality data from a recent multi center study, which he mentions to the exclusion of the depression data in the same study, which showed a depression rate in trainees of over 20%, with the rate higher in medical students.  Subsequent work has shown an increased incidence of burnout among residents and fellows rather than depression, although burnout is higher in all levels of physician trainees than in population norms.

As surgeons, we tend to want to believe that we are different:  we’re somehow tougher, more immune to the qualities that make everyone else merely mortal. Perhaps that tendency itself is one of many causes behind a rate of suicidal ideation in surgeons that is nearly twice that of the general population (and the associated tendency to not seek help for burnout and depression).  We also seem to want to find a simple formula for self-care and personal wellness that can serve as a panacea for depression, burnout, and their associated consequences.  And while the truth is that self-care and wellness help, perfectionism and an easily-accessed sense of shame are drivers of many high-performers…and I will agree that surgeons are, as a group, high-performers.

If you know me well at a personal level, you know that I have been a HUGE fan of Brene Brown’s work on shame and authenticity for several years now.  Quite honestly, her work was life-changing for me because of the perspective it provided me on dysfunctional behaviors that I witness and dysfunctional behaviors I may have exhibited myself at some point.  Using that lens of shame, I was able to see how often we use it as a tool in education.  I was flabbergasted when we were doing our interviews for the disruptive surgeon study and several interviewees mentioned the tendency of disruptive surgeons to use shame as a “motivational technique.”

We have seen the enemy, and apparently it is us.

So, where do I propose that we go from here?

If you’re feeling burned out, if you’re able to recognize that you’re depressed, ask for help.  Find someone whom you trust, someone who you feel has “earned the right” to hear your story, and talk to them.  In hindsight, I’ve realized the value of a couple of my friendships during residency, both of which were sanity-savers, if not life-savers.  In particular, during my last two years of residency, my friend Katie and I would meet nightly to walk her dog on the Shoreline Trail. I probably can’t count the number of times as we talked when each of us thought “Wow!  I get that.  It’s happened to me too.”

If you see signs of depression or burnout in a colleague, offer to be that support.  Providing some empathy if they say, “I’m stuck, it’s dark, I’m overwhelmed!” might just make the difference.