It's OK for physicians to say they're struggling

Physicians are trained to assess and care for patients who walk through their hospital or clinic doors. Few of us are prepared to watch for signs that one of our colleagues may need help.

That changed for me with one trauma case. I came into the emergency department as the patient arrived — a 33-year-old female with multiple, self-inflicted stab wounds. I walked around the corner to the trauma bay and was stunned to find a familiar person in the bed. The patient was a colleague of mine, a physician I worked with and knew both professionally and personally.

As she was being prepared to go to the operating room, I was able to speak with her. Her care was in the hands of an excellent trauma surgeon, so I was confident she’d do OK. But later I received a call from the surgeon explaining she didn’t make it.

I was devastated. I kept wondering how someone so young, so incredibly bright could do this to themselves. I talked to one of her friends who told me she had felt hopeless. That still rings in my head to this day.

I understand that — in general — physicians are not comfortable being on the other side of the bedrail, being patients. It’s very difficult for us to admit when we’re having trouble. I’ve been there myself. But we’ve got to change our attitudes and our actions around seeking and offering help during difficult times. There are far too many stories about physicians like my colleague.

In fact, statistics indicate that physician burnout — an important risk factor for suicide — is on the rise, and there are any number of factors that may be contributing. Medical students are graduating with greater debt than ever before, possibly contributing to a sense of being “trapped” in their jobs to pay off their education. Increasing documentation and reporting requirements also are raising physicians’ administrative workload, while at the same time reimbursement pressure creates urgency to treat more patients.

A Medscape survey released this year showed 51 percent of physicians reported frequent or constant feelings of burnout. Among some specialties, the rates are even higher — 59 percent among emergency medicine physicians, 56 percent in OB/GYN, and 55 percent in internal and family medicine. Physicians are up to 15 times more likely to experience burnout than those in other professions.

And though physicians as a population are much less likely than the general public to have health conditions such as heart disease and diabetes, we are more much likely to die by suicide. Industry estimates show female physicians are 2.3 times more likely to die by suicide than the general population and male physicians are 1.4 times more likely. An estimated 300 to 400 physicians die by suicide each year — equating to about one physician per day or the equivalent of two large medical school classes.

And as an industry, we need to stand ready to provide those individuals with support. At an individual level, medical directors like myself can educate their staffs about warning signs — such as sudden tardiness or absenteeism, evidence of substance abuse, etc. And we need not be afraid to approach our colleagues if we suspect they may need us.

For organizations, it’s critical to provide a formal support structure. Employee Assistance Programs (EAPs) can provide free, confidential counseling and other services for personal and work-related problems, including depression, stress, substance abuse, and grief, among others. Physicians need to know when these programs are available and that, if they use them, they’re not going to lose their jobs.

That day in the emergency department was a terrible wake-up call for me. Looking back, I’ve asked myself what I could have done differently. I knew she was sad, and I knew she was struggling a bit, but I didn’t realize the extent of what she was going through.

As I think about her legacy, my hope is that more physicians realize it’s OK to raise your hand and say I’m struggling, I feel helpless. It’s OK to ask for help when you need it. And I hope those of us who are in a position to identify the warning signs and offer help do it when we can.

Kip Wenger is an emergency medicine physician and a regional performance medical director, TeamHealth.