Medicine must stop eating its own

Despair has been trying to find me again. That fickle nightmare is breathing down my neck once more. I know her all too well — she has nipped at my heels most of my career and has kept me running for the past 20 years. Running from friendships, running from family, running from loss, running from debt, running from jobs, running from guilt — running as hard as I can, just to run another day.

Today is the day I stop running. It’s time to turn around, square my shoulders, and tell despair she’s in for a fight. It will be her or me — and it sure as hell isn’t going to be me. She will growl and snarl and bite and claw. And all I can do is laugh in her face. For me, the pen is my sword, and it is now game on.

So why take the fight against despair public? Because I am not the only one running. Depending on which survey you read, upwards of 60 percent to 70 percent of physicians may be running their own race with despair. And we largely have our own profession to blame, as select winners from the past few generations of physicians have become the very teeth of modern-day despair. Those old docs gave up the race and made deals to buy themselves a little more time before they would let the wheels of modern American medicine start grinding us to bone. Medical heroes turned villains, willfully.

And it is hard, if not near impossible, to get anyone outside of medicine to understand the assault on physicians. The public still thinks we all get paid vacations to play golf in the Caribbean, and our Porsches and BMWs are outward trappings of immeasurable, luxurious success. It’s hard to find a sympathetic ear when those are the preconceived notions we have to overcome. I do not golf, have never had a free vacation, drive a Ford, and can’t get a free pen these days. I couldn’t even get my last hospital to buy a bag of decent coffee beans for my team. Hospital coffee is a cruelty in and of itself. Seriously.

Over the past two years, I’ve worked side-by-side with no less than 100 physicians who I would consider victimized by our own profession. Our boards create more and more expensive hoops to jump through and fill the coffers for a select few. Payors pay less while electronic medical records decrease efficiency and cause overhead to skyrocket, forcing tired and overworked doctors to see more and more patients and not to lose more money. And the public is then complicit in the attacks.

Nameless Google reviews rail against doctors who then can’t answer the complaints for fear of legal repercussions. The wild west of the internet is all too often the bane of our professional existence.

Reflecting on my own journey, I realize I have no choice but to fight to restore dignity to our profession. I’m bound and destined for this fight. I’ve written before about the loss of my Mom when I was a child and the impact it had on my life. It was immeasurably painful but also provided the spark for my career in medicine. That experience strengthened me and forged a resolve that matches anything this pitiful monster of despair can throw at me. It gave me the undesirable, yet invaluable, gift of “despair context” that so many of my peers do not have. They feel the crush of growing and unrelenting despair, and its overwhelming nature puts them in harm’s way. And for far too many — medicine kills them.

The profession of love, mercy, compassion, and healing destroys them and inflicts collateral damage on their friends, family, and colleagues beyond any measure.

Which brings me to Peg. We were childhood friends and went to church together as kids. Her family was a pillar in my hometown. She was a beautiful woman, inside and out — and she took her own life earlier this summer. In fact, I’m weeping as I type these hollow, empty words. Equal parts sorrow and equal parts rage. “Medicine” — promises of a cure and a disease at the same time — so much conflict in one little word.

Peg called me before going to med school, as I’d already been there and done that. I desperately wish I could remember what we had talked about when she called me those many years ago. But the years have washed that conversation from my memory, and sadly we never spoke again. Now she is gone. It is inexcusable, immoral, and senseless that healers are dying by suicide at higher rates than any other profession in this country. Roughly one doctor dies each day at their own hand, and countless others die young because of the self-neglect this career continues to breed.

You can search for this subject online and find stale, cold, and dispassionate talking points. We treat the disease in our profession as if we are watching a surgery in the old school surgical theaters. The academicians ponder and study and talk and talk and talk, while corporations consider risk analysis and liability exposures. State medical boards, health systems, and payors egregiously consider honest acknowledgment of an individual’s psychiatric stressors as character flaws. The human cost is an inconvenient variable that cannot be openly discussed. As for me, I will rage and write. Emotion and humanity are precisely what is missing from the conversation.

The absence of consistent, safe, structured, and non-career threatening mental health care in our profession hearkens back to the days before antibiotics. It’s what the generations before settled for, and we now reap what they have sown. Peg cannot die in vain. The thousands of other medical students, residents and physicians cannot simply die in vain. Medicine must stop eating its own.

Uncomfortable? Good. It means you care.