Why doctors hide their own depression until it nearly breaks them [PODCAST]

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For 23 years, an emergency physician stayed calm in the chaos and held the line. Then one night he sat in the hospital parking lot, unable to start his car and drive home. In this episode, Kenneth Scott Burnham shares how depression crept up on him gradually, how his clinical training gave him the tools to deny it for years, and what he learned once he was the patient instead of the doctor. He explains why the health care system is good at stabilizing people in crisis but nearly indifferent to what comes next, where the long wait for care and the gap between knowing what to do and being able to do it is where recovery is won or lost. This episode is based on his article “The real work starts after a mental health crisis,” published on KevinMD. You will hear why asking for help is a clinical act rather than a personal failing, and why the crisis is the turning point, not the end of the story.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Kenneth Scott Burnham. He is an emergency physician. Today’s KevinMD article is “The real work starts after a mental health crisis.” Scott, welcome to the show.

Kenneth Scott Burnham: Kevin, thanks for having me here. I would like to share a little bit about myself and my story.

I spent 23 years as a board-certified emergency physician. The training was to stay calm in the chaos and make tough decisions under pressure, to hold the line, and I did that for most of my career. What I was not trained for, and what nobody told me, is that you can be doing all those things on the outside while quietly falling apart on the inside.

I developed depression, and it started the way it often does with clinicians, gradually. I was able to rationalize all those signs and symptoms away, telling myself it was due to long shifts, no sleep, getting old. By the time I could not rationalize those ideas away anymore, I found myself after a long shift in the parking lot of the hospital, unable to start the car and just unable to go home to face another day.

Eventually what I did was ask for help. It was something I had seen patients do my whole career, but I finally decided I needed to do that myself. I made an appointment with a family physician, one who I had actually trained in the hospital when she did her rotation through the emergency room.

What followed was two years of medication adjustments, therapy, and learning things about myself that I had spent my career trying to avoid. By the end of that, I had what I realized was a roadmap, helping you find your way from the crisis to recovery. That is the book. It is “Lifeline.”

It exists because the system I worked in is very good at stabilizing people, but very poor at helping them figure out what comes next.

Kevin Pho: So you were an emergency physician for 20-plus years, and then, like you said, these symptoms of depression started insidiously. What specific symptoms are we talking about? How exactly did you feel while you were working in the emergency department that made you feel something more was going on?

Kenneth Scott Burnham: That is a great question. The signs and symptoms of depression, I knew clinically. I knew them intimately from having to describe them to the people I saw. But when they happened in myself, I was able to just ignore them all.

As a physician, you are taught to push through, to work harder, and you have this professional competence that makes you think you are doing OK. As long as I could work in the emergency room, I thought I was doing fine. But these symptoms were loss of enjoyment, an inability to sleep well, moods that were shifting, and I just was not enjoying life. It was a dark cloud, and that took its toll on me.

Kevin Pho: You mentioned that scenario where you were sitting in your car dreading the next day, because nothing was likely going to change unless you made an intervention. So you went to your family physician. Tell us a little bit about that conversation and how it went.

Kenneth Scott Burnham: Yes. I came to the point where I knew something had to be done. There was a fork in the road, and I needed to make a choice. There were dark thoughts, but nothing devastating, nothing where I wanted to hurt myself, just a need for this pain, this darkness, to go away. That was the time I decided I would call and make an appointment.

I had never had a family physician before, never seen a doctor. Sitting in that waiting room was just exposing. It was an experience I could not have imagined I would ever have. I finally got back into the room, and when she came in and said, “What brings you in today?” all the thoughts I had planned to explain vanished. All I could say was, “I am in a really bad spot, and I need help.”

Kevin Pho: And what happened next? You mentioned the role of medications. Tell us about the time course and that journey to recovery.

Kenneth Scott Burnham: Yes. What I found was that the journey is not a quick, linear process. She put me on medications, gave me referrals to psychiatry and counseling, and I was to take these on.

When I walked out of the office, I wanted to get these appointments, I wanted to get started, but the timeframe, the waiting, the delay, the gap between getting treatment and actually starting the recovery, is prolonged and enormous. There is this gap that we have a problem with in our system, one that does not give patients guidance on what to do afterward.

You see, I wanted the Zithromax treatment. I wanted five days and then to be better. I wanted to jump on this problem and get it corrected so I could go back to work the next day. But that is the journey I learned about: It is not a quick process. There are ups and downs. There are cycles. I knew clinically what I needed to do. Exercise was important, yet it took me two years to be able to walk around my neighborhood on a regular basis. So there is this gap between knowing what will help and being able to do it, and that is one of the things I learned.

Kevin Pho: So you mentioned that you wanted that instant fix. But you talked about something like gaps, and I am going to infer that it took a while for you to see a behavioral health specialist after your family physician suggested you see one. In the interim, while you were waiting, were you just on medications? Just tell us about some of the gaps that persist, because this is something that many of our patients deal with every day.

Kenneth Scott Burnham: You are absolutely right, and what it took was for me to experience this on both sides of the table, both sides of the gurney.

I was the physician for 23 years treating mental health patients. I thought I understood what they needed and how to give it to them. It was not until I was the patient on the other side that I saw what was missing. There is this gap that our system does not have a protocol for. In the ER, we see the patient, treat them, provide them discharge instructions, advise them to follow up as soon as they can, and give them a list of phone numbers.

That is it. We call that a job well done. But there is this gap between stabilization and really being well, and that gap is enormous, and that is where the relapses happen. That is where patients’ families get lost. That is where the work we did in the acute setting gets lost as well.

That is why I think it is important, with your clinical audience, that this is the perfect opportunity to express how important their acute treatment is, but that there is more that can be done on the discharge end. We can remove the language of shame. We can provide more than just numbers. We can actually help them and guide them to get this help.

Kevin Pho: What do you mean by the language of shame?

Kenneth Scott Burnham: You know, as a physician, I have all the answers when the patient walks in. I was the one who was supposed to fix people. I was the one who was not supposed to have problems. I was not supposed to ask for help. There was this professional shame that comes with asking for help. It is almost like saying, “Hey, I am not cut out for this job.”

We know the data on physician suicides. We know the addiction rates. We know about the untreated mental health in all of our health care workers, and that is tremendous, and it comes from training our group of people to push through our own suffering silently.

Kevin Pho: So let me ask, Scott, how are you doing today? Are you back at work? And if you are, what has changed today compared to where you were in the past?

Kenneth Scott Burnham: Oh, thank you for asking. I have retired from the emergency room. I no longer do clinical shifts. I have transitioned to a few other roles, one of them being a mental health advocate. That is where I find myself.

Looking back, I find that this journey has been a tremendous learning experience, and I have to be grateful for it. I never will be the same person I was before, but I understand that. I still am on a small dose of medications. I still regularly see my counselor and family doctor for follow-up.

Kevin Pho: Now, how much of the recovery was the support and behavioral health treatment you were on, versus just being away from the sometimes toxic environment that clinical medicine is today?

Kenneth Scott Burnham: That is a great question. The work environment is toxic, and it definitely has changed. That part did give me a space to be able to focus on myself.

I feel that for all those years of giving and treating, one of the things I lacked was self-awareness and self-care. The therapy helped me see that this was important to do to get my mind back in the game. The medications helped stabilize. The counseling helped me understand things about myself that, again, I had hidden for years, things we did not want to address. So it takes both medications and therapy and counseling together to be able to help the healing process.

Kevin Pho: So what kind of advice do you have for other emergency physicians who may be where you were years ago? You do not want them to reach a crisis point before acting. So do you have any advice for these physicians who are still practicing, sometimes in these toxic environments?

Kenneth Scott Burnham: That is a very strong point that does need to be spoken about. There are things I want every clinician in the audience to know about. The first one is that you are not immune. Your clinical knowledge does not protect you. It does not make you a faster healer. In fact, as we have spoken about, if anything, it gives you the tools for denial, and I used mine for years.

A second thing I would like people to understand is that the patient experience is not what you imagine from the other side of the table. I spent 23 years caring for mental health crisis patients, and again, I thought I understood it. There is shame at discharge. There is paralysis when they go to the pharmacy counter. There is an inability to do things that I clinically thought I knew we needed to do, things that are just impossible to do. There is the gap between knowing and being able to act, and we do not account for that when we discharge our patients. When we do not, we are handing them instructions and sending them into a world they are not ready for.

The third thing I think is important is that asking for help is a clinical act. It is not a personal failing. I tell clinicians I run across and talk to that I mean it. I tell clinicians that we need to give ourselves the same grace we give our patients. When they walk into the emergency room at their worst moment, we ask them to be honest about what is happening, and we have to be willing to do that ourselves. The physician who is going to get help is not the weak one; he is the one who is going to be around in 5, 10 years.

Kevin Pho: As you know, in medicine, there is a culture of shame when physicians need that help. It prevents physicians from asking for that help. It prevents physicians from being vulnerable. Now, I want to thank you, of course, for sharing such a vulnerable story. As you were going through this, what were some of the reactions you could perceive from your colleagues, your family? Did you hear any whispers as you were going through this vulnerable period in your life?

Kenneth Scott Burnham: The support from loved ones was tremendous, but you had to let them know. I had a hard time asking for help. The pride, the physician culture, did not allow me to speak about it until I got to the very bottom. When I was finally able to admit that and speak about it, the support was tremendous.

I think it was very surprising, the number of coworkers and colleagues who would send a note, a text, and say, “Hey, I have been there. Hey, we are thinking about you.” There is a lot of silent suffering in health care, and that is basically the physician culture on display. We all have the vocabulary to speak and describe what we are going through, but the professional risk is too great to want to do that.

I think going through this opened my eyes that sharing my story was kind of like a permission slip for coworkers and colleagues to say, “Hey, if this guy who has been in the ER for 23 years ends up in a parking lot unable to start his car, maybe I should be honest about where I am at today.” Asking for help is one of the bravest things you can ever do.

Kevin Pho: We are talking to Kenneth Scott Burnham. He is an emergency physician. Today’s KevinMD article is “The real work starts after a mental health crisis.” Scott, let’s end with some of your take-home messages that you want to leave with the KevinMD audience.

Kenneth Scott Burnham: What I would like people to know is that the mental health crisis one experiences is not the end of the story. It is actually the turning point, because the energy, the effort, the treatment that goes into the next weeks and months after somebody leaves the ER or the hospital is actually where the recovery happens, or does not happen. We built a good system at stabilizing the crisis, but we are almost indifferent to anything that follows after.

The book “Lifeline” exists to fill that gap. This book is for patients, family, and the people who love them. But for the clinical audience you have here, my message is really that the work you do in that acute setting matters tremendously, and it is not enough to just hand them a discharge and a list of numbers. We need to provide them guidance, care, support. If there is somebody in the audience right now who is struggling, or you know somebody, a friend, family, that is who this book is for. If there is somebody this resonates with right now, 988 is a number that is available 24 hours a day. And again, the bravest thing you can do is ask for help.

Kevin Pho: Scott, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Kenneth Scott Burnham: Thank you, Kevin. Appreciate your time.

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