Lately, I have been thinking about the lies we tell each other as doctors.
Mostly, these are lies of omission. We share stories of slick procedures, clever diagnoses, and post-shift half-marathons. We skip over the mediocre feedback that followed us home. We hide the weekends that we waste wallowing in exhaustion and self-pity. Sometimes it seems harmless – considerate, even – to keep this heavy stuff to ourselves, but these lies create a climate of inadequacy and isolation. There is nothing lonelier than believing that no one is struggling but you.
I recently heard whispers that a talented old friend from medicine was dealing with substance abuse. Talented is an understatement, really. He was a true superstar. He knew everything without being a know-it-all, and was loved by everyone without being a brown-noser. He inspired envy without being cocky. When I heard the rumour, I was worried, but I was also impressed. In keeping with the grin-and-bear it culture of medicine, I romanticized his stoicism. Medicine is a tough ride, and it often seems that there is space only for poise and competence.
Mental health breakdowns, substance use, and social crises fill our emergency departments, but we are uncomfortable discussing these issues when they affect us personally. Recent media attention has highlighted critical levels of depression among resident physicians. Studies show that 1 in 5 physicians struggle with substance use, with emergency physicians especially vulnerable. Still, it’s hard to reconcile these statistics with my personal experiences in medicine. Everyone I know is always fine. Everyone I know is always coming out on top.
Talking about these topics, and talking about them publicly, would be good for us. It would be good for those who are struggling to know that they are not alone. It would help to know that there are others who have survived these struggles. With that goal in mind, I am creating a blog post and audio podcast series where physicians and residents can share insights and stories of struggle. How have physicians addressed mental health struggles in the context of their careers? How has patient care been affected by personal suffering?
My friend is gone now. I wonder if he broke the silence with some or if he felt paralyzed by his public image until the end. I wonder if people would have surprised him with empathy and continued respect. I remember that I never reached out, convincing myself that it would only add insult to injury to know that his secret was out. There is a question here that was never answered for my friend, one that I think this project may answer: Can I share this part of myself and still have people respect me as a doctor?
My hope is that these stories will paint a fuller picture of what it means to be a physician and a fallible human. Despite the pressure of acting as authority figures and role models to patients, perfection is not what our profession needs. Human flaws and vulnerability are a vital part of what makes physicians compassionate and compelling.
If you are a physician or resident who has something to say about substance use, mental health, or other personal crises in the context of your career, please email [email protected]. If you are willing to share your story (anonymously or otherwise), we would be interested in publishing it as part of the “Physicians as Humans” project on CanadiEM as either a blog post or podcast.
Please also consider sharing this post and project widely with anyone who may be interested or might benefit from knowing that they are not alone. To kick things off, next week we will be featuring a “Physicians as Humans” post by Bruce Fage (@FageMD), a Canadian Psychiatry Resident, who will provide further background on this important issue.
- Sladky, L. Depression burden weighs heavily on resident physcians. CBC News. 2015. Retrieved from http://www.cbc.ca/beta/news/health/depression-residents-1.3355358 on December 8, 2015.
- Oreskovich MR, Shanafelt T, Dyrbye LN, et al. The prevalence of substance use disorders in American physicians. Am J Addict. 2014. PMID: 25409782