Today, we talked about care for the caregiver. After all, there is no other workplace like the hospital in terms of sacrifice, acuity, and risk of burnout. With such high stakes, healthcare providers are subject to exorbitant levels of stress that perhaps defy human physical, mental, and emotional capacity.
An estimated 400 physicians die by suicide each year. Furthermore, according to a meta-analysis by Dr. Eva S. Schernhammer from Harvard Medical School, the suicide rate among male physicians is 1.41 times higher than the general male population and among female physicians, the suicide rate is 2.27 times greater than the general female population.
Why is this happening? We, the physicians, need to speak up. We need to consider how talking about our own reactions to and reflections of patient care events is indeed a critical piece of patient-centric care. Today, we finally had a chance to let it out, to vent our frustrations, to discuss our feelings of self-blame and near self-collapse.These stories are so important because we have to let each other know, YOU ARE NOT ALONE.
At my own hospital, on March 8, 2016, a 28-year old resident presumably jumped off the top of a 33-story high-rise apartment building to her death overnight. I did not personally know her since I started residency later that summer in July.
When I first heard about this woman, of course, I thought it was awful. But as with most situations in which we hear about tragedy on the news or through a third party, I did not really feel too involved and could continue to go about my days unaffected.
That feeling of emotional distance completely changed at the one-year anniversary of her death. We received an email from our resident union announcing her name and commemorating her life.
Time seemed to stop when I realized I actually recognized her name. I had been receiving her mail all year. You might be saying, huh??? Let me further explain – I am currently living in her apartment. My hospital owns a building mostly inhabited by residents, and by sheer randomization, I was assigned to her apartment.
Suddenly, she became extremely real to me. The space I retreat to at the end of the day was perhaps also her refuge from the harsh implications of our doctor lives. I can relate with how much work and sacrifice it takes to even get into residency, and I think about how much she must have suffered and how her death is such a loss to the community. The trail of letters/journals/notices addressed to her make me witness to aspects of her life, and it becomes strangely apparent that our lives are intertwined.
When I first had this revelation that I was living in a dead woman’s apartment, I wanted to tell someone. I got mixed reactions which was to be expected. Suicide makes people extremely uneasy. With our innate drive to survive, suicide goes beyond human understanding.
To remain silent about physician suicide is to condone a profession that quite feasibly kills our own, whether that be in the metaphorical or literal sense.
On the drive to Telluride, I stopped at a trading post where I met a former physician assistant who left a 20-year career as a cardiovascular surgery physician assistant. He got so fed up with the demands placed on him that he began to feel undervalued and overworked. He adamantly voiced that although he loved helping patients and he was good at what he did, he would never go back to such crude work conditions.
Sure, we are no longer in a malignant “House of God” era with 110+hour work weeks. Residents have gotten a cutback, most notably with the Accreditation Council for Graduate Medical Education (ACGME) introducing duty hour restrictions and capping the average number of hospital hours per week at 80 and limiting single shifts to 30 hours in 2003. Nonetheless, decreased work hours are causing consternation with increasing hospital admissions and a growing physician shortage.
Ryan Park of The Atlantic discusses the concept of “work compression” in his article, “Why So Many Young Doctors Work Such Awful Hours.” It is a dangerous trap to overshoot patient care expectations in a compressed amount of time for young doctors who are still learning and adapting. While talking to other residents over the past few days, I know I am not alone in often feeling overwhelmed by the tasks placed on me.
In “Why Hospitals Should Fly,” the author John Nance writes, “We task-saturate doctors, especially if they’re fatigued or distracted, and then we think they’re less than good practitioners because they couldn’t tough it out and perform flawlessly.”
Unfortunately, task-saturation is a dark truth many of us live with since we are maybe too embarrassed or ashamed to admit our limitations. This is why we need opportunities like Telluride to openly talk about what is hurting us and to then brainstorm ways we can renew a toxic system. We have to pledge to stand up not just for ourselves, but for each other, in order to revive and preserve joy and passion for our livelihood.
This post is written in memory and honor of Esha Baichoo.