Physicians, Heal Thyselves  

"There is a point where I feel cognitively drained; after about twenty patients, there is not an iota of empathy left."
Dr. Jonathan Harte, Nottinghamshire GP

"I did feel suicidal. That's what sparked my interest and desire to talk about it [physician job pressure, depression]."
"A lot of people do a pretty good job of  hiding it [high rate of depression among medical students, residents and doctors]."
"I'm doing really well and I want people to know that recovery is certainly possible."
Dr. Sarah Tulk, family doctor, Milton, Ontario

"When I did this research [for his new book] and I saw there were these families where the [doctor] husband or wife went from well to ill, to death, without going to anyone, like a family doctor, an internist, a psychologist, a social worker, the clergy, a psychiatrist, none of that."
"They killed themselves. And I thought, this is unprecedented in medicine."
Dr. Michael Myers, professor, clinical psychiatry, SUNY Downstate Medical Center, Brooklyn

Doctors say that burnout and stress can lead to higher rates of suicide in their profession. (David Donnelly/CBC)

"Some operations you go into knowing that you’re likely going to produce a neurological deficit for this patient."
"You do an excellent job; you do everything right. But despite that there’s a decent chance the patient is not going to be a perfectly happy camper at the end of the day. And, that weighs on you."
"If all the family doctors and neurologists who send me brain tumour patients, if they all read this article [a theoretical admission of deep depression through a piece of creative fiction] and said, ‘this guy is depressed, I better not send him any more cases,’ I could have seen a drop in referrals."
"It didn’t happen. Instead, I had people reaching out." 
"So her parents [of an 18-year old patient], these lovely, lovely people, were there with their precious daughter, who they know is probably going to die of brain cancer before she sees her 20th birthday. If that doesn’t get you, then you’ve got to hang up your spurs and get another job. Because you can’t stop caring."
"I think the bigger piece is the workload, the bandwidth issue — the making patients wait, the not-having-enough-hours-in-the-day …. the administrative crap, the system imperfections, the constant worry that you’re not going to serve patients well enough… It’s that sensation of drowning all the time. And that’s the way a lot of doctors are functioning in our system. It’s frightening and it’s exhausting and it leads to depression."
Dr. Mark Bernstein, Toronto Western Hospital, Neurosurgeon  

In her mid-30s, Pamela Wible experienced suicidal thoughts after becoming disillusioned with the medical profession. (Submitted by Pamela WIble)

Dr. Tulk for one, began thinking suicide. The pressure while training as a resident on her way to achieving her medical degree sapped her of a normal life and normal thought processes once depression set in as a result of having to work up to 24 hours at a time. She managed to complete her residency in family medicine at McMaster University in Hamilton, but while she did so she witnessed first-hand a system that was too demanding of normally resilient people already hard-wired toward hard work through their competitive drive.

The system failed them to the extent that they became burnout victims. Victims who remain silent in the face of the misery they feel for fear that if it became known that they were unable to cope with the stress, their careers would suffer as a result of a personal 'weakness'. She, on the other hand, sought help through a physician health program, in 2016. A program geared to raising awareness and to lead to the change so badly required speaking to her own experience, leading her to become involved.

The very fact of hearing about doctors taking their own lives in despair, as a result of deep depression led her to make common cause with psychiatrist Joy Albuquerque, medical director of the Ontario Medical Association physician health program. Five critical areas relating to physician suicide were related in a paper they had published in the Canadian Medial Association Journal, where they wrote that suicide has become an occupational hazard in the medical profession.

The suicide rate for male doctors came close to doubling in comparison with suicides taking place among the general public. For female physician that rate was two-and-a-half times greater than that of the general public. Doctors, as an example, are aware of how much drugs they would need to efficiently poison themselves to death, occasionally using benzodiazepines. Firearms are also used to speed the process from an agonizing depression to death.

In their paper, Drs. Tulk and Albuquerque point out that physicians face barriers to care in comparison to care provided to the general public, among people whose suicidal thoughts can begin in medical school. Those thoughts can be associated with complaints to regulatory bodies by patients. The realization that self-care in the medical profession while negotiating the professional challenges of a medical practise has been neglected in the academic environment at medical schools has led to changes there.

Dr. Tulk herself has undertaken the teaching of undergraduate programs at McMaster University. A 2007-08 Canadian Physician Health Survey conducting a random sample of over 3,200 doctors elicited the data of close to a quarter reporting a two-week depressed-mood stint. A flattened emotional numbness called "Anhedonia" was reported by one-fifth of the group. There are 300 doctors on disability, mostly for mental illness in Ontario today.

Dr. Michael Myers, professor of clinical psychiatry at SUNY Downstate Medical Center in Brooklyn, NY, explained: "We’ve done pretty well with the general public in terms of reducing the stigma associated with going for help, but we still have so far to go in the house of medicine". He recently published a new book: Why Physicians Die By Suicide: Lessons Learned from their Families and Others Who Cared, where he chronicles "the inner conflict and the irony of self-destruction and despair" among doctors.  

"We just really need to make it normative for physicians to get help if there’s a problem."
"We need to help them realize it doesn’t make them a worse physician or a worse person."
Dr. Katherine Gold, department of family medicine, University of Michigan

In the United Kingdom. the advice to patients is to avoid appointments to see their GPs in the afternoon since overworked doctors are empathy-drained by noon, according to research. Over half of family doctors in Britain feel the pace of their work places them above safe limits, with too many cases seen each day. Overload places patients at risk and fatigue leads to poor decisions, errors and irritability.

Pulse magazine polled 1,681 general practitioners to discover they deal, on average, with forty-one patients daily at the very time when they feel thirty patients should represent a 'safe' number. Risks to safety for patients rise as the day wears on. And concomitantly, the risk to the physician's well-being is on track to overwhelm him/her leading down the path to uncertainty that they are practising their chosen profession well.