A Double-Edged Sword: Physician's Drive
The human condition is complex, and many factors can lead to suicide. We often think of the lethal means- either by shooting or stabbing oneself or walking into traffic. But what about those who take their lives in a slow death by neglect? Physicians have the highest rate of suicide compared to any professional. These rates were the case pre-pandemic, and time would tell the aftermath of the pandemic will affect physicians' mental health. It is not just death by lethal means, and it's also sometimes the slow death from neglecting to take off one's personal needs.
Doctors have a drive that may be both blessing and curse: working hard for others while setting aside their own needs; having high standards at the expense of personal mental health and physical safety. For many years, the term "patient-centered care" has been touted as the gold standard for practice. Even in my own practice, I had used this as a tagline. However, this can be both a blessing and a curse for the physician, for a physician who has arguably lost boundaries for personal self-care.
Those who work with patients will experience the suffering of their patients. These emotions can lead to burnout, moral distress, compassion fatigue, and an unprofessional presence in a clinic environment, ultimately affecting those being cared for. Again, this is another situation that the physician must deal with and create a balance between their professional obligations and the natural responses as a human being.
Burnout is not a problem that only affects people in the helping professions. It can affect anyone who experiences physical and emotional exhaustion, cynicism, or inefficacy due to their work conditions. In addition to burnout, you may experience moral distress if your personal values are inconsistent with what's expected at your job. This often happens when institutions have set rigid policies, making it difficult to act on one’s own morals and beliefs (e.g., doctors being required by law to ask certain questions). Compassion fatigue is another common condition experienced by clinicians due largely because caring for patients day after day takes its toll emotionally – even those without clinical training know we need a time out every once in a while for self-care.
So, an important question to ask is, "how do we create an environment for physicians where there is a balance between professional obligations and the need for personal self-care?". I believe the culture of medicine must change and the general perception of physicians in general. In my own practice, over the years, I have said, "doctors are humans too." In hindsight, when I was younger and didn't have the responsibility of being a parent, I used to call myself "superwoman" because I was a working machine. I was raised to work hard and to put aside my wishes for comfort. Plus, medicine rewarded those who worked long hours and put in the "extra mile."
Physicians do not typically have the same protections that most employees have. I'm yet to run across a place that overtime rules, maximum continuous work hours, mandatory breaks, and personal accommodations apply to physicians. I know pilots and truckers have rules as to how many hours they are allowed to work consecutively. However, the professionals who make life-or-death decisions regarding patient care are not given this grace. As a society, we must deal with these questions. No amount of pay is worth the sacrifice and risk from working at this breakneck speed. Until we deal with this, I believe physicians will continue to have such high, alarming suicide rates.