When medical training is malignant

I was on the subway this morning, idly perusing Twitter, when a desperate tweet caught my attention: “Does anyone know who this blogger is? They sound suicidal. They need help. Please retweet.”

The link was to this post by an anonymous American surgery resident. In the post, an obviously suffering trainee describes working ridiculously long shifts under inadequate supervision, then being shamed when asking for teaching and guidance. It’s dated this past Wednesday and titled “Physician depression and suicide II”. The post ends on a hopeful note, which is reassuring.

Still, there is plenty of reason to sound the alarm. Physicians are particularly at risk for depression and suicide. As a matter of fact, suicide is the number one cause of death among male medical residents.

Why is this?

Just this month physician-author-crusader Pamela Wible, MD wrote a Washington Post analysis about what she has learned from studying 757 physician suicides. So many contributing factors are just par for the course in medical training: chronic sleep deprivation; patient deaths, even if there was no mistake nor fault; repeated exposure to traumatic events, like deaths and injuries; being held accountable or blamed for bad patient outcomes; shaming, bullying, and hazing, all famously ingrained in many training programs around the world. Danielle Ofri, also a physician-author, discusses medicine’s culture of impossible, unattainable perfection and how it leads to depression and suicide. Basically, the process of becoming a doctor destroys people.

And yet, physicians are famously expert at functioning clinically while hemorrhaging internally. No one knows until there’s nothing left to be done. Traditionally, there has been little mental health help offered to trainees. Asking for help is viewed as weakness. The phrase “physician burnout” has long been used to shift the problem to the physician, when a huge part of the problem is actually an untenable, even cruel work environment.

For this resident, it’s his residency program, and he may not be able to leave. It’s not easy to switch programs. Switching requires massive effort, time, and luck. Open spots are few and far between. Despite the facts– that physicians have the highest rate of suicide of any profession, that residency is highly associated with depression, that suicide is one of the top causes of death for residents– it seems that few programs have much consideration for the mental health of its trainees. And even if a trainee feels they can ask for help– medication, therapy, sleep– when are they going to do any of that? The pace, especially in surgery, is relentless. His blogging may be his only outlet.

You can bet I submitted a validating, uplifting comment to the author, a comment which has still not been approved. None have, despite the fact that the original tweet sounding the alarm was shared almost a hundred times. I feel certain that others have read his courageous statement and tried to offer support.

I hope he knows that he is far from the only trainee who has felt neglected, blamed, and hazed. I wish I could convey how exceedingly awful my own training experience was, and how isolated and depressed I became. I want to say: Look, it’s been over ten years, and I’m okay. I wouldn’t repeat any of it for a million dollars, but I’m okay. There’s help. There’s hope. 

His post today (Friday) is about how his longtime companion dog died. NOW I’m really worried. I’ve submitted my own contact info as well as that of Pamela Wible, MD, who runs a suicide prevention hotline of sorts for physicians.

Physicians or others who have been there, if you can, check out this surgery resident’s blog and offer a few words of support. Then, let’s be a part of the positive change for trainees moving forward. Residency shouldn’t rip people apart.

Addendum:

I heard back from Pamela Wible, MD, who says: “He just needs to reach out to me.. [] Happy to talk if he would just reach out to me.”

She informs me that she is headed to NYC to lead a vigil for a young Mt. Sinai medical resident, Dr. Deelshad Joomun, who committed suicide this week. Wible describes what happened and the response since in this Kevin, MD article, a piece that has been shared over 12,000 times since. Looks like the vigil is tonight, here is the information below and a link to Dr. Wible’s very intensely powerful blog post about this tragedy. Anyone in NYC please consider attending.

“Please join us in honoring Dr. Deelshad Joomun on Friday, Jan 26 – 6:00 pm Candlelight Vigil at W. 59th St. & 10th Ave. Saturday, Jan 27 – 1:00 pm Memorial Walk & Press Conference – 1:00 pm gather here to place flowers & cards at memorial site. At 2:00 pm we will host a brief service and then walk to 440 W. 57th Watson Hotel Renaissance A where we will continue to celebrate her life and honor those who have died before her (until 10 pm so come by when you can).”