suicide

{Napa, California}

2015 was a year to regroup and reassess my professional goals.  Immediately after residency, I did as most physicians do — apply and hope to get a job that pays well and is in a good location.  Similar to the personalities of most physicians, I am a workaholic and overachiever.  Therefore, since graduating residency, I strove to perform well at my job, treated my patients to the best of my ability, passed my psychiatry board exams, in addition to participating in extra professional activities on the side (gave psychiatry talks, restarted blogging again, enrolled in a psychoanalytic course, etc) while attempting to balance my personal life.  However, after the first two years as a practicing physician, I became disillusioned by the sad reality of our broken healthcare system.

When I first started working, I was an enthusiastic, energetic psychiatrist ready to use all the knowledge and expertise I acquired in my training to make an impact and help improve the lives of many.  But, then I recognized my limitations.  I noticed that the pressures exerted by the system to deliver cost-effective care, see a high volume of patients, and obtain exemplary patient satisfaction scores while maintaining my ideal ways of practicing, were nearly impossible to sustain.  I noticed a decline in my ability to balance life outside of work and took my frustrations out on those around me.  I participated in psychotherapy, group therapy, exercised, went to church, ate a healthy diet — basically, did everything that you’re “supposed” to do to manage stress.  It may have helped for one day, but then I still dreaded waking up the next morning to go to work.  And once I noticed a decline in my passion for practicing Psychiatry, I knew that such a decline in my quality of life was NOT the type of life I deserved after busting my ass throughout college, medical school, internship, and residency.  I deserved to be happy.  I deserved my ideal practice.

I have written posts about my personal experience with burnout, have read numerous articles about physician burnout, yet still struggle to fully describe how debilitating the experience is because it evokes a sense of failure, a “system malfunction” of everything we were programmed to do since day one of medical school.  This article by Dr. Dike Drummond most precisely describes the factors that lead to physician burnout.  As much as I would like to do so, I cannot fully fault my employer because I understand their methods from a business perspective.  In order for the organization to thrive, physicians are key components to meet the organizational goals.  And we allow it.  We adjust.  Most of us don’t know any better.  Medical school doesn’t teach us to be business savvy, nor how to market ourselves, nor give us the tools needed should we decide to venture out on our own to create our own practice.  And most notably, we are not taught how to prioritize self-care nor how to advocate for ourselves when stressed and overwhelmed.  Often such behaviors of speaking up for one’s self are viewed as weaknesses.  To this day, I still have the mentality that I’d need to be on my deathbed in order to miss a shift out of fear of being perceived as less than superhuman by my Attendings and peers.

Initially, I blamed myself for not being able to keep up with the heavy workload and for feeling so defeated.  But then I realized that I had a choice: either 1) Quit and seek my ideal practice, or 2) Adjust to the system and forego any sense of autonomy and watch my passion to make an impact in the field of Psychiatry further dwindle away.

I quit and spent 2015 working a reduced schedule and essentially recovering from my entire medical career thus far.  Throughout the process, I had to re-train my mind to let go of the standards that were ingrained since medical school: the need to be a workaholic, the need to be a genius and know everything (otherwise risk being ridiculed), the need to be superhuman, the need to suppress and hide my struggles, the need to be a perfectionist at all times, the need to function at 110% amidst exhaustion and fatigue.

A patient doesn’t benefit from a burned out physician (in fact, it has been shown to lead to greater medical errors).  And if a fellow physician is struggling to maintain, we must not consider them as weak.  Please understand that they deserve just as much care and attention because they sacrifice their own well-being for the sole purpose of providing care to others.

I will never forget one regretful time that I was on-call:  already worn out from the day’s clinic, I angrily dialed the number on my pager and spoke to another physician on the other line, who paged in hopes of getting advice to help a fellow physician struggling with suicidal thoughts.  My reflex response was uncharacteristic of me, lacked empathy, and to this day makes me cry with regret:

“I’m sorry, but I can’t help you.  Tell him to go to the ER.”

I would never even fathom giving such an insensitive response to one of my patients.  Just knowing that I turned my back on one of our own…someone who very well could’ve been me had I stayed and felt trapped in my job…someone who represents the growing number of depressed and suicidal physicians, makes me sick with disgust.  I vowed to never again lose myself so much in a job that I risk losing my empathy and compassion.  However, as I type this, I recognize that as much as I blamed myself, I see how that “programming” from medical school, which taught us that any sign of struggle represents weakness, overrode my empathy.

Therefore, my goal for 2016 is simple: to maintain balance.  For the first time in my life, I feel deserving of breaks and time off, feel open to share my struggles (and view them as signs of strength, not weakness), and feel confident in who I am as a physician deserving of a practice that supports my lifestyle (rather than one that consumes me).

And one last note:  I’ve observed the new class of aspiring doctors, have connected with them via social media, have met with the shining future leaders of our future healthcare system — and they are a population unafraid to support one another and voice their needs.  They are students who are starting to open up about their desire for self-care and balance.  They are students who are championing wellness programs in their medical schools.  They are students who are tech savvy and understand marketing tactics (because they have the tenacity to reach their own international following that closely watches and looks up to them as they develop as authentic role models on social media).  They will detect the bullshit of organizational “wellness” programs and any false attempts at showing they are being “cared for,” when in reality they are being appeased only long enough until thrown back into the same working environment that led to their decline…and the cycle continues.  Although most posts on physician burnout are pessimistic about the potential for change, with what I’ve observed, I have even more hope that our future doctors will come together and do what they can to put a stop to the cycle.

Photo by Alex Manipod