Toxic medical culture needs to end - for a healthy society, we need healthy doctors
Stigma attached to mental health issues is real, and it’s amplified exponentially for those in medicine
This column is an opinion by Dr. Ferrukh Faruqui, a family doctor who teaches in the Department of Family Medicine at the University of Ottawa. For more information about CBC's Opinion section, please see the FAQ.
Society's growing concern about the treatment of people with mental health issues is encouraging. What's often forgotten is that doctors themselves aren't immune to depression and suicide.
They're suffering and dying, too.
The stigma attached to mental illness is real. It's amplified exponentially in medicine, where weakness isn't tolerated. Coping with unprecedented workloads in the face of health care cuts and societal scrutiny, doctors were physically and mentally exhausted well before the pandemic struck.
With the added weight of pandemic care during the COVID-19 crisis, doctors are struggling even more. Recently, the New York Times highlighted this when it wrote about an ER doctor who took her own life. There's a growing urgency to address the pervasive despair among the ranks of doctors — and blow the lid off the code of silence that prevents many from seeking help.
Physicians are hurting and society needs to hear why.
Long before the pandemic, Oregon-based Dr. Pamela Wible resolutely began naming doctors who have died by suicide. She's taken on the heartbreaking task of gathering these stories of lives tragically interrupted, recounting them at idealmedicalcare.org. She offers resources for beleaguered physicians and indicts the systemic factors driving these avoidable deaths.
In Canada, no one's counting these deaths. But the National Physician Health Survey, conducted in 2018 by the Canadian Medical Association, revealed that 34 per cent of respondents screened positive for depression, while 19 per cent had contemplated suicide.
A scant 15 per cent said they had sought help, many of them hobbled by that old scourge: shame.
If you're thinking about suicide or are concerned about someone, there are people you can talk to:
- In an emergency situation, dial 911
- Crisis Services Canada: 1-833-456-4566, text 45645, chat at crisisservicescanada.ca
- In French, Association québécoise de prévention du suicide: 1-866-APPELLE (1-866-277-3553)
- Kids Help Phone: 1-800-668-6868, chat at kidshelpphone.ca
Medical myth declares that doctors lead charmed lives, when in reality they are masters of disguise. Doctors operate with steely hands while self-doubt churns inside. They've learned to mask their pain.
Abusive medical culture affects everyone in the profession. Training brutalizes idealistic students who dreamt of doing good. Practising physicians don't fare much better.
In this closed-off world, perfection is the standard.
The bar is set so high that any real or perceived error elicits not just guilt, but a corrosive shame. Professional consequences, including complaints to regulatory colleges, can tip doctors over the edge. Confessing mental impairment to such authorities can jeopardize one's licence to practice.
Some have gone public about their struggles. Dr. John Bradford broke down after decades of reviewing horrific video evidence as a forensic psychiatrist in Ottawa. Once treated, he discussed his post-traumatic stress disorder. The illness convinced him that he was a failure, leading to suicidal thoughts.
Toronto neurosurgeon Dr. Mark Bernstein fell into clinical depression. He likens the workload and stress to a sensation of drowning: "It's frightening and it's exhausting, and it leads to depression."
But many more are reluctant to speak. Secrecy, shame and stigma comprise the punishing trifecta that drives suffering underground.
Here's why we should care: Sick doctors make mistakes. Struggling physicians are prone to error. Society pays dearly when doctors falter.
As this pandemic has highlighted, we need healthy physicians to keep us well.
However, the rickety state of Canadian health care is an open secret. Dwindling resources can't meet burgeoning demand. Patient care is compromised by budgetary constraints. Frustrated patients turn to their doctors for answers. The daily battle to do more with less takes a grim toll on the physicians who look after us.
Meanwhile, cynical politicians of every stripe have pinned the failure of our collapsing health system on the front-line workers. The growing distrust between society and the profession erodes the foundation of good care.
As the novel coronavirus invades the globe, doctors have stepped up despite the shortages of N95 masks and other personal protective equipment (PPE), putting themselves and their families at risk to battle a virus that's killed many – including their colleagues. The pandemic has shown that physicians will be there, at all hours, to care for the sick, the scared and the dying. Perhaps this fact can help restore trust.
Because once the virus fades away, we can't slow down. We'll need to care for all those who've been waiting patiently – those with heart disease, with cancer, with untreated depression. Our workloads will only increase.
These staggering caseloads combined with an aggressive medico-legal climate will continue to breed hopelessness, yet burnout is a tidy buzzword that deflects blame from a dysfunctional system to the individual. Condemning doctors for perceived weakness is both disingenuous and dangerous – "Physician, heal thyself" is a callous and useless exhortation. No amount of yoga or deep breathing will repair this wound.
The dubious prestige of being a doctor doesn't come cheap. Physicians are human and can't remain the silent scapegoats for the ills of modern health care. Too many doctors dread going to work each day. Many are awash in guilt. They're numb with fatigue. They're about to implode.
And if they do, the system will implode too.
For a healthy society, we need healthy doctors. We need to begin a national conversation to revolutionize health care, and to say goodbye to toxic medical culture. It's time to care for the doctors who care for us.
If not for their sake, then for our own.