Is Wellness Well Enough Alone?
On first blush, my story is not at all unique:
- Aspire to be a doctor from early childhood
- Work my tail off in high school and college to get into medical school
- Play all the right cards to get into a “strong” General Surgery residency
- Specialize in Vascular Surgery (two more years of training, totaling 9 years in all)
- Join a regionally well-reputed surgical practice
- Have 10 years of relative success
Even the sad twist in my story is fairly cliché (did somebody say burnout?):
- Spend years saying things will get better now that the worst (residency) is over
- Spend years wondering why the supposed joys of medicine don’t register
- Spend years suppressing all of the bitterness and frustration that comes with the job
- Spend years instead taking out all of that bitterness and frustration on my family
Well, these next few bits might not be standard for the typical burnout narrative:
- Spend decades with the most sarcastic and deprecating inner voice that belittles every accomplishment, and berates even the smallest fault
- Spend years convinced all of my great results in hospital PLUS my wonderful personality…proved I was well adjusted, emotionally intelligent and certainly not depressed (AKA the “No YOU’RE depressed” rationale)
- Realize that it is in fact not normal to have visions almost 24/7, visions of taking my own life — most of them very graphic, often violent
- Spend the final year of practicing as a surgeon intermittently standing on ledges and bridges, before returning from the fugue-like suicidal state
- Quit medicine all together and withdraw from society.
Okay frankly, the last section is not standard for most narratives, burnt out or otherwise. Yet it is still all too common in society in general, and in the medical profession in particular. Mental illness is everywhere, but it is particularly insidious in healthcare. My suicidal thoughts made me another number, not some freak occurrence.
The move towards Physician Wellness is a burgeoning movement. Doctors who trained even just a decade ago grumble phrases like “Wellness?! When I was starting out, a doctor’s wellness only meant how many post-call drinks we needed!” Doctors who trained two decades ago couldn’t tell Yoga from Yogi (Bear or Berra). Yet today medical schools and residency programs have mandatory wellness classes, focusing on things like mindfulness, nutrition, and exercise. They can perform Downward Facing Dog and meditate towards inner peace better than putting in a chest tube or floating a Swan. And in the long run, for the health of our practitioners, this, the move towards wellness, is a good thing.
Wellness and particularly Mindfulness are absolutely needed by today’s physicians, if for nothing else than to keep us aware of our place in our mental health spectrum. We spend so much time learning to care for others, we literally forget to care for ourselves. If we get ill, say Norovirus where the floodgates open wide from both ends, do we stay home? Do we curl up in bed, vomit bowl in one hand, un-drunk bottle of gatorade in the other? Nope. We’re expected to slap an IV in our arm, and get back to work, with the iv still in our arm, wheeling the iv pole behind us. If we can’t take time to get over a fever, let alone major GI distress, imagine the idea of taking time out because we were feeling “a little sad”. We just don’t. Mental health takes the third row seat, behind physical health which takes a back seat to our careers.
Of course there are other reasons why Wellness and Mindfulness are necessary, but they can’t just stop there. We in healthcare (and in all of society) need to address our mental health specifically. For some of us Wellness cannot come without confronting mental illness. In the ideal world, Wellness should be synonymous with maintaining mental health, not just a surrogate word for “Not Burnt Out”.
Am I over-blowing this problem? I started blogging about Burnout many months ago, but only gained traction when I began to blog about mental health, my mental health. Once I wrote about my Depression, I received a multitude of messages lauding me for being so courageous in my honesty. COURAGE? Just for being honest? So many have (quietly) told me they suffer the same demons. They thank me for shedding light on the problem. But imagine if instead of mental illness, my “problem” was diabetes or asthma. Imagine I started a blog chronicling my A1C’s or my PFT results. Would there be any praise for how “brave and open” I was?
We avoid talk of mental illness. It is so much easier to blame our situation: the hours, our patients, electronic documentation, fear of litigation, anything but our own inner minds. We work doubly hard to show the world how functional we are, how unimpaired. We even blame ourselves with words like “burnout”. Burnout suggests it was we the doctors that went beyond our own limits, not that the system pushed us there. We put the responsibility on ourselves, saying we should check into our own Wellness with Mindfulness. We are fixers. We assume we can fix ourselves. We avoid even considering mental illness, not to mention diagnosis, and forget about treatment. The reasons for this, of course, are not new. Fear of loss—loss of reputation, loss of referrals, loss of privileges, loss of credentials. And let’s not forget the fear of losing the sense of self, sense of pride, sense of control. And in that fear and avoidance we become even that much more incurable. The window for treatment gets smaller, the illness more refractory.
I have been out of medicine for over a year. Conventional wisdom would say my burnout should have burnt out by now. I should be back to work by now. I should be at peace by now. None of these is actually true. I remain unemployed to this day. I have much more insight and understanding of my pathology with the help of months of therapy and not one, not two, but three antidepressants. My point is that burnout strategies alone cannot be our only tools for the mental health of healthcare providers. Furthermore treatment of mental illness cannot just be its own silo, only employed after mental illness rears its ugly head. It should not be a prn only. It should be an integral part of any wellness program, if even just as a check in. Part of wellness must involve trained mental health evaluation, preferably not by the physicians themselves.
Will our system accommodate this? Will it give doctors room to breathe? Even if it did, would doctors take advantage of the resource? Or will they themselves scoff at the idea of all doctors checking into their own mental health? Too many physicians will deny, hide, overcompensate for, or simply ignore any hint of mental health issues. I know I did a combination of all of the above. The ultimate consequence would have been the taking of my own life. I know where I was headed. I know I was not alone.