Sometimes It's Hard to Be a Doctor

Suicide is our way of saying to God, 'You can't fire me, I quit!'
Bill Maher

http://abcnews.go.com/Health/DepressionRiskFactors/depression-burnout-make-surgeons-mull-suicide/story?id=12634185

I have many issues with how doctors are portrayed on TV. What bothers me the most is how writers deal with complications and bad patient outcomes. Modern TV acknowledges that doctors cannot cure everything, but glosses over the impact on the physicians from such disasters. Although TV doctors can appear upset after botching an operation, the next week they are back, doing the same thing, as if nothing happened. Needless to say, it does not work that way. Complications and bad outcomes are as much a part of medicine as healing, but are misunderstood by both the public and often by the physicians themselves.

The article referenced today finds that many surgeons harbor suicidal thoughts, usually related to medical mistakes or burnout. The writers seem to express surprise at how high this percentage is. I think it is too low, and reveals a serious emotional issue endemic in physicians, which is not frequently discussed.

As I have stated many times previously, bad outcomes and complications are a routine occurrence, and patients inevitably get hurt. In some specialties, such as neuro and vascular surgery they occur every day. The normal human response to hurting another person, no matter what the relationship, is guilt and remorse. Part of a doctor’s training is to learn how to deal with these emotions, but not every physician copes successfully. Those physicians who are unable to address these issues become uncaring, depressed, and sometimes suicidal.

The generally accepted method for confronting these feelings is rationalization, or saying “I am a good doctor, and I did the best I could”. Unfortunately, this technique does not work for everyone. Eventually the reality that “I could have done it better” sneaks in, and this rationalization stops working. Doctors then often revert to denial and the dehumanization of their patients. This is a sad, but inevitable response at the heart of many of the problems plaguing healthcare. A certain percentage of unhappy, alienated and depressed physicians are an inevitable result of the profession itself. Greed, indifference, interpersonal difficulties and substance abuse are frequent responses.

So the next time your doctor seems distant, distracted or depressed, cut him a break, he is dealing with something very difficult that he may not entirely understand.