Across the United States, organizations and individuals are recognizing Mental Health Awareness month, shedding much needed light on an issue that affects nearly 1 in 5 US adults every year. Rates of mental health distress among healthcare professionals are even higher, with a 2015 meta-analysis demonstrating a prevalence rate of nearly 30% among residents and 300-400 physicians committing suicide every year in America. Yet despite the attention the crisis has received, both within the medical community and in the general population, it persists.
Much of the current discussion and wellness programming responding to this issue has focused on increasing resilience among trainees. Suggested strategies for improving resilience include promoting recognition of stressors, stress reduction through mindfulness training, and improving self-regulation of stress responses.
But at what point is asking trainees and physicians to become more resilient simply adding another task to what seems to be at times an endless to-do list? And to what extent does the focus on resilience lead trainees to feel that they have ‘failed’ when they feel they are no longer able to be resilient, further adding to the stigma associated with seeking care for mental health disorders?
In the long term, yes, we should be helping our medical students, residents, fellows, and even attending physicians to develop skills and habits that will help them cope with the stresses and challenges of a medical career. However, we also have to create a culture which recognizes that even resilience has its limits. Physicians and trainees need to feel empowered to seek treatment for mental health issues. However, they often hesitate due to barriers to seeking care such as repercussions during the medical licensing process, concerns about confidentiality, and difficulties scheduling counseling visits during typical clinic hours while also working 80 hours a week.
A paper published in the Journal of Graduate Medical Education (JGME) describes five steps institutions can take to help prevent resident burnout. The second focuses on the need to build systems to confidentially identify and treat depression. While no single, comprehensive set of best-practices for building these systems has been developed, a number of institutions and organizations have come forth with solutions. On a national scale, the AMA’s Steps Forward includes some suggestions for systems-level practices, including making resources available on a webpage that does not require a password and will not track user visits. On an individual institutional level, Oregon Health & Sciences University has promoted confidential care by making it easily visible on their website that counseling visits are not documented in EPIC. We may also be able to learn from the many undergraduate institutions across the country who have developed “Let’s talk” programs, providing students with confidential, free, drop-in counseling hours on campus. Providing a similarly styled, highly confidential counseling program at a discreet in-hospital location could provide residents of all specialities with a convenient access point to mental health care. While not a substitute for long-term care, it could help a struggling resident take that first step.
Lastly, as the final point made by the authors of the JGME article mentions, we need to continue to foster efforts to learn more about resident wellness. Like in any other area of medicine – we need evidence based approaches to address these barriers to seeking care and reduce the stigma that continues to surround mental illness – the health of our patients and our own health depends on it.
If you are interested in learning more about physician wellness and suicide prevention, please refer to the February 2018 open letter from the AWS Communications Committee which contains a number of resources, found here.
If you or someone you know is going through a difficult time, please reach out for help.
- Suicide Prevention Hotline 1-800-273-TALK (1-800-273-8255) or text TALK to 741741
Lea Hoefer is a fourth year medical student at the University of Chicago Pritzker School of Medicine. She is originally from Iowa, and completed her undergraduate education at Iowa State University. Her clinical interests include surgical oncology, clinical ethics, healthcare disparities, and increasing access to surgical care globally. She is excited to be continuing her training at the University of Chicago in the General Surgery residency program, beginning July 2018. Her twitter handle is @lehoef.
Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.