It was my final year in medical school. In less than a month, my classmates and I would be graduating from the University of Nigeria, Nsukka, a premier institution at that time in West Africa. We would be graduating with an M.D. degree as doctors.
Fortunately, a doctor or physician is still one of the most trusted professionals in America and possibly the world. In most of the world, medicine is a calling that represents service, nobility, and prestige along with good compensation. However, the fact remains that the medical doctor tag is acquired after several years of sweat and toil, physical and emotional duress, and a rigor that is unique to the medical training.
Our training in Nigeria was compounded by the rumblings of political and economic instability, a lack of regular water supply and frequent power cuts. Many evenings we had to read by the light of candles or oil lamps. Some mornings we fetched buckets of water from a nearby well to enable us to freshen up for the days round of lectures.
I digress. Anyhow, we had less than a month to go before our last two exams. We poured over our textbooks, reviewed endless pages of notes and answered as many practice test questions as we could. In addition we kept up with last minute lectures and clinical work. There was no time to exchange pleasantries or small talk. It was each student for his or herself.
Several days later, it happened. One evening we heard a loud shriek. Someone had seen blood trickling out of a room into a hallway from under a closed dorm door. Eventually the cause was found out to be suicide. The pressure of months of endless studying, impending finals and probably undiagnosed depression had taken a victim. He had decided that slitting his wrists and throat was the only way out of despair, the possibility of failure and the shame thereof.
The stigma of suicide everywhere is bad enough but in many African cultures, it is akin to an abomination. One can only imagine the mental anguish my unfortunate classmate had gone through before taking his own life.
There was an emergency meeting with the dean. We were informed that our exams would be postponed by two days to give us time to mourn the loss of one of our very own. I don’t recall if any counseling services were even offered or not as I left to spend the remainder of the week with my parents at home. I was too distraught to stay in the dorm any longer.
Fast forward twenty something years. I have been living and working in a different continent, in a wealthy and prosperous nation. Here in the United States, suicide remains the 10th leading cause of death overall in a study done by the American Foundation of Suicide Prevention in 2014.
Based on findings presented by the American Psychiatry Association at their annual meeting earlier this year, the suicide rate in doctors is twice that of the general population. Shockingly, the suicide rate among physicians is even higher than the suicide rate among the military. A physician commits suicide every day. If this is not a travesty, I don’t know what is.
Some would say it is the nature of the beast. Medical training and working hours are notoriously long, tedious and isolating. Add to that the psychological burden of dealing with sickness, disease and death on an almost daily basis. There is also a constant need to perform at one’s best at all times despite inadequate rest and sleep. Couple all that with easier access to drugs and medications and it is not hard to see how the grounds for depression and substance abuse can be easily laid.
The good news is that we are starting to acknowledge this. We are starting to talk more and more about it instead of sweeping it under the rug. That in itself is a big first step. What is also encouraging is that there are more and more conferences being dedicated to physician burnout and wellbeing.
The ACGME made sweeping changes in 2017 to limit residency hours while still taking into consideration patient safety, high quality care and physician well being. In addition, we need to push for increased residency spots. With the current physician shortage, there is no reason a graduate from a qualified US medical school should not match. We also must continue to push for more regulations and changes in regards to simplifying MOC, recertification, licensing and preserving some degree of physician autonomy.
Most importantly, we need to destigmatize mental illness and any associated addictions in the medical profession. There should be easy avenues to seek help with confidentiality and without devastating personal or professional retribution. We need to increase mentorship of medical students, residents and other fellow physicians . Who else can better understand their struggles, their journey and their pain than us? Ultimately we will all benefit from any positive change but the greatest beneficiaries will be our patients who need us and rely on us to continue to provide consistent, compassionate and quality healthcare.
As Women in White Coats, the imperative is on us more than ever. More women than men enrolled in medical school for the first time in 2017. This trend is expected to continue. We must harness our inner wells of empathy and compassion, listening and persuasion skills and take the lead in bringing about change. We can and must succeed. The time to tame this beast is here and now.