Short, quick, barely edited — so apologies. Longer one to come.
There’s this idea that depressed physicians — or any other professional with high-stress, high-stakes jobs — just ticking time bombs, waiting to detonate.
In some ways, this is true — but not ‘because they are depressed.’
Rates of suicide among male and female physicians are nearly 1.5x and 2.25x higher, respectively, than in the general population. These facts are particularly harrowing because physicians who attempt suicide are also more likely to complete it, due to their superior knowledge of human anatomy and access to prescription drugs. Rates of depression, alcoholism, and substance abuse are, likewise, particularly high among physicians.
It’s very likely that, sometime during my medical school interviews, I will be asked if I think someone with a history of depression should be allowed to pursue medicine. Many site these same statistics as reasons why someone with a history of depression cannot handle such a high-stress, high-stakes job (they also site concerns about the well-being of patients, which is a bit misfounded — again, I’ll write about it later).
And what will my answer be?
A big, resounding YES.
The reason that depressed physicians — or any physician — detonates is not simply that they ‘can’t handle’ the pressure. Yes, chronic stress, sleep deprivation, proximity to tragedy, and toxic organizational structures can certainly aggravate depressive symptoms or cause feelings of burnout. And yes, negative mental well-being of physicians have been linked to an increased number of medical errors (although, please proceed with a grain of salt — the evidence isn’t overwhelming).
Obviously, depression is implicated in a number of suicide cases. But the answer isn’t to discriminate against students with histories of depression.
Why? Because every single person, regardless of previous history, is susceptible to depression. It’s not the ‘weak’ ones. It’s not the ‘least competent’ ones. It’s ‘every’ one. If you tell medical students that they can’t be depressed and be good doctors — if you tell them that they will be seen as incompetent or unfit for medicine if anyone finds out they are depressed — you’re not stopping depression from entering the ranks of medicine. You are raising the amount of untreated depression that accumulates among bright, competent, and eager young medical students/residents who need help but cannot seek it without fear of stigma or — worse — someone else deciding they aren’t fit to continue with their education or practice.
So yes, if you keep building and building the pressure in someone while blocking any efforts to seek the help they need — if someone feels like all their hard work (because the path to medical school IS hard) will go out the window if they admit they need help — then, yes, it’s no surprise that some medical school students/residents/physicians eventually detonate. And that’s our fault. Not theirs.
Author’s note: I realize that, before I publish this, that this is not a post that directly relates to my current state of mental health. It is a criticism of a problem that exists in the world of providing healthcare.
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