Editor’s Note: The following article contains depictions of suicide.
While conducting rounds on the adult cancer unit, our team stopped outside a patient’s room for the intern to present. But he was nowhere to be found. As the attending physician became impatient, the intern ran up with a shocked look on his face. The attending angrily asked where he had been. The intern solemnly stated, “I just saw Dr. Peters jump off the 15th floor balcony of the hospital.” As a third-year medical student on the team, I immediately felt faint and confused. Our attending replied, “That’s a shame. He was a sick man. OK, on to the next patient.” There was no hesitation, no pause to process what we had heard and what this poor young physician witnessed. I stood there silent like an obedient student, following my mentor’s example. I then continued with my work, never to discuss this tragedy in any formal way.
We clinicians are trained in solving problems, swallowing emotions, and moving on to the next task at hand. For those of us raised as male in American culture, this is reinforced by what we’ve been taught our entire lives. This compartmentalization can serve us well when handling emergencies and making fast decisions to save lives. But when it extends to everything we do, day and night, the vicarious trauma we absorb never gets processed. We end up overwhelmed, isolated, and burned out.
The COVID-19 pandemic has been the most far-reaching global medical crisis of my lifetime. For all of us in health care, constant stress and uncertainty are the norm. We’ve been called to risk our lives while caring for patients; risk our families’ lives as we potentially expose them to the virus; attend to the emotional needs of critically ill and dying patients while their families are prohibited from visiting hospitals; and finally, become the targets of angry patients who refuse to heed the scientific evidence of the benefit of vaccines. The direct and secondary trauma we’ve experienced has not been fully processed either individually or collectively because that isn’t part of our culture.
Now, even before we have exited the COVID-19 pandemic, we are facing the next pandemic of widespread mental illness among health care workers, with many abandoning medicine altogether.
It doesn’t have to be that way. We are at a crossroads in health care, with one path leading to a pandemic of post-traumatic stress, and another heading toward a renaissance of post-traumatic growth. If we ignore the emotional impact of our experiences, we will go down the first path. If health care institutions likewise continue to ignore their responsibility to create supportive healthy work cultures, they will pave the road to a mental health crisis. However, if we all acknowledge the trauma and work together to process and learn from it, we can create positive life-giving work environments, leading us to a better place where investment in our own well-being results in improved patient care and professional fulfillment.
Resources exist already to help institutions take accountability. The AMA’s Steps Forward Program offers several successful, evidence-based interventions for institutions to use to support the mental health of their providers. Many of them are as basic as leaders showing up and asking front line staff how they can be better supported. In addition, the Institute for Healthcare Improvement has synthesized all the research published in this area in their article “Psychological PPE: Promote Healthcare Workforce Mental Health and Well-Being”. The article provides simple recommendations for both individuals and organizational leaders to promote clinician well-being, such as the “buddy system” peer support program and training for managers to recognize signs of mental distress.
However, these institutional interventions will not be meaningful until adequate and appropriate staffing is implemented in our clinics and hospitals. The Great Resignation of health care workers is in full swing with RNs, MAs, CNAs, and administrative staff quitting in droves, leaving clinicians on their own to attend to their patients. This is not sustainable.
In addition to improved institutional frameworks, individual clinicians must attend to their own emotional, physical, and spiritual needs before giving so much of themselves to others. Research has shown that practicing self-compassion and boundary setting significantly reduces secondary traumatic stress and burnout. This is not something that was role modeled to us in our training. Seeking help was directly connected to being weak. However, the reality is that those who have the courage to reach out for help and set limits on the amount of time and energy invested in their work turn out to be the best clinicians.
Many physicians still hesitate to seek out formal mental health treatment because of the possible impact on licensing and hospital staff applications. This sad reality is gradually changing for the better as states eliminate application questions regarding mental health treatment. As a flexible alternative, professional coaching has assisted many physicians in enhanced well-being and performance and has been proven to decrease burnout and improve resilience and quality of life.
Imagine a supportive health system where after Dr. Peters jumped off the 15th floor, the attending physician showed the same degree of shock and emotion we all felt, counselors met with each team member present that day, and all doctors, students, and staff members gathered to process the experience together.
Better yet, imagine a world where Dr. Peters never felt the need to jump.
How do you take care of yourself and others during these trying times? Share your individual and systemic solutions in the comments below.
Joe Sherman, MD is a pediatrician, professional development coach, and consultant to individuals and health care organizations in the areas of cross-cultural medicine, leadership, and clinician well-being. His mission is to help health professionals rediscover the joy of practicing medicine. Reach him at firstname.lastname@example.org.
All names and identifying information have been modified to protect patient privacy.
Illustration by Jennifer Bogartz