A recent New York Times article on suicide gave the dismal statistics that suicide rates have remained unchanged for 50 years and individuals are 15 times more likely to commit suicide in the immediate weeks after hospitalization. While national statistics are not necessarily true for the individual, we can see this was the case in the suicide of Lorna Breen, MD, which did occur after a hospital discharge.
Breen was an emergency medicine physician working in New York City in 2020, when there was not enough personal protective equipment for front-line healthcare workers and limited knowledge about the COVID-19 pandemic. Breen supervised two emergency departments during a time when the N.Y.C. community hit a peak of 800 deaths in a day, an unimaginably traumatic situation. With no previous history of mental illness, she was hospitalized for a time with self-described suicidal ideation. After discharge, she seemed to be doing better — but the day before she died, she said, “I couldn’t do anything,” in reference to her work during the pandemic.
Our communities may call Breen a heroine, yet her family does not want her lionized without recognition of the mental suffering and anguish that goes largely unspoken in the current medical community. There’s a systemic problem, a deep crack in the medical culture that has placed inconceivable burdens on healthcare workers throughout this pandemic. The issue has contributed to and been exacerbated by the Great Resignation.
To our fellow physicians, we say: Dr. Human, please be kind to yourself. There is a physician mental health crisis filled with anxiety, depression, and post-traumatic stress disorder, but the perfectionistic, patriarchal medical system does not give us permission to feel. As physicians, we’re taught to believe we have to be superhuman. Such mental health challenges are also contributing to burnout, which can include detachment, depersonalization, and distance.
Women physicians unfortunately carry a double risk of burnout and suicide compared to male physicians, and the physician suicide rate overall is double that of the general population. President Biden’s announcement that the pandemic is over and then the walk back of his comments reflects the confusing situation around us — COVID-19 restrictions have mostly disappeared, but hospitals still have patients gasping for air as the virus destroys their lungs. Hospitals also remain overcrowded with other diseases of the heart, mind, and body. Many hospital systems are overwhelmed without enough healthcare dollars and emergency rooms filled beyond capacity.
The healthcare crisis is not over. This is why doctors — and the healthcare systems employing them — must remember that doctors are human too. Time to take care of oneself is essential to survival. No one can have compassion for others without self-compassion. Those treated as “other” often cannot assimilate or acculturate properly. When everyone, doctors included, see physicians as “other” — whether positively, as an authority figure with the power to heal, or negatively, as someone too busy to take in their patient as a human being beyond their disease — we become relegated to automatons. The more doctors are put on a pedestal, the more they are seen as “other,” different from the patient, different from non-physicians, and different from other human beings. There are many ways to be “other,” but, doctor, you are still human.
Throughout the trauma and burnout associated with the pandemic, we physicians continually strive to exude strength and resiliency. But Dr. Human, emotional trauma needs to be processed, healed, and ultimately transformed into some kind of meaning. You deserve self-compassion. Expressing vulnerability helps humans to be validated and heal.
The healthcare system cannot run without physicians. Because of the existential condition that confronts doctors daily, physicians must be seen as human beings first, practice self-compassion during burnout, and seek help for mental health challenges before tragedy. In honor of every doctor’s humanity and in honor of Lorna Breen, physician well-being must be prioritized.
Christine Ko, MD, is a professor of dermatology and pathology at Yale School of Medicine. Eunice Yuen, MD, PhD, is an assistant professor of psychiatry at Yale School of Medicine, and the founder and director of Yale Compassionate Home, Action Together (CHATogether).
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