Opinion: Physician Suicide, PTSD, Medical Burnout: An Unexpected Casualty of Covid-19

We are living in unprecedented times. COVID-19 has stressed a population of healers who were already stressed in their work environment. While burnout, depression and suicide were associated with the stress of practicing medicine in today’s healthcare system, somehow this pandemic has made it worse. Is that really possible? Yes.

Resources for those physicians, nurses and other medical staff professionals who experienced burnout pre-COVID consisted of wellness initiatives within the hospitals, however many declined to use these resources because of the stigma surrounding mental health issues within the medical profession. Physicians especially feared disclosure because of the possible repercussions which included loss of licensure. They suffered in silence and some chose to end their lives.

With COVID-19, the symptoms of burnout: fatigue, frustration, helplessness, cynicism and loss of compassion for others, have been amplified. These frontline workers are seeing death day in and day out. They have a difficult time making sense of what is happening. These workers fear being fired if they speak out. They also fear for their families if they themselves get sick or worse, die. The fear that no one cares about them and they are seen as disposable. There is no one to talk to; no one to allow these feelings to be mitigated. Getting up in the morning to go to work brings on stress and that stress continues through the grueling 10, 12 or more hours of work. The fear that these workers must work no matter what. They hold constant stress that is going to lead many to become burned out and most likely become depressed.

Post-traumatic Stress Disorder is not burnout. As mentioned, being on the frontlines observing patient after patient die and there’s nothing one can do is the trauma producing this problem. Just imagine seeing these events live and in living color over and over and over again; while you sleep; while you’re awake; while you’re trying to just do your job.

Depression is one of the most common mental illnesses with symptoms of severe sadness, isolation and sleeping difficulties. Eating too much or too little may be present. Depression is an equal-opportunity mental disorder and medical professionals have no immunity to it. There is an assumption in the general public that physicians and other medical professionals can’t have a mental illness. Why is this? Are they not after all human? And humans get diagnosed with cancer, diabetes, heart disease and mental illness everyday. However, this flawed belief is why being a physician with a mental illness can cost that physician his license if disclosed on a credentialing application. The argument is that asking the question “Have you or are you presently diagnosed and being treated for a mental illness”? If you answer yes, you are put under a microscope to determine if you can practice. This needs to be changed.

In this new normal we are experiencing, mental healthcare for all must be addressed. Mental healthcare needs the proper funding to truly manage the needs of those affected by what essentially is a brain disease. And there should be no stigma attached. The healthcare system, in its attempt to provide better care for patients, has forgotten about those who provide the care. The introduction of the electronic medical record, although a great idea, should never have been part of the job-description of the physician. Physicians trained for 12 years or more to care for their patients and not to be data-entry clerks. Patients talk about the fact that their physicians spend more time with their backs to them entering data into a computer, than face to face in their eight to 15 minute visits. Physicians spend an additional 2 hours/day at home charting. This is after a usual 10-12 hour shift. Another stress is the number of patients physicians are required to see on their shift to meet their “quota”.  In addition, the lack of respect and the feeling of being a disposable body in the system is a stressor.  

What can be done?

Imagine dealing with these stressors and more over the course of 5 or 10 years. Something has to give. Physicians are the best and brightest entering into medical school and over the course of those 4 and 8 years that follow, they are demeaned, bullied and overworked. Student debt prevents them from seeing any other option but to stick it out in hopes that it will get better. And some see the only option is death. There are no documented statistics, but medical students and residents are also dying by suicide. The number for physicians is approximately 400/year. So knowing this, what can be done? First acknowledgement of the problem.  Physicians are dying by suicide at an alarming rate and the underlying cause is workplace abuse/stress that leads to burnout which leads to depression and for some, suicide.  Dr. Lorna Breen, an ER physician in NYC died by suicide last month. This physician gave subtle hints about her stressors. She spoke of her sadness in her inability to save the lives of the many patients she saw with COVID-19. Breen contracted COVID-19. Sometimes we can’t hear the call for help when it comes in.  And for others like Breen, a lifeline is truly necessary. We all need someone to talk to about what is happening in our lives right now.  We have never experienced this much anxiety-provoking uncertainty. With the social distancing, the only way to help each other is through face-to-face six feet away. It’s not the best, but it’s better than the alternative. Some hospitals have wellness programs and I have said “The cure for burnout is not a yoga mat,” however during this pandemic, making sure all personnel involved be allowed some “me” time away from the drama; some sleep time away from the drama; healthy eating and some form of exercise will help.

As to the stigma of mental health issues in medicine, it needs to stop now. By 2030, the U.S. will experience a shortfall of physicians around 120,000. I believe it will be more despite the recent graduation of 30,000 fresh new physicians. We the people need to be there for these physicians to help them be the best they can be. We need to allow them to have a life outside of the hospital. An eight or 10 hour shift should be just that. We don’t allow pilots to fly more than nine hours or truck drivers to drive continuously for more than eight hours. Why are physicians any different? No one can be at the top of their game if sleep-deprived and overworked. Physicians go into medicine because it calls to them. Why else would someone sacrifice so much time, money and their “formative” years?  Yes, it is a calling, but it’s not supposed to kill you! The only way to stop this annual death toll is to make mental health a priority. Without it, physicians and others in the stressful healthcare environment will continue to make the ultimate sacrifice. Their lives. 

Dr. Lynette Charity is a Board-Certified Anesthesiologist with over 35 years of experience “putting people to sleep.” She is also an author, humorist and award-winning international speaker who graduated with honors from Chatham College for Women and received her MD degree from Tufts University School of Medicine.