National Post (National Edition)
I WAS JUST IN SUCH BAD SHAPE ... I DIDN’T HAVE A CHOICE. ‘I’d have to be dead before missing work’
The creative, non-fiction piece, written for the Canadian Medical Association Journal, was stimulated by his own brief bout of depression.
Bernstein describes waking drenched in panic and sweat, struggling with feelings of “inadequacy and insecurity,” and sobbing like a baby after hanging up from a call from one of his daughters.
His wasn’t a serious depression. Bernstein didn’t miss any work, “although I’d have to be dead before missing work. But there was no question. It was clinical depression.”
By exposing himself, the risks weren’t just theoretical. “If all the family doctors and neurologists who send me brain tumour patients, if they all read this article and said, ‘this guy is depressed, I better not send him any more cases,’ I could have seen a drop in referrals.” It didn’t happen. Instead, “I had people reaching out,” he remembers.
His brief depression, in 2003, never progressed to the point it affected his medical judgment. While the stigma around mental illness isn’t as strong as it once was, with more attention being paid to burnout, depression and physician “wellness,” it lingers still, Bernstein says. “I think, underneath, covertly, it’s still there.”
The very nature of the work itself can sometimes be depressing. Bernstein recently operated on an 18-year-old girl with brain cancer. “So her parents, these lovely, lovely people, were there with their precious daughter, who they know is probably going to die of brain cancer before she sees her 20th birthday,” Bernstein says.
“If that doesn’t get you, then you’ve got to hang up your spurs and get another job. Because you can’t stop caring.”
Doctors do learn to compartmentalize. “I think the bigger piece is the workload, the bandwidth issue — the making patients wait, the not-having-enoughhours-in-the-day …. the administrative crap, the system imperfections, the constant worry that you’re not going to serve patients well enough ... It’s that sensation of drowning all the time. And that’s the way a lot of doctors are functioning in our system,” says Bernstein. “It’s frightening and it’s exhausting and it leads to depression.”
In a recently published survey of more than 2,100 physician-mothers who belong to a closed Facebook page, half of them believed they met criteria for a mental illness at some point in their careers — but had never sought help. Only six per cent who received a formal diagnosis reported it to their licensing boards.
The survey’s lead author, Dr. Katherine Gold of the department of family medicine at the University of Michigan, was surprised how often the women would warn each other against seeking treatment. “Instead they would say, ‘if you need help, go to a different town or make sure you pay cash for your prescriptions.’”
Many confessed to writing their own scripts for tranquillizers or antidepressants, or asking a trusted colleague, “I’m going through a rough time, could you write me for some Zoloft?”
“We just really need to make it normative for physicians to get help if there’s a problem,” Gold says. “We need to help them realize it doesn’t make them a worse physician or a worse person.”
When Dr. John Bradford realized he was in serious trouble, he contacted the Ontario Medical Association’s Physician Health Program, which refers doctors for assessment and treatment of problems related to stress, burnout, mental health, addiction and other issues. The program monitors about 140 doctors at any given time, 90 per cent of them ending in “satisfactory completion.”
“They jumped on it immediately, they did everything right,” Bradford recalls, adding his hospital’s CEO was also supportive.
“But to take that first step was anxiety-provoking. I was just in such bad shape at that point, I didn’t have a choice.”
Myers, in his research, found some physicians are dressed as doctors when they take their lives. One of his patients changed out of her street clothes and into her surgical scrubs before injecting herself with a lethal overdose. Another male doctor was found on his examination table, his wrist tethered to an IV pole with his belt.
“Could the means of death or setting of death have medical meaning?” Myers writes. “That in the moment of time, the individual is really in the role of physician?
“We can only hope the doctor has found some good memories and comfort in those lonely final moments of life.”
WE JUST REALLY NEED TO MAKE IT NORMATIVE FOR PHYSICIANS TO GET HELP IF THERE’S A PROBLEM. WE NEED TO HELP THEM REALIZE IT DOESN’T MAKE THEM A WORSE PHYSICIAN OR A WORSE PERSON. — DR. KATHERINE GOLD, UNIVERSITY OF MICHIGAN