Supporting Physician Wellbeing

Written By Suzan Song

“My pre-covid memories make me kinda sad. It’s been a long year. Love you, friend!” This was the last message I would ever receive from my friend. After having dinner with a friend a week later, he spoke about how painful it was to be an ER physician during the pandemic discussing ventilator use with patients while also worrying about the pile of life stressors that has accumulated over the course of the year. He died that night. When physicians pass away now, my mind immediately goes to two causes of death: infection from the COVID-19 virus or succumbing to the mental health effects of being a physician during the pandemic. Unfortunately, my friend died due to the latter. He’s not alone, as physicians have twice the rate of suicide than the general population.

Physicians are overwhelmed by death, uncertainty, and patients’ fears as they struggle to live. We are witness to the helplessness that families and loved ones feel, and powerless in our ability to protect among public fatigue, a new viral strain, and rising toll of over half a million deaths.

These are all parts of vicarious trauma – the emotional residue of witnessing the pain, fear, and terror, that trauma survivors have endured. Vicarious trauma is one of the occupational hazards of working in a pandemic. People feel emotionally numb or shut down, have difficulty sleeping, feel more irritable or use destructive coping (over/under eating, substance abuse, engaging in risky behavior), lose a sense of meaning in life or feel hopeless about the future, and can experience relationship problems. 

But our psychological burden isn’t only from the vicarious trauma of witnessing despair. The failed management at the beginning of the pandemic, with lack of available masks, slow and inadequate testing, and confusing guidelines, now is replaced with poor roll out of vaccines and a fight against public fatigue of pandemic public health precautions. We are left facing the burden of treating patients when society has seemed to turn their backs on us. In medical school, we are trained to put others’ needs before ours, delaying financial stability and relationships. We miss birthdays, anniversaries and funerals while our own personal health declines. It’s so indoctirnated that we feel bad for not only attending to our own needs, but merely having them.

There are many reasons as to why physicians are so hard on themselves, holding high standards to self-reliance and being able to manage anything that comes our way. Here are a few.

  1. The buck stops here. There is no higher level of care to send a patient to when we aren’t sure how to heal. Because of this, we feel a strong sense of responsibility and take ownership of our patients’ lives. It is an honor and a burden to feel solely responsible for one’s life or death - or quality of life. But this is not fact - we can always refer patients for second opinions. Sometimes our science and research aren’t robust enough to give us the direction needed for clinical care.

  2. Shaming is part of our training. "Pimping” is a horrible term, but one used to describe how attendings and senior residents throw questions at medical students to test their fund of knowledge, oftentimes in front of others. While the rare medical student thrives on this, for others, perhaps the more thoughtful ones, this type of questioning only serves to instill a sense of shame. Students are, by nature of their lack of training, insecure with their knowledge base and are trying to drink from the fire hose. This shaming pushes students into feeling isolated and embarassed in seeking help generally.

  3. Stigma. We believe that since we are in this profession, we should be able to manage anything that comes our way. If we have a mental health problem, our medical board and insurance companies can deny or alter coverage, providing a disincentive to seek help. Mental health problems are already generally stigmatized and misunderstood, and physicians are accustomed to playing the role of the helper, not the patient.

But it doesn’t have to be this way. We can change the culture of medicine - it already has changed quite a bit as I’ve seen with my current med students and residents. We can advocate for policy that de-stigmatizes mental health among helper professions. If you’re a physician and are struggling with any issues, not necessarily pandemic-related, please feel free to call the Physician Support Line. Spearheaded by Mona Masood, myself, Smita Gautham, Allison Cotton, and Ben Chang (all psychiatrists), co-founded this support line for physicians staffed by 800 volunteer psychiatrists. From 8a-1am EST, the hotline is available and is confidential/anonymous. We are here for you - please reach out. The world needs your care, and it’s one step towards letting someone else take care of your own needs.

For more resources, feel free to check out my other essays:

Fletch, we love and miss you. The world will not shine as bright without you here.

Suzan Song
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