It’s official: In Australia, doctors are depressed.
The results of a survey published by Beyond Blue in October 2013 showed that the rates of depression in over 14,000 doctors and medical students are over four times higher than in that of the general population. One in ten had suicidal thoughts in the last 12 months.
Almost 6 percent of doctors under age 30 experienced very high psychological distress, which was twice the rate of the general population.
Male doctors (especially young doctors) worked longer hours (more than 46 hours per week), were more likely to use alcohol as a coping strategy and had higher rates of burnout. Female doctors were far more psychologically distressed and thought about suicide more often (Beyond Blue, 2013; Harrison, 2013).
To make matters worse, doctors are unlikely to seek the treatment they need because stigma is rife within the profession. Over half of all doctors felt that their professional reputation would suffer and they would be seen as less competent if colleagues knew they were depressed. Their jobs might even be in jeopardy. They admitted that they would be embarrassed to seek help, since having depression or anxiety was a sign of weakness. Even if they did get help, they were afraid that their confidentiality and privacy would not be respected and that it would affect their registration and right to practice.
A sizable minority of doctors were the silent victims of bullying or racism.
Coping with depression was a largely private affair. Over a third cited exercise or jogging as a coping strategy. Some doctors prescribed themselves antidepressants or other drugs. Most suffered in secret.
This survey highlights a serious and concerning problem within our society. Physicians provide a great service to all. So what can we do to help them out of depression?
There are two aspects to consider in depression: extrinsic and intrinsic.
Extrinsic factors refer to the external pressures put upon our doctors that make it impossible for them to lead balanced lives. From a young age, our best and brightest academic stars are encouraged to enter the professions — to become doctors, lawyers, dentists and engineers, even before they have a chance to figure out what it is they really want to do.
So instead of choosing a vocation they are passionate about, they dutifully do what is expected of them. They may not enjoy their work but do it anyway because it seems like there are no alternatives. Before long, they are beset by the demands of the medical profession, which means very long hours and an expectation to perform, no matter what. They are treated as members of an elite and privileged class who are more competent than others, stronger, smarter and above needing the kind of help, support and compassion that other humans need. They exist to serve others, at whatever cost.
Add to that a significant workload. A typical general practitioner sees more than 25 patients a day. Most have minor illnesses. Some have cancer and other incurable diseases. Some are suicidal or irrational. Many refuse to take responsibility for their health. Being in close proximity to so much human suffering for more than 8 hours per day can be draining. It takes its toll in terms of emotional exhaustion, compassion fatigue and burnout.
Intrinsic factors refer to the inner world of doctors who internalize these pressures. Constantly striving to meet expectations, they become perfectionists who berate themselves harshly for having all-too human needs, feelings and failings. This harsh internal environment is always present in depression. The more virulent the inner critic, the worse the depression.
There is no escape from oneself, so if the self-talk is belittling with constant reminders of how inferior, worthless or useless one is, suicide may seem like a realistic escape route. Depression can be a silent killer, disguised in a smiling, competent face. All too often no one else is aware of how that person feels inside. Even a much-loved, competent and seemingly well-balanced doctor can feel wretched. The inner critic never has a measure of his victim’s true worth.
In order to rectify this situation, we must communicate to doctors that it’s perfectly acceptable to receive help. At the very least, a weekly therapy session is a chance to debrief and reflect with a fellow professional who will not judge, but listen respectfully as the doctor reveals his or her inner world. A big-picture perspective and fresh insights go a long way toward helping people of any profession feel better. It may be that a doctor needs to consider a different career path, re-examine his or her work/life balance or transform the inner critic into a kind, caring and benevolent friend, all of which can be achieved in therapy.
Doctors make excellent clients because they are intelligent and curious and capable of a depth of self-reflection. They also tend to be overly self-reliant, which means they don’t stay in therapy too long. However there are benefits in overcoming that self-reliance and persisting in receiving help. Doctors need allies who will respect, support and meet them as equals. Only when you are working within an environment that is a good fit for your skills, aptitudes and preferences and are your own best friend can you have a chance of beating depression for good.
If you are a doctor who suffers from depression, please contact me on: 042 223 2089 for a confidential conversation. I can organize a referral to a fellow primary care physician (general practitioner) who can give you a supportive, confidential and non-judgmental service with a Medicare referral.
Beyond Blue (2013). National Mental Health Survey of Doctors and Medical Students – Executive summary. http://www.beyondblue.org.au/media/media-releases/media-releases/action-to-improve-the-mental-health-of-australian-doctors-and-medical-students
Harrison, D. (2013). Doctors more likely to get depressed. The Age – National Newspaper. (October 7, 2013). http://www.theage.com.au