By Ami B. Bhatt, MD, FACC
June 14, 2018
Since the two very sudden public suicide deaths of Kate Spade and Anthony Bourdain, society has again recognized that we never know what is under the surface of another’s façade. As physicians, these tragic occurrences emphasize that our caregiving requires seeing the entirety of an individual’s many parts.
While we acknowledge that the façade is not fake—it is but one true representation of an individual, well-curated, like pages on Facebook or Instagram—no one mourns the corporate façade created for these individuals. We mourn the fact that despite feeling we know someone, we didn’t see it coming. This is that much harder when it is a loved one, and most frightening when you might see it in yourself. Especially, if you are a physician.
As physicians, we first learned to identify anxiety and depression in others. With the increasing rates of physician suicide and the (sometimes) fine line between that and physician burnout, we are now vigilant to identify at-risk colleagues as physician suicide permeates the fabric of American medicine. Using an objective lens is what we do best, but it is also our shield. To turn that lens on oneself is terrifying.
As physicians, what do we see when we turn that lens inwards?
In medicine, we are taught early on to be the best (in addition to becoming a “team player” and to care), to politely crush the competition, and to borrow an 80’s phrase, “never let them see you sweat.” Simultaneously, our patients’ lives demand that we always identify and rule out the worst outcomes first, so we are living in a persistent state of high alert. At the same time, every patient interaction deserves our full delivery of empathy for what each individual and family member sees as their plight.
While work hours have changed, those of us dedicated to our profession (thereby, most of us), take these responsibilities seriously—24 hours a day (24/7/365). Yet, regarding our emotional state, we have learned to outwardly “turn it off.” When we engage with friends and family, places of worship and schools, we do not bring all of our baggage with us. It makes for poor cocktail party conversation, and not only are we not sure people will understand, we do not think they could handle the full weight of what we do.
Over time, do these aspects of training create concerns in the physician psyche?
Although every person is unique, there are shared themes at the bottom of our emotional turmoil: the dark side of ambition where one is never done achieving; the hot mess that stems from negative automatic thoughts about self-worth and projections about what others might think; the challenge in finding fulfilling relationships when we are unwilling to let go of our superhuman facade (or worse, letting go of the facade and being labeled the ornery one, when perhaps it is a justified frustrated state).
What can we do for ourselves?
Strong social networks are certainly protective; suicide hotlines are available at most academic medical centers and large hospitals; our colleagues in psychology often have therapists themselves, and similar services are now available to physicians; meditation smart phone apps and stress management seminars are experiencing a resurgence; public awareness of and open conversation about burnout, anxiety, and depression has increased our ability to identify at-risk individuals and encourage them to seek help. However, the rates of physician suicide continue to rise. This is because we are practicing secondary prevention; we are taking individuals whom the system has broken, and we are trying to fix them. As a cardiologist, the importance of primary prevention is obvious to me every day. To my population health colleagues, primary prevention is the only way to truly handle endemic disease. Physician suicide may be considered an epidemic, but its root causes have become endemic to the training and practice of medicine. We do not practice primary prevention against emotional instability in our physicians.
Most dedicated clinicians, if they are brutally introspective, should be concerned about their emotional state. As we raise the next generation of caregivers, we need a societal shift in the paradigm of our view of the physician. For me, the Norman Rockwell image that I have long touted as the consummate physician may need to be put to rest. A physician cannot and should not be expected to live life on a pedestal, unaffected by the sea of emotional, physical, intellectual, and spiritual demands that engulf us. If we continue to expect that of ourselves then as the tide rises, it may seem like there is only one way out.
As an individual, I function entirely on hope. This is an important chapter in our story, the story of American medicine. What we choose to do next and how swiftly we do so will define whether, in the future, medicine will become an automated transaction or whether it will regain its place as a dedicated calling. This will only happen if our society reinvests in supporting the healers among us, allowing us to build relationships with our patients and use our intellectual and emotional quotients to improve the human condition.
The American Foundation for Suicide Prevention offers resources for health care professionals suffering from burnout and/or depression, including suicide prevention.
Dr. Ami Bhatt is the director of outpatient cardiology as well as adult congenital heart disease at the Massachusetts General Hospital Heart Center where she leads initiatives to provide state-of-the-art subspecialty cardiac care, runs her own Telemedicine Clinic for Adults with Congenital Heart Disease, and creates platforms for virtual cardiovascular care. Her research centers on using medical and patient-reported data to create prediction algorithms for risk stratification and optimal resource utilization.