Witold's Blog

MD stands for More risk for Depression

This had happened at the end of one of my surgical boards’ exams, quite a long time ago. The day was long and we all were exhausted. We were also anxious to know if we passed. Years of studies, sacrifices and high expectations finally came to the end. We were about to become board certified. We badly wanted to know the results.

I contacted the board secretary, quite pleasant older woman, who could be our mother, or a grandmother for some. Very politely, I asked whether she knew the results. She smiled and said “yes.” I raised my eyebrows, looking surprised, but really wanting to know the answer.

“I do,” she said, “but we can’t  tell. A few years ago a doctor jumped out of the window after finding out that he didn’t pass his neurosurgical boards.”

So now he can do it at home, I thought.

Every year 350 to 400 doctors commit suicides. One death every day!

A study shows that 29 percent of medical students have signs of depression.

So what’s going on?

There is this constant pressure to learn more and perform on the highest level. The amount of medical knowledge rose exponentially ever since I was in medical school. Since not everything is useful, each doctor, or doctor to be, must select the pertinent information. As a consequence, there is a general trend to specialize earlier in one’s medical career and a need for defining how much of the general knowledge is needed for a narrow subspecialist, particularly in surgery.

There has always been a need for performing up to the highest standards and anything less than “good” is not good enough. You are expected not to make any mistakes and the worst outcomes stay with you forever. You are your own most severe judge.

If the patient, or his family, are not happy with your care, they can always use the court system to seek retribution. It doesn’t cost them much and they are within their rights. Don’t worry, the backers of the legal system say, more than 90 percent of all malpractice claims are dismissed anyhow. That may be true. But the summary judgment in your favor after one year of legal wrangling already has taken its toll on any given doctor and his family.

So there is one more reason to fall into depression. And are you blame a doctor for being “gun-shy” after the case with a bad outcome? And for him practicing more defensive medicine? When you are being pushed by the patient’s family to do a surgery which they want you to do just to satisfy their desire to “do everything” for their loved one, and you don’t think it’s the best practice, are you in the position to argue with them? If the patient dies, as you beforehand suspected he could, there is no one to say”I told you so,” you get another blow to your psyche. And the hospital files several hundred thousand dollars in unnecessary charges.

If a pilot has near-miss, she or he is debriefed, counseled and is not allowed to fly right after the accident.

When a surgeon loses the patient on the operating table, he rarely cancels the next day case.

Interestingly, for every female doctor committing suicide, there are seven men.

I theory there is help for doctors with depression. But it’s understandable they don’t willingly seek treatment. Losing the medical license is a real possibility. So many of them seek a permanent solution to what seems to be a temporary problem.

One person every day.