First, do no harm. It’s one of the most well-known oaths physicians take when they graduate from medical school. Unfortunately, physicians are often exempt from this statement when considering their own health. Not by their own choosing, but as a result of the culture of medicine in which they’re immersed.

Research continues to indicate a lack of self-care by physicians can lead to depression and even suicide. As a profession, physicians face higher rates of depression, anxiety, and suicide compared to the general population. According to Medscape, an estimated 400 U.S. physicians die by suicide every year.

How Does It Happen?

As early as medical school, students begin to feel the pressure of their profession. According to the American Foundation for Suicide, medical students report rates of depression 15 to 30 percent higher than the general population. Between high-volume workloads, applying to residency programs and studying for rounds and licensing exams, medical students are faced with an overwhelming amount of stress that’s just beginning. Once they enter clinical settings, students are then faced with some of the most emotionally difficult aspects of medicine: gravely ill and dying patients.

This pressure only continues as physicians complete their residency and begin their careers. Society expects physicians to be in control and able to handle any situation despite working over 24-hours straight at times and being on-call at all hours of the day and night. They’re expected to provide expert medical and emotional support to their sick patients and worried family, beyond simply writing a prescription and sending a patient out the door. In addition, especially for emergency medicine physicians, witnessing trauma after trauma with little to no time in between to decompress can have lasting effects on a physician’s mental wellbeing.

Fearful of being seen as weak or incompetent, physicians rarely ask for help in dealing with these stressful situations, instead, they force themselves to push forward, ignoring the issues at hand, which can then quickly snowball into much greater problems like serious cases of anxiety, depression, burnout, or worse – suicide.

Recognizing the Symptoms of Physician Depression

How can you recognize the symptoms of physician depression and burnout before they lead to more serious issues? Answer yes to just one of these questions and there’s a good chance you’re dealing with burnout or depression:

• Is it hard to get yourself motivated to go to work each day?
• Have you lost the desire to be around family or friends?
• Do you feel irritable or lose your temper frequently?
• Are you struggling to handle the details of your job or lack the energy to do your job well?
• Are unable to recover between shifts or have trouble sleeping?
• Do you find it difficult to empathize with patients?
• Do you often ask yourself, What’s the use? and feel like what you do doesn’t matter?

How to Prevent and Alleviate Physician Depression

What needs to change to improve the culture and break the silence surrounding physician burnout, depression, and suicide? The solution will require changes from not only physicians, but facilities and medical schools as well.

While physicians are doing life-changing work and deserve respect, they are still only human. Medical schools can foster open dialog where medical students feel comfortable talking about their issues. For example, The University of Nebraska Medical Center (UNMC) is planning to switch to a simplified pass/fail grading system for the first two years of medical school to reduce competition among students and encourage collaboration. Additionally, they have developed a smartphone app that allows student to evaluate personal symptoms of burnout and easily find available services. They have also hired a psychologist to develop stress management programs for students, residents, faculty, and staff.

Some hospitals have also begun taking preventative measures to alleviate physician burn out and depression. Stanford Department of Emergency Medicine currently has a time banking program where doctors can clock hours spent doing things like serving on committees, mentoring, covering colleagues’ shifts, or deploying in emergencies. As a result, they can redeem credits for things like food delivery services, housecleaning, babysitting, handyman services and dry cleaning pickup. Programs like these help physicians avoid burnout before it begins by offering a much-needed helping hand to stressed-out physicians.

As a medical student or physician, if you are affected by burnout or depression the most important thing to know is that you are not alone. There are many of your peers that are in the same boat, even if it’s not apparent. Don’t keep symptoms to yourself. Arm yourself with facts and talk to you peers and your school’s or facility’s administration about what you need to stay well and be successful in your career. There is help out there.

Help is Available – Depression Resources and Information

If you are suicidal and need emergency help in the United States, call 911 immediately or the National Suicide Prevention Hotline at 1-800-273-8255. The website also features an online chat option. The lifeline provides 24/7 free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.

If you are in a country other than the U.S., find a 24/7 suicide prevention hotline at IASP, The International Association for Suicide Prevention. https://www.iasp.info/resources/index.php

Breaking the Culture of Silence on Physician Suicide Shareable graphic from the National Academy of Medicine meant to get people talking about physician suicide and breaking the stigma surrounding it today.

Creating a Safety Net: Preventing Physician Suicide – An article by AFSP Chief Medical Officer Christine Moutier, M.D., for the Association of American Medical Colleges’ AAMC News.

Reducing the Stigma: Faculty Speak Out About Suicide Rates Among Medical Students, Physicians – An article by Dana Cook Grossman, for the Association of American Medical Colleges’ AAMC News.

Preventing Physician Distress and Suicide – Tools for identifying at-risk physicians and facilitating access to care from the American Medical Association – worth 0.5 CME credits.

Interactive Screening Program – Call for applications to bring ISP to institutions of higher education open now. Click here to apply today. An online tool used by medical schools across the country to connect students, residents, and faculty, encouraging them to use available mental health services before crises arise.

Three things to say to a suicidal physician  Pamela Wible, MD gives advice for physicians on how they can help their peers who may be suicidal.