Doctors At Risk: A View On Physician Vulnerability In The Medical Scene
Doctors are considered to be pillars of society. They are hope personified. As individuals expected to fulfill a public standard, they are compelled to show extraordinary resilience, patience, and other characteristics associated with being “perfect stewards”. However, as cynical as it may sound like, perfection has its limits. Hiding behind the doctor’s white coat is human vulnerability shrouded by the profession. In this paper, I elucidate on the concept of how doctors live in a façade of strength and discuss the stigma of vulnerability in the medical profession. I present different concepts on medical student and physician mental health, and how these ideas provide structural arguments justifying the need for active self-care amongst medical professionals. Approximately 400 doctors in the U.S. die from committing suicide each year. In the past century, multitudes of reports have been published linking physicians with increasing rates of suicide (Ross, 1971). Stack (2004) had reported that physicians have 2.45x greater suicide risk than the general population. These statistics disclose the existence of self-directed deaths among physicians and provide a brief record of the stigmatized concept on doctor vulnerability.
Physicians have always played an irreplaceable role in humankind. Beyond the concept of disease and treatment, doctors primarily bridge the gap between science and society through medicine. To effectively do this, medical students undergo rigorous training and intensive medical education for them to become capable physicians. Medical education has always been connoted to be a highly demanding type of pedagogy. Aside from academic-related burdens, it is primarily focused on the healthcare of the people which in turn makes it a type of training that has very little tolerance for mistakes. Due to the idea of perfection as its paradigm of instruction, medical students experience mental health degradation as they progress through their medical education which can be called student burnout (Carson et al, 2000).
As concerning as it may sound, “burnout”, which is a shorthand for emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment, is characteristic of professional healthcare culture (Stehman et al, 2019). Due to the customary principle of faultlessness within the field of medicine, blame and isolation caused by medical blunders result in physician emotional injury. This can be attributed to the so-called “second victim syndrome (SVS)” which involves the psychological trauma experienced by healthcare workers after being involved in an adverse event particularly due to a clinical error resulting in poor patient outcome. SVS is both a result and a causative factor of burnout in doctors. Burning out and other psychological morbidities have also been reported to be highly prevalent amongst medical students (Rosal et al, 1997) and has been elucidated to begin during medical school.
Suicidal ideation, a consequence of burning out, in medical students has been reported to range from 6% to 43% from a study relative to the Norwegian medical student population. Varying causes have been correlated with the vulnerability of medical students to suicidal ideation. Generally encompassing personal and professional stressors, causative factors include increasing academic burden, deprivation of leisure time, and financial debt. Also, various reports have shown that medical school admission requirements are predisposed to the selection of individuals who are at risk of manifesting depressive disorders, and suicidal ideation. This is due to the homogenous personalities that are observed with accepted medical students namely perfectionism, obsession, introversion, and low self-esteem.
Stuck in a cycle of consequences, burning out and suicidal ideation are two major causative agents of poor medical practice. Aside from the ultimate tragic outcome of suicide, negative impacts of burnout on healthcare quality, patient safety, and financial performance have also been observed. It has also been reported that physician burnout can be contagious, wherein burned-out physicians negatively interact with other co-workers thus amplifying poor performance leading to the creation of a negative clinical work environment risking patient safety. Amidst all of these studies exposing the existence of physician mental health issues, why is physician mental health and wellness not a priority? Alarmingly, traditional customs in medicine consider burnout as a sign of weakness indicating incompatibility with the medical profession. Due to this stigma, physicians are unwilling to engage in mental health assessment and treatment. This can be supported by the study of Gross et al (2000) wherein it was reported that 35% of physicians do not seek regular healthcare for themselves.
The zero-mistake standard of the society towards physicians remains as the foundation of the profession. As callous as it may seem, doctors continue to live in a façade of indomitability since patients are not used to the reality of physicians getting sick. Physicians suffer due to the public’s otherworldly expectations of doctors as people without vulnerabilities. All of these elements contribute to why doctors are unwilling to seek professional treatment since they will never get used to being a patient. Studies about the harmful repercussions of physician burnout have already been widely elucidated and these results further justify the need for mental health and wellness in the medical field. However, as much as mental health wellness should stem from the individual, the healthcare system, itself, should also be obligated to provide support and remove the stigma on doctor vulnerability. Stepping outside the box of being a “professional” can be an uncanny feeling, however, doctors are also humans under that white coat. To become a better doctor, a physician must first be good to oneself. These issues expose a problem within the medical field and these further justify the need for a better healthcare system, not just for the patients, but also for the doctors. The world should never lose sight of the patient behind the professional; Doctors, like superheroes, have weaknesses too.
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