Content warning: brief discussion of depression
Today’s topic may seem a bit heavier, but it’s important.
This post was inspired by a few recent conversations I have had with people who have known me since I was in fellowship training and with leaders I have met since that time.
For clarity: “trainee” refers to anyone who is currently in training to become a licensed physician (a “resident” or “fellow”), “attending” refers to a licensed physician who has completed training
In case you’re new here and/or don’t already know, I experienced burnout and an episode of major depressive disorder nearly 9 years ago when I was in fellowship training for pediatric critical care medicine. This experience and the recovery from it have served as the foundation for my current non-clinical work.
As I wrote about last year, I would have never chosen this for myself. However, the post-traumatic growth I’ve experienced has allowed me to impact the culture of medicine (and myself) in a way I truly did not know was possible when I started this work almost 7 years ago.
As I’ve recently started to write and speak about, I was the person to unofficially diagnose myself with depression. It took quite a while until it occurred to me, and I didn’t recognize that I was depressed until I was experiencing a high amount of dysfunction. No one in my training program or workplace had seemed to recognize it, even though my dysfunction was impacting my ability to get my scholarly work completed on time.
Even after the diagnosis was officially made and I was getting treatment (in the form of medication and therapy), my experience with depression was not something I talked about openly at work.
There were several reasons for this:
I felt shame related to thinking there was something wrong with me. (There wasn’t. Data show that 1/3 of trainees experience depressive symptoms during medical training regardless of their specialty or country of practice.)
My workplace wasn’t really the type of place where trainees were asked to share openly about our personal lives. With nurses and other trainees? Yes. With attendings? Maybe. With leadership? Rarely.
Almost no one asked. Some people did know about my diagnosis and the treatment I was getting, but very few of them checked in to see how things were going. I can imagine a variety of reasons for this, but it felt isolating and added to the first bullet point above. Other people were not aware. This could be related to not paying attention or to the fact that most physicians are incredibly skilled at masking their dysfunction. By the time a physician is noted to be ‘struggling’ (aka experiencing dysfunction), they have likely been suffering for a long time and need help ASAP.
After I became an attending, it took a while for me to start talking about my experience with and recovery from depression and burnout. At first, the only people I told were the trainees in the debriefing sessions I was leading. However, as I shared with more of them, the message they gave me became overwhelmingly clear:
More people in positions of power (aka attendings and leaders) need to talk about these experiences openly. So, I started. And I haven’t looked back.
I don’t view my experience with burnout and depression as a “failure” given that these conditions were not the result of something that I did or didn’t do. And, I certainly did not choose them. But, I did struggle as one would when experiencing a ‘failure’ of any kind. And, as a trainee once told me, “There seems to be a hierarchy of who is ‘allowed’ to struggle.”
This trainee meant that, as we in medicine have begun to understand how important it is to normalize struggle and our own humanity, the people with the most power are the ones who seem to have the most permission to show their imperfections. Many trainees still voice that they feel that they have to be ‘perfect’ in order to be viewed as competent. This is not limited to trainees, but the stress of it is amplified while they are in training due to the need for positive evaluations and achievement of training milestones.
You aren’t required to have experienced burnout or depression in order to be aware that burnout, depression, addiction, and other mental illnesses affect a significant number of trainee and attending physicians (and other healthcare workers). As with building knowledge around any topic, you can learn about the experiences of others and use that knowledge to make things better for those around you via empathy and the creation of a culture of belonging.
As leaders (especially those of us in medical education), it is part of our job to help create a culture where we truly care about others as human beings, not just as physicians.
The more we are able to do this and to do it with empathy, the more likely it is that trainees will reach their full potential. As a result, patient care and patient outcomes will also be better. This is the foundation of a culture of wellbeing.
I’ve heard from a few people I’ve known since fellowship that they “wish they would’ve known” about my depression in order to have been able to help me. But I’ve always wondered… would they have helped? In other words… would they have known how to help?
I think it’s an unanswerable question based on a lot of speculation, and it’s not all that important.
The more important question that I have for them and for all of you today is: “How can you help someone now?”
If you aren’t sure how to start, try this:
Normalize experiencing ups-and-downs and create a culture of sharing your wins and failures. If you have experienced burnout, a mood disorder, a medical error, etc., share these experiences with others. Share what resources you’ve used. Talk about going to therapy, taking medicine, getting coaching, or speaking with a mentor. Help decrease stigma and shame.
Get to know people as human beings, not just as professionals. The more you understand about who someone is and how they operate, the easier it is to recognize when they are struggling, and the easier it is to reach out to offer them support. When I was experiencing depression, I was unable to get my work done. This was highly unusual for me and could have served as a red flag to the people who knew me.
Ask how people are doing… really. Create spaces for people to be honest in their dialogue with you. This doesn’t always take extra time. It can be as simple as acknowledging and validating the person’s experience. It may also allow for you to identify people having a hard time and intervene before there are struggling significantly.
Learn the resources available in your organization and refer people liberally.
Use the resources available in your organization (or outside) if and when you need help.
If you’re not already doing this…. try it and see what’s possible.
If you’re already doing it… I’d love to hear what has worked for you in your own workplace. Leave a comment below!