As an emergency physician on the frontlines of the pandemic, initially I feared for the safety of my friends and colleagues because of personal protective equipment shortages and direct exposure to COVID-19. But there is a hidden side effect of the virus that will be just as dangerous, although likely underreported -- physicians' mental health.
We knew a pandemic could be our health system's tipping point, but the scale of suffering and death, the likes of which most of us have never seen before, is taking a large psychological toll on professionals on the frontline. We face stress and grief at work, and then many of us remain isolated from our homes and our support systems, causing more anxiety and depression. While we try to compartmentalize all the suffering we see as emergency physicians, we are human, and it affects us all.
Physicians have one of the highest suicide rates of any profession, and female doctors are even more at risk. Emergency medicine in particular is incredibly stressful and known for high burnout rates.
Emergency physicians feel we need to be superhuman while on shift, but many friends and colleagues have admitted to me during this pandemic that the hardest part of the day is when they finish their shifts and they are alone, processing the day's pressure, stress, and grief.
The toll our days take on us may not manifest until later down the road but sadly, for others it can be too much to bear. Emergency physicians are mourning the loss of one of our best and brightest from suicide, Lorna Breen, MD, who left us in April 2020. I fear there will be many more tragedies, unless we break the stigma of mental illness and end the idea that for a physician, seeking treatment is taboo.
Physicians in all specialties are reluctant to reach out for mental health help, even in the best of times. Many of us fear that seeking treatment could jeopardize our career. Questions from some hospital credentialing and medical licensing boards can be worded with sweeping statements that could imply that receiving treatment for a mental health condition would be an impairment that affects our capacity to practice. This approach may go beyond the intent of the Americans With Disabilities Act, and it is understandable that physicians are reluctant to answer these types of loaded questions.
Physicians, just like everyone else, face normal pressures such as a difficult divorce, family issues with children acting out, or the death of a loved one, any of which could reasonably require a little help in the form of counseling or medication. It is unreasonable to expect a physician to absorb and handle these issues themselves while others can seek counseling or care. And it's even worse that we would feel forced to ignore or downplay these stressors during a pandemic.
It is tragically ironic that we are vocal advocates for the mental health needs of our patients while we forgo treatment ourselves and must hide our own human frailty.
The status quo must change. The American College of Emergency Physicians and many other medical associations are fighting to protect the health professionals responsible for millions of lives.
My fellow physicians should be able to seek appropriate mental healthcare without fear of reprisal. Credentialing authorities should encourage physicians to prioritize their mental health. Doctors are people, too. We should be able to get the same mental healthcare as anyone else, without feeling like we are risking our jobs.
Leigh Vinocur, MD, is an emergency physician practicing in Baltimore and a member of the American College of Emergency Physicians.