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When Brigham and Women’s Hospital researcher Douglas Mata began searching for research on depression in residency a few years ago, he was surprised to find that no comprehensive studies existed.
So he set out to do one himself.
“We found about 54 studies that we extracted data from and combined together, and then we were able to show that, overall, the prevalence of depression or depressive symptoms is about 29 percent among residents, which is a huge number," he said.
In fact, figures from the National Institutes of Health show it’s more than four times higher than the percentage of the general American population that has depression.
Mata is himself a resident. He switched to pathology from a urology residency after a depressive episode of his own.
"There were a lot of different reasons for it," he explained. "One is that a colleague of mine unfortunately had committed suicide shortly before I started. And then on top of that, there was the stress of having moved across the country and lost that support group that used to be around me when I was a student."
The suicide of a friend, as well as the death of a relative, also triggered a depressive episode for Dr. Elisabeth Poorman, who just completed her residency at Cambridge Health Alliance.
"I felt like water was rising, rising, rising, and I was staying afloat and then I was in it — and it didn't matter what I did," she explained. "I was still completely disconnected from any kind of happiness. And, it didn't feel like it was gonna end."
'Our Whole Lives Are Work'
Poorman wrote about her struggles with depression for WBUR's CommonHealth blog. She said it took her a few months to get proper treatment, but when she did get help, those in charge of the residency program helped her schedule therapy sessions into her work week.
She said she didn't seek help immediately, because she, like many other residents, was concerned about the stigma attached to admitting she had depression, about the fear of being judged by peers and issues of confidentiality. And, she said, her depression wasn’t affecting her work.
"Our whole lives are work, so as long as you’re able to get up and go to work and work these 16-hour shifts and do a good job, which I feel like I was doing at least a decent job, then it’s fine. Then it’s not a disorder. It’s just some variation of normal life experience," she said.
This is something hospital management and state medical officials are trying to change.
'We're Taught We Have To Almost Be Super Human'
Board of Registration in Medicine Chair Dr. Candace Sloane urges doctors to get help for mental health issues early.
"That's why our application says you don’t have to tell us unless it’s going to involve patient safety. So that is a way of us saying go get the help before you have a problem," Sloane said. "It is always better to prevent or to treat early."
Depression isn’t the only mental health issue affecting residents. Dr. Brieze Keeley, who is a resident at Massachusetts General Hospital, said she had what’s known as an acute stress episode. She describes it as a sort of mini-post-traumatic stress disorder.
"I lost a lot of weight, in a very short period of time," Keeley said. "I was probably sleeping two hours a night, but was having terrible dreams and waking up from like these nightmares every hour. And then physically, I felt like my limbs were numb. I didn’t feel in my body at all. And I felt scared."
Keeley said the stress episode lasted only two weeks, but it affected Keeley’s work and a patient, after she missed some warning signs of looming kidney failure in the man’s lab results.
"I shouldn’t have let it slip, you know?" she said. "And I just didn’t realize, and I didn’t realize that the days had passed and I hadn’t looked at those labs. And that was terrible."
The patient survived, and Keeley learned that she — and all physicians — need to seek help at the first sign of a problem or episode that might affect patient safety. She said that when she approached her supervisors, they quickly linked her with a therapist and she began to get better.
Get Help — And Get It Early
"I had a very treatable condition, but I was getting the message that I should just grin and bear it, that it would magically get better on its own."Dr. Elisabeth Poorman
While Keeley and Poorman spoke up about their depressive episodes, many doctors keep silent.
Even Sloane recognizes the challenges in getting physicians to admit when they might need help.
"We’re taught we have to almost be super human," Sloane said. "People who pick medicine tend to be people who want to care for others. They want to be the caregiver. They don’t want to take care of themselves, they’re not thinking about themselves, they’re thinking about everyone else."
And at Cambridge Health Alliance, Poorman said she encountered peer pressure among some residents.
"A lot of medicine doctors that I had talked to, internal medicine doctors, would say, 'oh, this is just residency, residency is terrible, everyone feels terrible all the time, it’ll get better,' " she said. "But, I think that’s a really dangerous message. It was certainly a dangerous message for me, because I had a very treatable condition, but I was getting the message that I should just grin and bear it, that it would magically get better on its own," Poorman added. "And I think it’s very clear from the research, too, that that’s not the case."
Hospitals are working to replace that message with another one: get help, and get help early.
"There can be a point where white-knuckling it through is neither good for yourself nor optimal for patient care," said Dr. John Herman, associate chief of psychiatry at MGH and medical director of the Partners Employee Assistance Program. "It's not that you can't gut ball it through this, but you don't have to."
Herman said the motto of his program and message he hopes to share with struggling doctors is: "Don't worry alone."
If you are a doctor who thinks you might need help and are currently working at any Massachusetts medical facility, you can find help at this website. If you are affiliated with Partners HealthCare, you can also call this 24-hour hotline: 1-866-724-4327.
This article was originally published on August 24, 2016.
This segment aired on August 24, 2016.
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