Ask for Help: Fighting Depression and Burnout in the Trainee Community

As soon as the clock hit 7:00 a.m. each day, my anxiety burgeoned. The pager didn’t stop until 7:00 p.m., and I began to resent my job. With every beep and subsequent phone call, I turned into the annoyed and unfriendly fellow I feared becoming. Along with the routine anemia and thrombocytopenia consults, I was struggling with the emotional burden of a particularly difficult case. A 22-year-old patient had presented with aggressive metastatic disease, and the overwhelming feeling of helplessness chipped away at my resilience day after day. In addition to consults, there were clinic, overnight call, research, deadlines, reading, and morning conferences, but I had to keep moving, never stopping to reflect, to adjust, to just be present.

My experience is not unique. Burnout, depression, and suicide have increased at alarming rates for physicians, especially among trainees. Burnout is a “syndrome characterized by emotional exhaustion and depersonalization (which includes negativity, cynicism, and the inability to express empathy or grief), a feeling of reduced personal accomplishment, loss of work fulfillment, and reduced effectiveness.”¹ Factors that contribute to burnout include increased workload, electronic medical records, and spillover of work (such as catching up on notes) into evenings/weekends.

This growing problem is systematic rather than personal in nature; the solution is not simply within each of us. Approximately 300 to 400 physicians commit suicide each year — on average, one each day. The National Academy of Medicine (formerly Institute of Medicine), along with more than 130 organizations including ASH and the Accreditation Council for Graduate Medical Education (ACGME), have made formal commitments to research factors that influence burnout and address ways to improve clinician well-being.²

In my case, I recognized what was happening, but as most of us do, I kept moving forward, waiting for the next month to arrive. I should have asked for help. I have reflected on why I didn’t seek assistance, and I think the answer is a universal one: We don’t want to seem weak to our colleagues and superiors, and we don’t want others to have to pick up our slack.

Organizations are taking strides to change the cultural response to mental exhaustion by providing various forms of support and awareness. However, these resources will only be helpful to us if we are more forgiving and understanding of ourselves. Resilience is a concept with different meanings for each of us, but in medicine it is oft synonymous with “pushing through”. Pacing ourselves, being present, and seeking help will not slow us down or make us weaker, but rather help us retain our love for medicine, our compassion for our patients, and our sanity.

The ACGME offers numerous resources for residents and faculty members to promote well-being.

References

1. Dzau VJ, Kirch DG, Nasca TJ. To care is human – collectively confronting the clinician-burnout crisis. N Engl J Med 2018;378:312-314.
2. Dyrbye LN, Shanafelt TD, Sinsky CA, et al. Burnout among health care professionals: a call to explore and address this underrecognized threat to safe, high-quality care. NAM Perspectives. 2017.