Can We Reconstruct Ourselves

by M. Shuja Shafqat, MD

Our lives as surgeons, more than others, are like Instagram. We show the world and our peers only a glimpse what we want them to see; a strong, unwavering, invincible warrior that cannot be taken down by illness, exhaustion, financial difficulty, death in our families, or even depression.

I was recently intrigued by two articles. The first was from ESPN about Madison Holleran, a freshman at the University of Pennsylvania, who committed suicide in January of 2014. The article brilliantly focused on social media and how services like Twitter and Instagram can give young people an outlet. Not for their true feelings, but how they want their lives to be seen by others. That people spend “a significant chunk of each day absorbing others filtered images while they walk through their own realities, unfiltered.” (1) That those closest to us may struggle with our same issues, yet we feel unable to share them for fear of what we might be perceived as. As surgeons, we are the most guilty.

The second was an article in Time, “Doctors on Life Support”, which is an incredibly raw article about mental health in physicians. The piece dealt specifically with surgeons and surgical residents, using examples from Stanford University and an innovative program developed there. This one hit me hard. These quotes came from 3000 miles away, but I swear I could hear these words coming from our resident workroom, or the surgeons table in the cafeteria. “Overworked, sleep-deprived and steeped in a culture that demands that you suck it up. Everyone you meet, you think, might be smarter and more capable than you – and you’re the only one struggling.” “But sleep deprivation is still a rite of passage for residents, who work overnight and for days in a row to earn experience.” “The stigma against signs of weakness within the profession plays a role too. ‘Part of it is thinking about wellness as something for wusses.’ ” (2) I am still shocked by these quotes. I have felt every one of these sometime in the last 4 years. Yet I am just the same. I can recall times when I have needed an IV and fluids from vomiting, but continued to round in the surgical ICU, put in central lines, and do tracheostomies. There are times where I wear it like a badge of honor, and there are times when I realize how insane it would seem to someone outside the 4 walls of this hospital.

A big part of me feels guilty. Very guilty. I as much as the next person do not want to be perceived as complaining or lazy. I remember listening to my dad’s stories about residency in the 80’s. Being a foreign medical graduate, he was confined to the worst hospitals in Brooklyn and Queens. He was taking care of the toughest that New York City had to offer, under much more grueling circumstances than I’ll ever deal with. They survived and lived to tell about it, like war stories. Over a decade ago, the ACGME countered by making rules restricting resident hours. What was truly interesting was that the rates of depression in physicians did not change as a result (2).  We were burning out. Burnout syndrome is defined as “emotional exhaustion, depersonalization, perceived lack of personal accomplishment that leads to decreased effectiveness at work.” And we are burning out more than ever. 40% of surgeons and 30% of plastic surgeons suffer while 30% of plastic surgeons meet screening criteria for depression (3). These are directly related to increased self-reported major medical errors, decreased patient satisfaction, and increased conflicts at home (2,3). The truly frightening part of it all is that this isn’t just burn out. 400 physicians die due to suicide each year and 6% had suicidal ideation in the last 12 months (2,4). In addition, physician deaths related to substance abuse are reported to be 16% or higher (5).

That’s just with attending surgeons. What about residents? A recent article in Plastic and Reconstructive Surgery by Verheyden et al. took a survey of plastic surgery residency programs and found striking results. Out of 59 programs, 22 residents did not complete their program and 12 were asked to leave, 39 suffered significant family, financial, or legal issues, 53 had interpersonal conflicts, 19 had significant illness or injury, and 5 had drug/alcohol issues (5). In our small world, that is a significant amount of people. Since most plastic surgery residency programs are smaller than their general surgery counterparts, this can make it that much more challenging to find someone to confide in.

I told myself that when I wrote this, I wouldn’t rattle off a bunch of statistics, but it is hard to argue with numbers. What can we do, if anything, about these problems? Stanford has developed a Balance in Life program to help promote a balance between home life and work while addressing professional, physical, psychological, and social well being (4). This was met with opposition. Dr. Arghavan Salles, chief surgery resident at Stanford, stated, “There are definitely faculty members who think this is all a bunch of crap. I find it disturbing, although not surprising, that every time we talk about this program we have to say, ‘There was someone who died, and that’s why we need this.’ ” (2). Unfortunately, many places do not have programs like this implemented.

Again, the question is raised about what we can do. As fellow residents, plastic surgeons, and doctors, I urge you all to have meetings to talk issues out. I urge you to have the not-so-comfortable conversations with each other if you see a colleague with a problem. Discover those issues your fellow residents may have before they turn into real problems. Ignoring them and pushing them aside because we are too “proud” or “strong” will only lead down the wrong road, even if it is what we have been programmed to do for generations. We cannot continue to portray a filtered image of who we are. We have to rise to the challenge.

We are surgeons, after all.

References

  1. Fagan, Kate. “Split Image.” ESPN, 7 May 2015. Web. 12 Sept. 2015. <http://espn.go.com/espn/feature/story/_/id/12833146/instagram-account-university-pennsylvania-runner-showed-only-part-story&gt;.
  2. Oaklander, Mandy. “Life Support.” Time 7 Sept. 2015: 42-50. Print.
  3. Qureshi HA, et al. Burnout Phenomenon in U.S. Plastic Surgeons: Risk Factors and Impact on Quality of Life. Plastic & Reconstructive Surgery. 2015; 135(2): 619-626.
  4. Salles A, et al. Promoting Balance in the Lives of Resident Physicians: A Call to Action. JAMA Surgery. 2015; 150(7): 607-608.
  5. Verheyden CN, et al. Social Problems in Plastic Surgery Residents: A Management Perspective. Plastic and Reconstructive Surgery. 2015; 135(4): 772-778.
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