4th resident to commit suicide at LLUMC since July... (3/4 are anesthesia residents)

[CodeBlu]

Not really a clue what's happening at LLUMC... but, this is tragic.

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[GravelRider]

Physicians have a high suicide rate. There was a recent resident suicide in NYC.

A physician suicide: covered up with a tarp and silence

 

[NICMAN]

LLUMC is supposed to be a very balanced residency program lifestyle-wise. Not sure why the rash of suicide there.

 

[nimbus]

LLUMC is supposed to be a very balanced residency program lifestyle-wise. Not sure why the rash of suicide there.

I do believe this problem depends more on the individual than the program. Some of the most malignant programs have probably had zero suicides in the past decades. More than likely Loma Linda did not have any for many years. Tragic.

 

[Wiscoblue]

Very sad. If it was any other program, I’d say it was drug abuse. But I think Lima Linda attracts a different type of person that is not drawn to drugs, alcohol or tobacco. Maybe just severe endogenous depression?


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[aneftp]

Very sad. This is tragic. Real depression. Judging by her picture. She’s skinny.

On a lighter note. I think way too many people are prescribed anti depressants. Many fat people who eat too much. The dsm criteria of depression has changed since the 1980s. Dsm 2? In the 1980s includes WEIGHT LOSS as part of depression.

Yet many people who write the dsm are brought out by drug manufacturers. So as Americans get fatter and fatter. The drug manufacturers bribed these dsm to include WEIGHT GAIN AS A PART OF DEPRESSION.

I know I’m going off topic slightly. But the vast majority of people who have true clinical depression are SKINNY. too many fat people are over prescribed anti depression drugs. They aren’t truly depressed.

The 3 people I know who have committed suicide (no drug overdose either...true clinical depression) recently in anesthesia have all been skinny with true clinically depressed as it was originally written in dsm-2 including a former colleague last September.

 

[GA8314]

Very sad. This is tragic. Real depression. Judging by her picture. She’s skinny.

On a lighter note. I think way too many people are prescribed anti depressants. Many fat people who eat too much. The dsm criteria of depression has changed since the 1980s. Dsm 2? In the 1980s includes WEIGHT LOSS as part of depression.

Yet many people who write the dsm are brought out by drug manufacturers. So as Americans get fatter and fatter. The drug manufacturers bribed these dsm to include WEIGHT GAIN AS A PART OF DEPRESSION.

I know I’m going off topic slightly. But the vast majority of people who have true clinical depression are SKINNY. too many fat people are over prescribed anti depression drugs. They aren’t truly depressed.

The 3 people I know who have committed suicide (no drug overdose either...true clinical depression) recently in anesthesia have all been skinny with true clinically depressed as it was originally written in dsm-2 including a former colleague last September.

I think there are plenty of people with legit depression who are heavy. The "old" debilitating depression where you were very seriously suicidal, not eating, unable to get out of bed depression, severe psychomotor slowing etc. is seen less and less. Likely this is due to people getting treated BEFORE they get to that point. Perhaps this woman was one of them, and while that "type"/severity is surely horrendous, I do not believe that dysthymia/persistent depressive disorder, or "anxious/neurotic depression" (whatever you want to call it) is a walk in the park for people. Many of those people will have little correlation of symptoms to body habitus.

Someone mentioned good books in another post. While not an anesthesiologist, Peter. G. Kramer MD wrote an excellent book (voluminous but excellent) called Ordinarily Well. Should be required reading for any resident in psych IMO.

 

[aneftp]

I think there are plenty of people with legit depression who are heavy. The "old" debilitating depression where you were very seriously suicidal, not eating, unable to get out of bed depression, severe psychomotor slowing etc. is seen less and less. Likely this is due to people getting treated BEFORE they get to that point. Perhaps this woman was one of them, and while that "type"/severity is surely horrendous, I do not believe that dysthymia/persistent depressive disorder, or "anxious/neurotic depression" (whatever you want to call it) is a walk in the park for people. Many of those people will have little correlation of symptoms to body habitus.

Someone mentioned good books in another post. While not an anesthesiologist, Peter. G. Kramer MD wrote an excellent book (voluminous but excellent) called Ordinarily Well. Should be required reading for any resident in psych IMO.

I have seen very few suicidal people who are fat.

Get it? If u are truly fat. U lose interest in thing u love the most. If u are fat. U love food. If you are depressed. U stop eating and LOSE weight.

But fake depressed people GAIN weight.

We are over drugged society just because the drug manufacturers bribe the doc’s and policy makers.

Let me make it clear. I’m talking true clinical depression.

I think many (fat) people who are diagnosed with depression have subclinical depression.

How many actors with true depression who commit suicide are fat? I’m not talking the accidental overdose either. Robin Williams lost a lot of weight prior to killing himself.

My former colleague who committed suicide last fall was frail thin even with 4 kids.

 

[deleted697535]

I have seen very few suicidal people who are fat.

Get it? If u are truly fat. U lose interest in thing u love the most. If u are fat. U love food. If you are depressed. U stop eating and LOSE weight.

But fake depressed people GAIN weight.

We are over drugged society just because the drug manufacturers bribe the doc’s and policy makers.

Let me make it clear. I’m talking true clinical depression.

I think many (fat) people who are diagnosed with depression have subclinical depression.

How many actors with true depression who commit suicide are fat? I’m not talking the accidental overdose either. Robin Williams lost a lot of weight prior to killing himself.

My former colleague who committed suicide last fall was frail thin even with 4 kids.

Wtf!?!
Someone died man

Rip.

 

[parcus]

Your “fake” depression sign is an atypical depression sign. Just because depression with atypical signs (and it is equally bad) is now recognized doesn’t mean the “normal” type is not.

Btw, very strange for 3 residents suicides at once at a single program, maybe people are missing something there.

RIP

 

[deleted59964]

Very sad. This is tragic. Real depression. Judging by her picture. She’s skinny.

On a lighter note. I think way too many people are prescribed anti depressants. Many fat people who eat too much. The dsm criteria of depression has changed since the 1980s. Dsm 2? In the 1980s includes WEIGHT LOSS as part of depression.

Yet many people who write the dsm are brought out by drug manufacturers. So as Americans get fatter and fatter. The drug manufacturers bribed these dsm to include WEIGHT GAIN AS A PART OF DEPRESSION.

I know I’m going off topic slightly. But the vast majority of people who have true clinical depression are SKINNY. too many fat people are over prescribed anti depression drugs. They aren’t truly depressed.

The 3 people I know who have committed suicide (no drug overdose either...true clinical depression) recently in anesthesia have all been skinny with true clinically depressed as it was originally written in dsm-2 including a former colleague last September.

my very overweight friend of 20 years suicided last year after a decades long struggle with depression.

i suggest we leave psychiatry to those who have a better understanding of it than we gain from a rotation as a med student

 

[aneftp]

my very overweight friend of 20 years suicided last year after a decades long struggle with depression.

i suggest we leave psychiatry to those who have a better understanding of it than we gain from a rotation as a med student

Are obese people less likely to commit suicide?

Stuart Jeffries: A study shows that thin people are more likely to commit suicide than their corpulent counterparts. How can we be sure the research wasn't undertaken by fat people with a grudge?

 

[Pooh & Annie]

I have seen very few suicidal people who are fat.

Get it? If u are truly fat. U lose interest in thing u love the most. If u are fat. U love food. If you are depressed. U stop eating and LOSE weight.

But fake depressed people GAIN weight.

We are over drugged society just because the drug manufacturers bribe the doc’s and policy makers.

Let me make it clear. I’m talking true clinical depression.

I think many (fat) people who are diagnosed with depression have subclinical depression.

How many actors with true depression who commit suicide are fat? I’m not talking the accidental overdose either. Robin Williams lost a lot of weight prior to killing himself.

My former colleague who committed suicide last fall was frail thin even with 4 kids.

Depressed people often find different ways to cope. Some eat obsessively. Some exercise. Some shop. Some starve themselves. It’s a complex issue. To suggest fat people don’t have “real” depression doesn’t seem well-informed.

 

[abolt18]

I have a friend who is in their anesthesia program and he has expressed his complete surprise at the event. I know the previous Anesthesia resident's suicide was an OD. I can tell you I loved that program when I interviewed there last year. Residents really seemed very happy.

 

[GA8314]

I have seen very few suicidal people who are fat.

Get it? If u are truly fat. U lose interest in thing u love the most. If u are fat. U love food. If you are depressed. U stop eating and LOSE weight.

But fake depressed people GAIN weight.

We are over drugged society just because the drug manufacturers bribe the doc’s and policy makers.

Let me make it clear. I’m talking true clinical depression.

I think many (fat) people who are diagnosed with depression have subclinical depression.

How many actors with true depression who commit suicide are fat? I’m not talking the accidental overdose either. Robin Williams lost a lot of weight prior to killing himself.

My former colleague who committed suicide last fall was frail thin even with 4 kids.

This is a very narrow minded assessment. "Fake" depressed people? Come on man.

 

[D P356]

@aneftp
Robin Williams had Lewy Body Dementia.

 

[The Physician Philosopher]

This is just sad. Praying for the lives of those impacted by this.

While I agree that there is some personal onus with some of these cases, let's not pretend that there aren't systematic problems that need to be fixed.

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[kidthor]

I'm so sorry to hear that she died.

It's important that someone mentioned surprise that she took her own life. I think a lot of people on the edge of despair probably look normal to the rest of us.

Notwithstanding individual factors that contribute to this, the sometimes brutal nature of medical training pushes some into a very difficult place.

 

[aneftp]

This is a very narrow minded assessment. "Fake" depressed people? Come on man.

So i reckon u believe fibromyalgia as a diagnosis than?

My point is “real” clinical depression is a very grey area.

It’s way over diagnosed.

My best guess is 90% plus of people who commute suicide are NOT FAT.

I’m only stirring the pot here cause the pic o the anesthesia resident who committed suicide shows she seems NOT FAT.

Same with nyc medical doctor resident who jump to her death last month from nyc roof top.

The vast majority of people who committed suicide who have real clinical depression who drive them to commit suicide are not fat. True or false? Depression equals hopelessness. Losing desire to eat. Weight loss. Read the dsm-2

Munching away on food ain’t real depression.

 

[Mman]

Read the dsm-2

I probably wouldn't suggest reading a text from 1968 as the definitive source today.

 

[MirrorTodd]

So i reckon u believe fibromyalgia as a diagnosis than?

My point is “real” clinical depression is a very grey area.

It’s way over diagnosed.

My best guess is 90% plus of people who commute suicide are NOT FAT.

I’m only stirring the pot here cause the pic o the anesthesia resident who committed suicide shows she seems NOT FAT.

Same with nyc medical doctor resident who jump to her death last month from nyc roof top.

The vast majority of people who committed suicide who have real clinical depression who drive them to commit suicide are not fat. True or false? Depression equals hopelessness. Losing desire to eat. Weight loss. Read the dsm-2

Munching away on food ain’t real depression.

Dude...be like Elsa and LET IT GO!

 

[aneftp]

I probably wouldn't suggest reading a text from 1968 as the definitive source today.

My point is half the guys who write the dsm are bribed by the drug manufacturers. Too much conflict of interest these days.

Do u really believe the cholorprep study when the company got fined millions and key researcher was paid handsomely?

 

[Mman]

My point is half the guys who write the dsm are bribed by the drug manufacturers. Too much conflict of interest these days.

Do u really believe the cholorprep study when the company got fined millions and key researcher was paid handsomely?

If I knew what that had to do with a decades old version of DSM and fat people possibly having legitimate depression I could possibly comment.

While some depressed people lose interest in eating, other depressed people self medicate with food that they are addicted to. I'm not a psychiatrist so I will refrain from playing one on the internet.

 

[MaximusD]

This is just sad. Praying for the lives of those impacted by this.

While I agree that there is some personal onus with some of these cases, let's not pretend that there aren't systematic problems that need to be fixed.

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I’d say the way the medical community eats its young should be addressed...

When the only outcome discussed as relevant with respect to resident hours is patient mortality, there’s a problem.

The medical community has some major issues, and I’m nearly at the point where I’ll have power to change and confront these issues. You’d better believe that I will.

 

[nimbus]

FWIW I actually have a family member who was obese and suffered from debilitating depression and anxiety. After a series of ECTs which helped lift his depression he started eating better and working out and lost 50lbs.

 

[GA8314]

So i reckon u believe fibromyalgia as a diagnosis than?

My point is “real” clinical depression is a very grey area.

It’s way over diagnosed.

My best guess is 90% plus of people who commute suicide are NOT FAT.

I’m only stirring the pot here cause the pic o the anesthesia resident who committed suicide shows she seems NOT FAT.

Same with nyc medical doctor resident who jump to her death last month from nyc roof top.

The vast majority of people who committed suicide who have real clinical depression who drive them to commit suicide are not fat. True or false? Depression equals hopelessness. Losing desire to eat. Weight loss. Read the dsm-2

Munching away on food ain’t real depression.

You are talking about two very different things here. You don't need to be suicidal to have clinical depression. I agree with you that, from what I've read (two excellent books by a very talented psychiatrist), it used to be much more common to see (from what many older psych docs say) the FORM of depression you are associating with this resident. Yes. That is reported to have been the massively debilitation, can't get out of bed, don't eat, ARE SUICIDAL, psychomotor issues, and all of the rest, type of depression. DEEP DESPAIR. Often requiring hospitalization. Sure. Those exist. Sure, many of those people are reportedly on the thin side.

But, holy cow, you can't tell me that there isn't a spectrum here, and a spectrum worth treating. I would wager that many people are out there just "toughing it out" not very successfully.

Also, depression (and associated inflammation?) is associated with other serious illness such as coronary disease, and I think this will get more attention in the future. One could just as easily make the argument that we are under treating. But, that's very hard to tell.

 

[anbuitachi]

Not really a clue what's happening at LLUMC... but, this is tragic.

Do you mean 2 out of 3 residents are anesthesia residents? The post says only 3 residents total suicided there, with 2 being in anesthesia.. whos the 3rd anes resident?

 

[SoManyCars]

Not really a clue what's happening at LLUMC... but, this is tragic.

I know of the person, and it has nothing AT ALL to do with the residency or it's pressures.

Very tragic and we are all just shell shocked. She had accomplished a lot and was very hard working.

 

[anbuitachi]

I know of the person, and it has nothing AT ALL to do with the residency or it's pressures.

Very tragic and we are all just shell shocked. She had accomplished a lot and was very hard working.

How are you so certain? I'm never certain with these things since people tend to be secretive about it. You'll ask them if it's xyz and they'll say no, doing great, residency is amazing. Even if its not directly due to residency, i find it difficult to imagine that your job as a resident which takes up most of your time had NOTHING AT ALL to do with it. For example, you may be depressed because your parents got killed in a car accident broke, but b/c you are in residency, you are left with minimal time to grief over it, or seek professional help (how many psychiatrists are available between the hours of 7pm and 5am? or on weekends?)

I think studies demonstrated that a lot of suicides happen to colleagues you wouldn't expect it to happen to, and then everyone is shocked, but i guess it shows how well you truly knew the person?

 

[rakotomazoto]

Do you mean 2 out of 3 residents are anesthesia residents? The post says only 3 residents total suicided there, with 2 being in anesthesia.. whos the 3rd anes resident?

the facebook post says that it was 3 total, 2 of which were anesthesiology residents. The third one was a psychiatry resident. Agree that it seems to be 3 in total, which is still 3 too many.

 

[nimbus]

How are you so certain? I'm never certain with these things since people tend to be secretive about it. You'll ask them if it's xyz and they'll say no, doing great, residency is amazing. Even if its not directly due to residency, i find it difficult to imagine that your job as a resident which takes up most of your time had NOTHING AT ALL to do with it. For example, you may be depressed because your parents got killed in a car accident broke, but b/c you are in residency, you are left with minimal time to grief over it, or seek professional help (how many psychiatrists are available between the hours of 7pm and 5am? or on weekends?)

I think studies demonstrated that a lot of suicides happen to colleagues you wouldn't expect it to happen to, and then everyone is shocked, but i guess it shows how well you truly knew the person?

You are making a lot of assumptions. Her work and the residency could just as well have been the best part of her life and a respite from her other problems. I don’t know, but unless you know, don’t assume. Especially if you are not close to the situation, it’s all conjecture.

 

[GravelRider]

Three resident suicides are not coincidence. It's a trend. Residency had something to do with it despite what the system will want to tell you.

 

[VA Hopeful Dr]

Three resident suicides are not coincidence. It's a trend. Residency had something to do with it despite what the system will want to tell you.

I think we can all agree (even those of us in other specialties) that residency is very demanding. It can suck in a myriad of different ways.

Some of those can be improved, some probably can't - or rather, can't without major changes like increasing residency length which very few people want.

 

[GA8314]

How are you so certain? I'm never certain with these things since people tend to be secretive about it. You'll ask them if it's xyz and they'll say no, doing great, residency is amazing. Even if its not directly due to residency, i find it difficult to imagine that your job as a resident which takes up most of your time had NOTHING AT ALL to do with it. For example, you may be depressed because your parents got killed in a car accident broke, but b/c you are in residency, you are left with minimal time to grief over it, or seek professional help (how many psychiatrists are available between the hours of 7pm and 5am? or on weekends?)

I think studies demonstrated that a lot of suicides happen to colleagues you wouldn't expect it to happen to, and then everyone is shocked, but i guess it shows how well you truly knew the person?

Many people will hide it more or less well. But, most will try to hide it due to shame/guilt/stigma or whatever. For a person to get to the point where this person found herself, it was INTERNAL for her. Sure, stressors (such as residency training) could play a role as there are often precipitators to a major depressive episode, but when a person gets to suicide, it's the DISEASE of depression which has totally taken over. People whom have commented on thoughts of suicide say that they think of it as a means to end the depression. So, the pathology of depression has taken over a great deal by that time. Sure, environment and life circumstances can play a large role initially but by the time one is contemplating suicide the reports seem to be that they are way beyond the ability to think rationally about their environment. By that point, it is an emergency for them, and it would seem that it's NOT always easy to tell when a person is going through this.

 

[GA8314]

Amazon product

This is a long, but excellent book. The insight, readability, and review of the data pertaining to depression and medications is exceptional.

Peter Kramer mostly wrote it after some major critique of antidepressants in 2008 from Irving Kirsch who made arguments that they do little more than placebo.

Kramer presents clinical perspective as an MD in the field, but it is somewhat technical from his own review of the studies. Lots of them.

Like I've said, this should be mandatory for any psych resident.

 

[GravelRider]

I think we can all agree (even those of us in other specialties) that residency is very demanding. It can suck in a myriad of different ways.

Some of those can be improved, some probably can't - or rather, can't without major changes like increasing residency length which very few people want.

There is a difference between a demanding job and the toxic culture that exists within medicine. We are constantly hearing stories of resident suicides and physician burnout. I remember my first day of medical school the dean gave a speech saying we were entering a profession that had one of the highest rates of suicide, depression, substance abuse, and divorce. Why is that acceptable?

There is something rotten in our profession right now and it starts in medical school and continues into retirement. Until we acknowledge it and stop with the culture that encourages you to brag how many hours straight you can work without sleep, more lives will be ruined.

We must hold the system accountable and not allow them to shift the blame back to us. The lectures and powerpoints on how to recognize and cope with sleep deprivation and burnout are not only insulting, but they only serve to give the institutions responsible a pass. I remember sitting through a PowerPoint presentation about recognizing the signs of sleep deprivation during my intern year. When the lecture finished I asked why don't we create a system where sleep deprivation is not an issue. The response I got was basically a chuckle. With the incessant discussion and studies about resident work hour limits, the only outcomes ever mentioned are patient morbidity and mortality. The physicians' physical, mental, and emotional well-being isn't even given a glancing mention. I have a problem with that.

 

[VA Hopeful Dr]

There is a difference between a demanding job and the toxic culture that exists within medicine. We are constantly hearing stories of resident suicides and physician burnout. I remember my first day of medical school the dean gave a speech saying we were entering a profession that had one of the highest rates of suicide, depression, substance abuse, and divorce. Why is that acceptable?

There is something rotten in our profession right now and it starts in medical school and continues into retirement. Until we acknowledge it and stop with the culture that encourages you to brag how many hours straight you can work without sleep, more lives will be ruined.

We must hold the system accountable and not allow them to shift the blame back to us. The lectures and powerpoints on how to recognize and cope with sleep deprivation and burnout are not only insulting, but they only serve to give the institutions responsible a pass. I remember sitting through a PowerPoint presentation about recognizing the signs of sleep deprivation during my intern year. When the lecture finished I asked why don't we create a system where sleep deprivation is not an issue. The response I got was basically a chuckle. With the incessant discussion and studies about resident work hour limits, the only outcomes ever mentioned are patient morbidity and mortality. The physicians' physical, mental, and emotional well-being isn't even given a glancing mention. I have a problem with that.

In terms of work hours, in residency to achieve better hours that you'd most likely have to make residency longer. That's certainly an option, and now that I'm through with training I would have no objection to that. Everyone might not agree to that though. There is also much to be said about patient continuity of longer shifts. That's obviously more the case for some specialties than others of course - take a look at the trial the surgeons did a few years back looking at this very issue.

Burnout in attendings, at least in my specialty, has very little to do with medicine itself and more everything associated with it - increasing paperwork, loss of autonomy, assembly line practice, and so on. This has nothing to do with a toxic medical culture and much more to do with increasing administration.

 

[anbuitachi]

You are making a lot of assumptions. Her work and the residency could just as well have been the best part of her life and a respite from her other problems. I don’t know, but unless you know, don’t assume. Especially if you are not close to the situation, it’s all conjecture.

Of course i was making assumptions. i didn't say i assume that is what happened. I gave an example of how residency can affect things without directly being the cause. Also what you said makes no sense. If i knew, i wouldn't be assuming. I only use examples because i dont know.

 

[GravelRider]

In terms of work hours, in residency to achieve better hours that you'd most likely have to make residency longer. That's certainly an option, and now that I'm through with training I would have no objection to that. Everyone might not agree to that though. There is also much to be said about patient continuity of longer shifts. That's obviously more the case for some specialties than others of course - take a look at the trial the surgeons did a few years back looking at this very issue.

Burnout in attendings, at least in my specialty, has very little to do with medicine itself and more everything associated with it - increasing paperwork, loss of autonomy, assembly line practice, and so on. This has nothing to do with a toxic medical culture and much more to do with increasing administration.

Assuming an 80 hour work week, what percentage of those hours are dedicated towards actual medicine and learning? Residency doesn't have to be extended, but residents have to stop being used as cheap labor. We are opening up more doors for lesser trained people to do the same jobs as physicians at the same time we are advocating for lengthening of physician training? Something doesn't make sense here.

You are describing our medical system. That is the culture. Whether it is fellow docs or administrators responsible doesn't matter. There is something rotten that needs to be taken care of.

We like to discuss the physician vs. nurse dichotomy on this board and I think that gets to the root of some of the problem. We are indoctrinated early on to not ask for help, not show emotion, and always demonstrate a duty towards patients. The administrators turn that mindset against us. Meanwhile, nurses are shift workers from the start. They know their hours and they know exactly where they stand in terms of value. If they work extra, they demand extra pay. As doctors we are taught to "stay until the work is done." Is it a coincidence that nurses don't experience burnout to the same degree as physicians? I think not.

 

[Orin]

A suicide in a high functioning tight knit residency would have significant ripple effects. I suspect it was a linchpin person, in a system that isn't designed to be resilient, with resources not accepted by those most at risk.

https://www.sprc.org/sites/default/.../OlsonSuicideContagionSuicideClusters2013.pdf

Depression is like hypotension; there is a spectrum. In general, try to ignore the societal/population impact and deal with the person infront of you instead of assuming everyone is a horrible human being.

 

[Orin]

Meanwhile, nurses are shift workers from the start. They know their hours and they know exactly where they stand in terms of value. If they work extra, they demand extra pay. As doctors we are taught to "stay until the work is done." Is it a coincidence that nurses don't experience burnout to the same degree as physicians? I think not.

I disagree; mainly because plenty of doctors are shift workers. As someone who is perpetually on the verge of burnout, I see it as more a matter of loss of autonomy or a mismatch between expectations/reality.

 

[anbuitachi]

I disagree; mainly because plenty of doctors are shift workers. As someone who is perpetually on the verge of burnout, I see it as more a matter of loss of autonomy or a mismatch between expectations/reality.

It's everything combined. It's not just shifts of course but also how shifts work. There's a difference between working shifts totally 80 hrs a week and working shifts totalling 40. But that is just one part of it. It's also about your responsibilities during your shifts, etc.

 

[pgg]

When I was in training, the thing that weighed on me most, and at times pushed me in the general direction of burnout, wasn't the long hours, the sleep deprivation, or taking another human's life into my hands several times per day.

It was being a grown up adult, a married man, a father, a person who made the cut to get into medical school and graduated and passed the USMLE, a person who held an unrestricted license to practice medicine ... and yet I lived and worked in this surreal kindergarten-like world where I and a bunch of other people like me were constantly seeking approval from attendings like they were distantly neglectful parents.

I don't remember having that kind of relationship with my professors in college or medical school. There wasn't a culture that revolved around "staying off the radar" or pleasing anyone. In my interactions with them, I was a respected adult learner, and they were there to guide me. Somehow, when I became an intern, I became a child again. And to make it worse, to an extent I embraced that role because I understood it to be the only way I'd be able graduate and move on to a less caustic place in life.

I actually felt worse about it because I voluntarily assumed that role.

I'm just an armchair psychiatrist, but I can't help but think of of Maslow's hierarchy of needs. You've got a bunch of mature adult high achievers, fresh out of medical school, in that top self-actualization tier of the pyramid, and then they enter the world of GME and get roughly kicked down to a level where all of a sudden the overriding concerns are for "security, order, law, stability, freedom from fear" ... one bare notch above basic biological needs for food and shelter. Safety needs.

That stuff at the top of the pyramid is important, and while residency could and should be structured to lift people up, too often it feels like we've created some kind of gradeschool-esque popularity contest where the residents need to show a smile, never show a sign of fatigue, always verbalize enthusiasm about that high-value afternoon wound washout add-on case aka opportunity to excel even when we know they're just as disappointed in getting an extra couple hours of low-yield labor as we are.

Over and over again I've seen very junior trainees who are just as incompetent as their peers, but their demeanor, speech patterns, personality, sense of humor get them "on the radar".

A majority of staff eval narratives include comments on attitude. Even when complimentary, when residents see such comments, it just reinforces the notion that they're being judged on nonclinical personality trait intangibles.

There's something fundamentally pathological and humiliating about our system. It's no wonder that physician burnout, depression, and suicide are such problems. I think we fixate on work hours being the main culprit waaaaaay too much. We're the better part of two decades into this work hour limit experiment and residents are still burning out and killing themselves. It's not because they're tired.

I think it's because the system makes them feel small.

 

[GA8314]

When I was in training, the thing that weighed on me most, and at times pushed me in the general direction of burnout, wasn't the long hours, the sleep deprivation, or taking another human's life into my hands several times per day.

It was being a grown up adult, a married man, a father, a person who made the cut to get into medical school and graduated and passed the USMLE, a person who held an unrestricted license to practice medicine ... and yet I lived and worked in this surreal kindergarten-like world where I and a bunch of other people like me were constantly seeking approval from attendings like they were distantly neglectful parents.

I don't remember having that kind of relationship with my professors in college or medical school. There wasn't a culture that revolved around "staying off the radar" or pleasing anyone. In my interactions with them, I was a respected adult learner, and they were there to guide me. Somehow, when I became an intern, I became a child again. And to make it worse, to an extent I embraced that role because I understood it to be the only way I'd be able graduate and move on to a less caustic place in life.

I actually felt worse about it because I voluntarily assumed that role.

I'm just an armchair psychiatrist, but I can't help but think of of Maslow's hierarchy of needs. You've got a bunch of mature adult high achievers, fresh out of medical school, in that top self-actualization tier of the pyramid, and then they enter the world of GME and get roughly kicked down to a level where all of a sudden the overriding concerns are for "security, order, law, stability, freedom from fear" ... one bare notch above basic biological needs for food and shelter. Safety needs.

That stuff at the top of the pyramid is important, and while residency could and should be structured to lift people up, too often it feels like we've created some kind of gradeschool-esque popularity contest where the residents need to show a smile, never show a sign of fatigue, always verbalize enthusiasm about that high-value afternoon wound washout add-on case aka opportunity to excel even when we know they're just as disappointed in getting an extra couple hours of low-yield labor as we are.

Over and over again I've seen very junior trainees who are just as incompetent as their peers, but their demeanor, speech patterns, personality, sense of humor get them "on the radar".

A majority of staff eval narratives include comments on attitude. Even when complimentary, when residents see such comments, it just reinforces the notion that they're being judged on nonclinical personality trait intangibles.

There's something fundamentally pathological and humiliating about our system. It's no wonder that physician burnout, depression, and suicide are such problems. I think we fixate on work hours being the main culprit waaaaaay too much. We're the better part of two decades into this work hour limit experiment and residents are still burning out and killing themselves. It's not because they're tired.

I think it's because the system makes them feel small.

You make some great points. I agree with much of what you said.

The only thing is that I don't think people truly get suicidal (and then attempt it) unless they are suffering from severe depressive state. Surely, everything you've just mentioned could be a sufficient stressor to perhaps push a susceptible person into some sort of a mood disorder with a depressive component, but I don't think any of that alone is sufficient to push someone to suicide, absent a clinically depressive state.

 

[GravelRider]

I disagree; mainly because plenty of doctors are shift workers. As someone who is perpetually on the verge of burnout, I see it as more a matter of loss of autonomy or a mismatch between expectations/reality.

I don't disagree. I think my point is that we are taught early on to always put a smile on our face out of a sense of duty no matter how tired we are or how menial the task is. I think that is what is backfiring here.

I think the problem with burnout and suicide in medicine is multifactorial and work hours are playing a role. I know if I've worked a 30+ hour shift, I find myself getting angry at things that would normally never bother me. It's not hard for me to imagine someone who is not suffering severe clinical depression chronically making a rash decision after a tough couple of weeks and some sleepless nights on-call. I'm not a psychiatrist, but I wonder if many of these physician suicides are not actually people with chronic debilitating depression, but rather a bad decision made while sleep deprived.

 

[VA Hopeful Dr]

Assuming an 80 hour work week, what percentage of those hours are dedicated towards actual medicine and learning? Residency doesn't have to be extended, but residents have to stop being used as cheap labor. We are opening up more doors for lesser trained people to do the same jobs as physicians at the same time we are advocating for lengthening of physician training? Something doesn't make sense here.

You are describing our medical system. That is the culture. Whether it is fellow docs or administrators responsible doesn't matter. There is something rotten that needs to be taken care of.

We like to discuss the physician vs. nurse dichotomy on this board and I think that gets to the root of some of the problem. We are indoctrinated early on to not ask for help, not show emotion, and always demonstrate a duty towards patients. The administrators turn that mindset against us. Meanwhile, nurses are shift workers from the start. They know their hours and they know exactly where they stand in terms of value. If they work extra, they demand extra pay. As doctors we are taught to "stay until the work is done." Is it a coincidence that nurses don't experience burnout to the same degree as physicians? I think not.

Granted I didn't do an anesthesia residency, but there was very little in my training that seemed like just using me for cheap labor. I mean, on inpatient we rarely admitted more than 5-7 patients/24 hours. At most, that's 1 full time attending. To accomplish that we had a team of 3-4 interns and 2 upper levels. Hiring another physician would have been cheaper than all of us doing the work, and fairly inefficiently I would say. As for time spent not learning, I guess that depends how you look at it. At a certain point, I didn't really feel like writing daily progress notes on some of those same hospitalized patients was teaching me all that much but that's part of the job of being a doctor. And yeah some of the noon conference lectures weren't all that good, but not all CME is good either. You can't win everything. I dunno, maybe I was lucky but I don't recall, even at the time, thinking that much of residency was a waste of my time.

See I don't consider administration stuff to be the culture of medicine. I consider that more like the stuff that PGG mentions a few posts up. If the administration stuff bothers you, find a job where that isn't an issue. I had a DPC clinic for a few years that had none of that burden. No insurance, no boss other than myself, just seeing patients all day, writing notes that contained what I thought was important not what Blue Cross did. I did have to run the business part, but that was maybe 1 hour/week of work.

As to nurses, they burn out too. In fact, a study from 7 years ago showed that hospital nurses who actually take care of patients have a burn out rate of around 35%. That's not as high as the roughly 50% rate of medicine as a whole, but its still a pretty high number.

As for "staying til the work is done" versus strict shift work... depends how you're paid. If you get paid based on the work you do, then you do get paid more for working more. If you're paid hourly, you also get paid more. If you're straight salary, you need a better contract. I did a year of urgent care a few years back. We were salary with an expectation of working X shifts/month with defined hours. After about 2 months I noticed that I stayed late probably 2/3rds of the time with last minute walk ins. So I went to admin and they adjusted my total shifts worked down by 1/month. Basically it worked out to them paying me for 13 hours/day despite the official hours being 8-8. If you're staying late and not getting paid, do the same.

 

[GravelRider]

Granted I didn't do an anesthesia residency, but there was very little in my training that seemed like just using me for cheap labor. I mean, on inpatient we rarely admitted more than 5-7 patients/24 hours. At most, that's 1 full time attending. To accomplish that we had a team of 3-4 interns and 2 upper levels. Hiring another physician would have been cheaper than all of us doing the work, and fairly inefficiently I would say. As for time spent not learning, I guess that depends how you look at it. At a certain point, I didn't really feel like writing daily progress notes on some of those same hospitalized patients was teaching me all that much but that's part of the job of being a doctor. And yeah some of the noon conference lectures weren't all that good, but not all CME is good either. You can't win everything. I dunno, maybe I was lucky but I don't recall, even at the time, thinking that much of residency was a waste of my time.

See I don't consider administration stuff to be the culture of medicine. I consider that more like the stuff that PGG mentions a few posts up. If the administration stuff bothers you, find a job where that isn't an issue. I had a DPC clinic for a few years that had none of that burden. No insurance, no boss other than myself, just seeing patients all day, writing notes that contained what I thought was important not what Blue Cross did. I did have to run the business part, but that was maybe 1 hour/week of work.

As to nurses, they burn out too. In fact, a study from 7 years ago showed that hospital nurses who actually take care of patients have a burn out rate of around 35%. That's not as high as the roughly 50% rate of medicine as a whole, but its still a pretty high number.

As for "staying til the work is done" versus strict shift work... depends how you're paid. If you get paid based on the work you do, then you do get paid more for working more. If you're paid hourly, you also get paid more. If you're straight salary, you need a better contract. I did a year of urgent care a few years back. We were salary with an expectation of working X shifts/month with defined hours. After about 2 months I noticed that I stayed late probably 2/3rds of the time with last minute walk ins. So I went to admin and they adjusted my total shifts worked down by 1/month. Basically it worked out to them paying me for 13 hours/day despite the official hours being 8-8. If you're staying late and not getting paid, do the same.

I did an internal medicine residency and I did a lot of faxing forms to get outside hospital medical records and answering nursing pages at 2am for a lotion order to treat a patient's dry skin. The hours of my life spent filling out discharge paperwork are hours that I will never get back.

I personally think internal medicine residency is too long as it is. I think the training could be completed in 2 years if we cut some of the fat out. I think anesthesia residency could be cut by a year as well. The idea that if we cut work hours then we would have to extend residency doesn't make much sense to me when we have midlevels doing our same jobs independently with less time training. That's a discussion for another thread, though.

 

[rakotomazoto]

@GravelRider, I totally agree that residency could and should be shortened, a year less seems about right. Unfortunately, the people who could change things are also the ones who benefit from keeping the cheap labor force around as long as possible.

 

[kidthor]

I personally think internal medicine residency is too long as it is. I think the training could be completed in 2 years if we cut some of the fat out. I think anesthesia residency could be cut by a year as well. The idea that if we cut work hours then we would have to extend residency doesn't make much sense to me when we have midlevels doing our same jobs independently with less time training. That's a discussion for another thread, though.

Agreed - a lot of residency stuff these days is spent on nonsensical, non-doctor tasks. That's why I have little patience or respect for those who claim residency needs to be extended if hours are restricted.

During internship as a medicine PGY-1 I too spent countless hours faxing forms to get records, managing prior authorization nonsense, making appointments for patients, creating lists, telling ancillary staff to do their jobs, and writing handwritten notes despite my hospital having half of an EMR. The actual time spent doctoring was disheartening. It was all dispo, forms, and doing other people's jobs. And what did all of the hordes of administrators or ancillary staff do - those who were employed to assist the doctors? Lunch, "meetings", and heading home early due to family needs. None of that for us though - we were demanded to stay late, smile, work holidays, never complain, lie on hours worked, and do the work till the work was done. Can't do or won't do is never an option.

As an anesthesiology resident I had plenty of wasted time too. Induce the patient --> wait an hour in the OR till the surgeon showed up. Finish the case --> oh now you're on an 8 hour ICU hold while everybody screws around and you make sure the patient doesn't die... at 3am. On call you stay up all night to pre-op every patient for tomorrow so that the overlords (and CRNAs) have a nice easy pre-op day. The patient isn't being sent from the floor fast enough? Go pick them up yourself from the floor while the "transport team" hired to do that job is nowhere to be found. Oh and wipe down your machine, re-stock your cart, and go to the pharmacy to re-stock all the meds they never put in your med cart. They hire techs, but they don't do that (what DO then do?) And then stay for "teaching rounds" after you've been working for 28 hours straight. Now pay for your board exams and medical license that you'll never be reimbursed for and watch your student loans explode.

Then you're a senior resident with an abstract accepted to a conference and the department waffles on whether they'll give you time off to go... and they won't reimburse you due to "the budget". Oh and when they give you permission you share a hotel room with two other people... two other doctors. Three of you with 4 years of undergrad, 4 years of med school, and nearly 4 years of post-graduate training are sharing one room because you can't afford it otherwise.

All the while a 22 year old HR lackey with a degree in communications gets all expenses paid conference trips with hotel rooms at the W and comped meals at Nobu. They get paid more than you. And if they don't like the job they'll soon jump to the next one for more pay with better perks. They have had employer match for their 401k too, while your residency scoffs at this being something that could ever happen. So you've got no retirement savings at all.

As a resident you're trapped in ****hole. The only way out is to smile, nod, and beg for more absurdity. If you complain your career and financial life will be vengefully ruined. How dare you complicate the staffing or the schedule!? Oh and heaven forbid you ever consider having a child during all of this...

I could stomach all of this nonsense, barely, but it wore on me. For those with emotional or mental health issues... I'm not surprised it might push them over the edge.

Modern medical training is rotten to the core for the reasons I and others cited. It's infantilizing and traps high-achieving people in a prison with no options and with no respect while their peers can prosper in a world with options, better pay, and way more respect. Things in medicine are on track to get much much worse and will likely never be fixed (now there is astronomical med school tuition, no subsidized student loans, more administrators and ancillary staff who do nothing, more midlevels who claim to do your job better with their online "doctoral" degrees, now you'll get less pay, there are higher home prices, and there's way less respect overall for physicians).

I like (but don't love) my job as an attending. But often I hated my "job" and life as a resident. The pestilence of residency and medicine needs to be fixed.

 

[anbuitachi]

@GravelRider, I totally agree that residency could and should be shortened, a year less seems about right. Unfortunately, the people who could change things are also the ones who benefit from keeping the cheap labor force around as long as possible.

I found intern year to be pretty useless.