Monday, April 21, 2014


For those of you who haven't seen it, this excellent piece was on KevinMD today.

For those of you who don't believe this is what American medicine has come to... you should. I've felt the same things other docs have more times than I can count.

For those of you looking to a career in medicine... I repeat what I said last Thursday: GET OUT NOW.


Margaret Aamodt said...

Dr. Grumpy, Every day, first thing in the morning, I say a prayer for my family, the men and women who are in the Armed Forces and for my country. I will now add Doctors and Nurses to my list. It's about all I can do. I have always treated my doctors with courtesy and respect, even when a few times they didn't deserve it. I can't imagine being rude to someone who is doing his or her very best to keep me well.

Anonymous said...

Holy crap that is scary. And sad. So..if we look at moving forward..what can be done? can we help?..where can we start helping? Is there a solution that can help those in need today? And tomorrow?? Thanks for bringing this plight to the fore. Keep it up - you might just save more that a few lives. xx

Anonymous said...

The next question is: And do what?

I'm married to a second-year IM resident and all of this sounds familiar. That said, I'm in law and it's pretty much the same for us as well, except recent grads have no guarantee of even being able to find a first job to pay off the crushing non-dischargable-but-through-death debt..

If one wants to stay in health care (which isn't a terrible idea as it will always be necessary), where should one go? As much as life sucks for the MD, shit rolls downhill.

If not, what do you do with all those pre-med pre-req's? Humanities-based professions are no better, even worse in the long term.

Somehow, the professional class has become the indentured servants, sold on a lie to get us to willingly sign up for the transatlantic crossing to the tobacco farms.

Packer said...

The stories all carried a signature desperation in them. the only thing that needed to be brought to each person was an injection of hope. when one seriously considers suicide hope is the furthest thing from the mind. Only one who has been there can truly understand it. After a bad scene drug episode in my 20s, I was as desperate as any of the subjects. hope came back to me in the form of a sunrise so beautiful, I knew it was meant for me. I , 40 , years later know that only hope and gratitude really matter. hope carries you when you cant gomon, gratitude comes after hope has taken you through. i try and spread hope and intry to show gratitude. modeh ani, amen

Anonymous said...

Hugs, Grumpy!! Do you think NP's are subject to this same madness? Graduating next week and it worries me a little!!

Anonymous said...

Sleep. The common thread. Sleep deprivation and excessive amounts of mental strain wear down a mentally healthy individual. Mental illness, or perhaps we should say, deficit of mental wellness is more common than society cares to think about. No matter who, where, why, how.

Struck by a Turtle said...

While sleep deprivation certainly plays a role and allows for people to act differently than normal, I think it all comes down to the lack of feeling valued.

All people want to feel valued. Healers especially. Not worshipped, not idolized, just valued for his or her contributions.

Take that away from a doctor and you take everything.

Coogie said...

Thanks Dr. Grumpy for referring me to that post. I read it, it certainly seemed to match medscapes quoted 400 physician suidices per year (over 1 physician per day) in the USA.

Im just graduating medical school am incredibly grateful to have matched into an internal medicine residency.

Unfortunately my experiences (and pretty much everyone around me I know) have been reflected by those statements. My residents above me, and especially those students that were alongside me all are less mentally stable from when we began.

For some reason I have come out of medical school a very different person than I was going into it and I dont quite understand why. The extreme pressures are certainly felt, and the constant feeling of inadequacy certainly never helped but I hate most that on an almost daily basis for a what seems like a very long time now I have met the official diagnostic criteria for major depressive disorder. I know I am not alone but as young doctors we're in a situation where we can't be viewed as weak, and if anyone of us admits to being seen for any mental health disorder, or taking any mood-altering substance including antidepressants then I guarantee you the lawyers, and our employers would have a field day. Not to mention my residency program director would probably not have had me match there in the first place, and now my upcoming physician in training license would have that stigma if I had checked off the box on my application saying I was being seen or treated for any mental issues.

These things are absolutely ridiculous because they pretty much make it impossible for any of us to actually go out and seek treatment for any mental instabilities.

I have had classmates die, I have seen patients die frequently in my hands during codes, I have seen so many suicide attempts, homocide attempts, and these things stay engraved in your mind. Some of us tune them out, but its always there. Not only that but we (as doctors) know what works and what doesnt work. Which is why successful suicide attempts for doctors is so much higher than for the general public.

Before I went to medical school I was a very happy person and to this day I am always the most outgoing, optimistic person on my teams because I find it helps promote teamwork and thus efficiency, but honestly these past two years I found myself thinking about death constantly, and dipping into depression.

When (rarely) discussed with classmates and upper level residents or attendings everyone seems to have or had the same experiences which is comforting, but I dont know of a single one that is willing to take measures to help themselves out of fear of repercussions (myself included).

However I do find solace in a few things such as, despite the administrative issues, the hostile nature of patients and other members of the healthcare team, the drug addicts, I absolutely LOVE patient interactions. Its those uncommon (yes I said uncommon despite public belief of the contrary) situations where I actually make a difference as a provider and I can improve someones quality of life that is more rewarding than anything else Ive experienced. Perhaps as I get further into my years this will fade, but for now its comforting.

The other thing that keeps me going is knowing that Im not alone. So many physicians admit to these feelings (even Dr. Grumpy in his post admitted to feeling some of these feelings) and I certainly admit that Ive been depressed, mentally unstable, and even [not gonna say it] at more times than Im ever going to admit to anyone just in the last few years alone to date. However, we are not alone, we are not the only ones feeling helpless and inadequate and underappreciated. Others are just as afraid to admit it as we are, and thus we need to treat each other with less hostility in healthcare.

I dont honestly know the answer to this problem but perhaps legislation barring the grounds of antidepressant use or depression as something that can be held against a physician in a court of law would be nice.

-Coogie, M.D.

Coogie said...

Also, for those who want to know more about this topic here's a few decent quick reads:

Anonymous said...

A friend of mine, who is also a nurse, was talking with her college-bound daughter about life plans. The daughter was considering medicine. My friend said, "Oh, no! Don't be a doctor - be a vet. The patients are nicer, you are more likely to get paid, and less likely to be bitten." TCG, RN

The Patient Doc said...

This just breaks my heart. I've been there with feelings of hopelessness. My first job after residency made me never want to practice medicine again. I became a person I could no longer recognize., not the open, bubbly person I'm known to be. I knew things were bad, but I didn't realize so many of us were killing ourselves.

Steeny Lou said...

Thanks for those links, Doc.

I understand PTSD. I've got it. But I've gotten a lot of help over the years, the latest being EMDR treatment. Help is a must.

Seems like not much is recommended in the medical field lately. I myself strongly recommend against medical transcription as a career.

Thank you, Dr. Grumpy, for keeping on in what sounds like a stressful place to be. I appreciate that you've shared this bit of what it's really like.

Anonymous said...

The most alone I've felt is when a pt. of mine killed himself. My colleagues, psychiatrists all avoided me like the plague. Only one asked how I was doing. I spend my life trying to give meaning to my patients' lives and thinking that maybe ending mine would be solace. Not always but sometimes.

Anonymous said...

Don't be a vet. We're less likely to get paid, more likely to commit suicide, and the patients might be nicer but the clients are crazy. Just skip the medicine fields all together.

Anonymous said...

I second anonymous at 1:32. The hours are just as grueling, the pay is worse, the debt is awful and the clients are ungrateful. If legislation ever gets passed where owners can sue for loss of companionship, it'll be just as ridiculously priced too. Cover-your-ass medicine hurts everybody, but what can you do when you live in a society that treats lawsuits like a chance to win the lottery?

Anonymous said...

One more veterinarian agreeing with all anonymous veterinarians: suicide rate is approximately twice that for physicians. It's not that they're low, but our rate is really high. Clients are cheap and ungrateful. On the job injuries, especially back injuries and bites, are frequent. Pay is abysmal. Veterinarians with several years' experience often earn as little as medical residents. Student loans are every bit as high as medical school loans.

I've lost a friend and a classmate to suicide and another classmate to an accidental drug overdose.

I am no longer in private practice. I don't miss it. When socializing, I no longer introduce myself as a veterinarian, because I am really tired of politely telling cheapskates "you really should make an appointment with your veterinarian for your dog/cat/ferret/bird/goat/horse."

Anonymous said...

Thanks Dr. Grumpy. I've read your blog for a while now...most notably on long call nights in the ICU during residency! It has helped keep my spirits up many times. I second Coogie, MDs comments above. I, fortunately, have not lost a colleague to suicide, but I did suffer from depression in Medical School and was treated.

The real kicker is that if you ever admit to something like that, not only will you have a tarnish on your license, but you won't qualify for disability insurance either. So...if you ever have a true major depressive episode, that keeps you from working and therefore, keeps you from paying back your ridiculous student loans, you are screwed (pardon my language!). It's crazy.

Thanks to all for shedding a light on this issue.

Anonymous said...

I can't help but think that most of us come from privileged families, and never really had a real (ie career) job. Recently there was a report of a finance intern dying in the job from "stress". I think serious careers (eg pilots, lawyers, politicians) are all difficult. We all want an easy life once we've gone through medical training, because we perceive it to be a large sacrifice to our life (starting family late, large debt, etc). But I don't think this is different from other careers.

That said, the crying certainly happened for me on call. I was too exhausted to deal with someone else's respiratory exhaustion. I had a friend to call (who tends to be up at 4am) and calm me down; this friend has helped me many times.

In summary: all careers are hard in this world today. We're not special as doctors. We just think we are.

-third year neuro resident

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