The Silent Struggle: Burnout and mental health stigma among medical fraternity

Doctors are often seen as warriors leading and fighting heroic battles with deadly diseases and death itself. They are perceived as omniscient on matters of health and disease, omnipotent against fighting diseases, having unfaltering skills, inexhaustible stamina, and unfailing in the outcome of their professional pursuits. However, especially the toll of the pandemic and the relentless demands of their profession have left many doctors experiencing burnout and struggling with their mental health. What is even more concerning is the increasing trend in suicidal deaths and suicide attempts among medical students and doctors in recent years. This growing inclination has caused serious concern within the profession and society at large. Despite all the technological advances, the best training, and dedication, clinical medicine does not provide such a zero-error track for any doctor.

In the demanding world of healthcare, therapeutic setbacks can arise unexpectedly, causing a profound impact on the emotional well-being and professional self-esteem of medical practitioners. These setbacks frequently intensify the pre-existing pressure to uphold an impeccable image of professional expertise. Also, the litigation and the loss of professional excellence in the public's mind compound these adverse impacts. In addition to these challenges, medical professionals are often subjected to external pressures stemming from the healthcare system itself. Corporate healthcare environments, with high-performance pressure, may prioritize productivity over the well-being of doctors. This can result in a sense of alienation and a lack of support, contributing to feelings of burnout and disillusionment. Similarly, smaller clinical establishments may face regulatory and financial burdens that add to the strain experienced by medical professionals. Moreover, manipulative political interference in healthcare systems can further erode the trust and morale of doctors, leading to a deteriorating work environment.

The psychological impact of medical practice

The intense and prolonged exposure to human suffering and the challenges of saving lives can have severe psychological implications for doctors. Drawing parallels with the mental health issues experienced by soldiers in World War I, medical practitioners frequently develop conditions such as post-traumatic stress disorder (PTSD), depression, anxiety, panic disorders, and substance abuse disorders. The demanding nature of the profession often leads to a scarcity of leisure time and strained personal relationships, amplifying the risk of mental health challenges.

While a select few medical professionals may enjoy the compensations of success, reputation, and social standing, the reality is that the majority do not. Depression, anxiety disorders, alcoholism, drug dependence, marital discord, and family disruptions are the consequences. They set a substrate for suicidal ideation. When these pathologies cumulatively thicken over a period, suicide attempts occur. Acquaintance with lethal methods and accessibility to lethal drugs and surgical instruments often turn these attempts fatal.

The silent struggle of medical students and residents

High incidence of suicide attempts and prevalence of suicidal behaviour is seen in graduate medical students, postgraduate trainees, and resident junior doctors as well. In fact, a retrospective survey conducted by the IMA reported 350 cases of suicides in medical professionals over a ten-year period, with almost an equal number of graduate medical students, postgraduate medical trainees, resident junior doctors, and practising doctors. Competitiveness, examination stress, and relationship issues are involved in many suicide attempts of medical students. The heavy work and study burden, long duty hours, and substance abuse are seen as causative factors for suicidal acts of medical residents and postgraduates.

A call for action

Addressing high-intent suicidal acts and mental health concerns among medical professionals necessitates a holistic approach involving personal, organizational, institutional, and governmental efforts. De-stressing strategies should find an important place in mainstream content of medical education, fostering resilience and empathy, promoting early identification and peer support systems, and combating stigma. Spending quality time with family and friends, and developing and maintaining positive social networks should become a lifestyle priority.

Self-help systems and counselling services should be established and conducted effectively and efficiently in medical care and medical education institutions. The stigma attached to participating in self-help activities and seeking mental healthcare services exists among medical professionals as much as it does in the general population, perhaps even more so. Legal and administrative regulations in healthcare are necessary, but harassment and exploitation in connection with these should be avoided. Political, community and communal leaders should not cater to persons with vested interests and vengeance with doctors and hospitals. It is crucial for all stakeholders to recognize the significance of this pressing issue and work together to create a healthier and more supportive environment for those who dedicate their lives to caring for others. May this Doctor's Day be yet another wake-up call.

(Dr. K.A. Kumar is Senior Consultant, Psychiatry & Behavioral Medicine, KIMSHEALTH, Thiruvananthapuram)