I already know I won't sleep well tonight. I should look forward to the respite of sleep after a long shift in the emergency department, but as my head hits the pillow—like most nights—my mind will be nowhere near at ease.
Alone with my thoughts, I will question whether I did enough for my patients today. Familiar waves of stress, guilt, grief, doubt and failure will wash over me in a moment that's intense and overwhelming, then gone, locked away in a dark place with the others like it, each too numerous to count after a 30-year career as an emergency physician.
I wonder if it's just me, or do many of my colleagues spend nights tossing and turning too? Emergency medicine can be a turbulent and overwhelming field. Every day is hard and that takes an emotional toll. We make life-or-death decisions in a split second and we have to find ways to live with the consequences of each action we take. This affects us not just as physicians, but as people.
Numerous studies show that emergency physicians have historically higher rates of career burnout and post-traumatic stress disorder than other medical specialties. It's clear this job can take its toll, with data suggesting that, in the last year, as many as 6,000 emergency physicians have contemplated suicide and up to 400 have attempted to take their own life.
With a record number of COVID-19 cases in several new hot spots, it is reasonable to expect the strain on emergency physicians and hospitals to continue.
Admissions across Texas, Arizona and other states are soaring, testing our system's capacity. At the same time, communities across the country continue to reopen. Already stretched EDs across the country are preparing for another wave of positive cases that will create more challenges for everyone.
Emergency physicians like me will be at the bedside of people who may die without their friends and family close. And, when all our medical care fails, we try our best to grapple with our feelings of inadequacy and to provide whatever final moments of human-to-human comfort we can. Then when our day ends, many of us retreat to solitude as we isolate to protect our families. We are left alone to process the horrors of the most recent shift.
Working in the ED gives me a unique understanding of the resilience of the human body and spirit—but I also know its limits. Healing is hard on its own, but it can be nearly impossible when we are forced to do it without professional help.
Despite the prevalence of depression, feelings of burnout and other mental illness, there is a legitimate fear of consequences that deter physicians from seeking the care they need, leaving many with no better option than suffering in silence.
Stigma prevents us from openly confronting our mental health concerns. Physicians should be able to prop each other up rather than stifle conversations about their experience. And our health systems could do more to help too.
It's past time that we take a constructive look at the role of mental illness in physician licensing laws, reporting requirements, credentialing and employment. Some state licensing boards continue to ask questions about physicians' mental health histories or past treatment and practicing physicians who have sought mental health treatment have faced discrimination with respect to receiving hospital credentials and privileges.
Recently, the American College of Emergency Physicians, alongside the American Medical Association, American Psychiatric Association, and more than 40 other leading medical associations, academics and psychiatry experts set forth recommendations on how we can remove the existing barriers to seeking treatment—including the fear of reprisal—and better encourage professional support and nonclinical mental health initiatives, such as peer support.
It's unethical to force physicians to choose between their career and their mental health.
Emergency physicians serve as sentinels of the nation's healthcare safety net, risking our physical and mental well-being to battle this pandemic. While we work on finding ways to better care for patients with COVID-19, I hope we also find a way to better care for the caregivers too.