Physician Mental Wellness: When the Messenger Ignores the Message.
Three months ago, while grocery shopping at Walmart, I got a call from a friend who said ‘Hey Arthur! So we are working on this project, and I believe it is something you might be interested in. We want to do a deep dive into the psychological impact of the pandemic on the mental health of the individual.’ ‘Fantastic! Sign me up.’ I responded. After much deliberations, the project was decidedly focused on College Students as the primary sample demographic. The literature review borne out of that exercise was titled “Psychological Implications of Covid-19 Pandemic in College Students — A Systematic Review” and was recently published in the Journal of Psychiatry and Psychiatric Disorders. To summarize, the study found that college students were greatly impacted by the pandemic, but even more interesting that female college students were more affected within that subpopulation.
I am proud of the work we put together to say the least. But there is something about data-driven papers that distracts the eyes, bores the soul, and is sometimes devoid of that compelling human connection that moves a person from precontemplation to contemplation — and if you are persuasive enough, eventually action. It is stories like that that keeps my eyes glued to ‘Humans of New York’, a photoblog instagram page that boasts of over eleven million followers. What Brandon Stanton, the author and curator of the page, has done is nothing short of magical. People are a multiplicity of stories: they carry with them a tapestry of things, sometimes seemingly contradictory, and other times insanely beautiful. In moments like this, the words of C.S. Lewis “We meet no ordinary people in our lives” holds true because, indeed, I am yet to meet an ‘ordinary person’ whose story did not leave me itching for more.
Reflecting on my aforementioned paper, I realized the story did not end there. A key element of that story was missing, one which focuses on the mind of the observer himself rather than the observed. I have often wondered about the growing spate of mental health crises and suicides rates amongst physicians (estimated to be more than double the rate in the average population). Of course, some of the confounding factors to that data is the fact that physicians are resolute individuals by training, and they have the wherewithal to ensure a more likely successful attempt than the average population.
Lately, however, I have considered that perhaps there might even be other variables that further confound the situation. One of which is the fact that physicians seem more likely to ignore their own red flags when they first appear. Now, it is not entirely clear to me if it is that we ignore those red flags because we are oblivious to it, or because there is an overarching stigma and a real fear of being deemed unfit to practice. I suspect both are at play. But there is a sort of ‘out-of-body-experience-like’ approach with which physicians navigate medicine. We have this culture of ‘do what I say, not necessarily what I do.’ Take me for instance, during my quotidian patient encounters, my routine health promotion spiel is to educate patients on lifestyle modifications; reduce caffeine intake; engage in moderate physical activities; eat more fruits and vegetables; but I find it ironic that I have to start my day with coffee and you will not find a single apple in my fridge. I suspect that there is a subconscious idea we sell ourselves that because we know the literature, we are either immune to it or in the worst case scenario equipped enough to be able to calibrate our behaviors so well that we would always remain in the ‘sweet spot of moderation’ before anything sinister becomes imminent.
Indeed one can ignore the physical limitations and care of one’s own body while sufficiently attending to the physical limitations of the body of another. But the physical limitation of the mind and its fragile nature has the tendency to be autopoietic — and chaos begets chaos. Even if you ignore what your body is saying, you can’t ignore what your mind is saying — mental wellness is the bedrock of any optimal occupational output, the mind will reproduce itself. The mind and work have a relationship that can be best described as directly proportional — as one goes down, the other goes down with it. Again, chaos begets chaos.
On a phone call last night catching up with my friend who currently practices in Jamaica, I asked her how she felt on her first few days back at work after going into quarantine for a positive Covid test result, and she had this to say:
‘I am mentally and physically exhausted. I’m almost at my wits end. I have been on call for the last 48 hours, my feet feel very sore and I was cursed out earlier today by my consultant during ward rounds. I teared up, and for a moment I felt like quitting.’ She says, as her eyes burned red with frustration.
There was a certain palpable helplessness to her tone, and her voice still sounded a bit raspy. There are those that will be quick to say ‘but this is what you signed up for, deal with it!’, and I am quick to make the education (and distinction) that one signs up for the norm, and not the abnormal: it is true that you sign up for the norm even while being aware and accepting about the possibility of the abnormal, but the clarification must be made that you signed up for the norm, and nothing about the pandemic is normal. The point can even be stretched further with an analogy that draws a parallel with the military, to be ‘ready and willing to die’ for one’s country, for a cause, for a profession, is not the same thing as ‘desperately wanting to die’ for that thing. These are two different things.
What happens when the mind of the one who heals is in disarray? Far away in my home country Nigeria, there is a trending headline allegedly attributed to one of the country’s top health officials. In his reaction to the protracted strike by the National Association of Resident Doctors (NARD), he seemed to try to make the point that it was perhaps unconscionable for doctors to embark on strike during a pandemic. A very fair point at face value, I must say, except that he deliberately misses the main point which is the fact that those doctors embarked on that strike due to several months of unpaid salaries while Nigerian top government officials perpetually embark on medical tourism abroad. There should always be a balance in storytelling.
The impact one makes as a clinician is dependent on the internal workings of the clinician’s mind and an optimal level of mental wellness. I hope we seek this wellness for ourselves, I hope our colleagues provide a working environment that is not toxic to that process, and I hope policy makers consider this important enough for attention.
