Editor’s note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.
My story is probably familiar to many people in medicine. Starting as early as high school, I had that laser-focus drive to become a doctor. You know: get the grades, go to the right college, get into a good medical school, match with a strong residency. I became a vascular surgeon and practiced for 10 years — quite successfully, I might add. I was well-liked by my patients and well-respected among my peers. I saved many lives, and I helped many more.
Until one day I stood standing on a bridge, looking down at a waterway almost 200 feet below, my impulse to let go of the edge only interrupted by a passing child asking me what I was doing. So what went wrong? Where did my career and life fall off a cliff (almost literally)?
Looking back, I recognize that I had all the signs of depression starting as early as medical school. But medicine and the pursuit of a medical career offer built-in excuses to ignore those very signs: the tiredness, the stress, the bad moods — all of these can be explained by the pressures of medical school and residency. Surely the long hours, sleepless nights, and stressful cases, not to mention the sheer volume of knowledge to be learned, are the real problems and NOT — scoffs dismissively — mental illness.
Was I simply burned out? Physician burnout is not a new concept — we’ve all read the stories and seen the statistics. In 2016, of physicians met the criteria for burnout (emotional exhaustion, depersonalization, low sense of personal accomplishment), with surgeons like myself particularly affected.
Looking back, I recognize that I had all the signs of depression starting as early as medical school. But medicine and the pursuit of a medical career offer built-in excuses to ignore those very signs.
“But wait,” said my inner voice. “You made sure to dedicate time to both kids and to participate in their lives. You had hobbies. You exercised. You were cheerful and humorous. Doesn’t sound very burned out to me.”
Then again, this probably doesn’t sound very much like someone with crippling depression either. Yet as I continued to work, even after that day on the bridge, my depression grew stronger; my self-loathing grew more sinister; and my urge to end it all grew more and more convincing.
I finally admitted to myself that I needed help. Even still, it took me almost a year to actually get that help. Finally, I started therapy and medication. I made a contract for safety. I looked for reasons to live. And for one more year after that, while I continued to work, I never once admitted to anybody that I had a problem.
Why had it taken me so long to seek help? Why did I go well outside of my hospital system to seek help when I finally did? Why, when asked on credentialing questionnaires, did I reply “NO” when asked if I ever had mental illness? We all know the answer.
There is still far too much shame, stigma, and fear of repercussion surrounding mental illness in health care providers. Among physicians, there is also denial and even ignorance. I honestly did not think I was depressed until I stared down from that bridge, and even then I thought maybe it was a fluke. It took several more episodes of severe suicidal ideation to realize that this urge to take my own life and the self-hate surrounding that urge were products of depression.
It shouldn’t take me getting so close to despair, so close to death, to finally feel free enough to speak out. It shouldn’t take physicians literally dying for us to speak truth to attitudes.
Keep in mind, we’re a profession full of self-sacrificing zealots. Say we’re on call and get the dreaded norovirus. Does constant vomiting keep us from making rounds or running a full clinic? Of course not! We don’t take sick days for projectile emesis; what makes anyone think we’ll take a sick day for depression, anxiety, or another mental illness?
Many hospitals have begun to address the issue of physician burnout. A few have even hired chief wellness officers to promote physician well-being. But all the burnout prevention in the world would not have helped my depression. It’s not that burnout prevention isn’t useful; it most definitely is. But as long as burnout prevention strategies only address burnout, without a systematic, stigma-free effort to identify and treat mental illness, then those prevention strategies will fall short for too many physicians.
I left medicine completely almost 18 months ago. Yet despite being away from this environment, I remained severely depressed for at least a year. Only now, after months of therapy and medication, do I see hope, function, and purpose.
My purpose now is to speak out about mental illness in the medical profession. People call me courageous and brave, but it’s easy to be courageous and brave when you feel you have nothing left to lose.
It shouldn’t take me getting so close to despair, so close to death, to finally feel free enough to speak out. It shouldn’t take physicians literally dying for us to speak truth to attitudes. As the saying goes: something’s got to give. I intend for it not to be us.
Leonard Su, MD, is a board certified vascular surgeon with 10 years of clinical experience. He earned his medical degree at the University of Pennsylvania School of Medicine and completed a surgical residency there as well. Su has left the practice of medicine to pursue a career in speaking, writing, and blogging about physicians' mental health, in particular as it relates to burnout and depression. He lives in Seattle with his wife, two children, and dog.