Behind the mask: Physician heal thyself…..or not: Part I

A suicide death which has rocked the medical world and the African continent in particular, is that of Professor Bongani Mayosi at the age of 51 years. He was an outstandingly brilliant Professor of Cardiology, and the Dean of the College of Health Sciences at the University of Cape Town.

He was married to a doctor and had a beautiful family. His academic career had been stellar – entering medical school at the age of 16 years and excelling at both undergraduate and postgraduate levels. His research career is the stuff of legends – he discovered one of the genes associated with heart failure and he was the most cited African researcher with over 50,000 scientific citations of his work.

He was the pride of not only South African Medicine, but the entire African Medical Community (and indeed, the entire world of Cardiology) embraced and were happy to collaborate with him on research projects. He had several international grants for his research work. He was a ‘made’ man.

Why on earth would such a man, commanding such respect among his peers and beyond, contemplate and then commit suicide? He had been suffering with depression for a few years prior to this sad occurrence. But why was this not treated like the VIP he is? How could he have slipped through the cracks that resulted in this tragedy? What are the issues involved? How can we help?

Pressure and stress of Medical Practice

Medical practice, starting from undergraduate student days, is especially demanding and requiring huge amounts of energy, sacrifice, and unrelenting pressure not to make mistakes, for the cost of ignorance or medical errors are often very expensive and can result in the loss of a life.

Most doctors are often racked by guilt, self-doubt, feelings of helplessness and overwhelming sadness when their patients die. Could I have done something differently? Maybe tried another drug? Invited someone else to see? How else could I have averted this outcome?

Furthermore, all standard hospitals hold morbidity and mortality meetings (dreaded M & M) where all mortality cases are reviewed and officially discussed to ascertain cause of death and what the management team did right or wrong so that everyone can continuously learn and improve.

But there is also the gradual dampening of the initial enthusiasm of a young doctor with starry-eyed dreams of becoming a super hero, that is committed to saving lives and making the world a better place – one patient at a time.

Reality hits, that life and death are inevitable and sometimes you just can’t help everyone – either because the disease is already too advanced; or the treatment is unavailable. And you learn to put up a bold face even when you are cracking inside, for you are supposed to be a veteran who is not easily moved, and is in control of his or her feelings.

Until you get to the privacy of your office or home, when you can shed some tears for the loss of a patient with whom you have developed a connection, and who had been discussing their hopes and aspirations with you. But you can’t dwell too much on it, as other patients await your attention and you have to step out with a smile for each one…or at least make the effort.

In addition to the above, the work environment is often toxic and brutal, with bullying of junior doctors by some senior colleagues, professional rivalry and friction which makes the work environment unnecessarily tense. Add long working hours and inadequate rest/sleep and little or no time for family and friends and the stage is set for transforming into an emotional wreck.

This can occur in several ways: become cold/aloof and function mechanically (to protect your emotions); seek solace in alcohol and drugs; suffer from anxiety or depression; break down of marriages or family dysfunction etc.

Stigma of mental illness

The challenges highlighted above are worsened by the stigma of having an emotional problem even among physicians. ‘How can I be seen consulting a psychiatrist?’. ‘People will start whispering behind my back’. ‘My Consultant (other colleagues) will no longer trust my judgement’. ‘All the nurses will now be making fun of me’. ‘I am supposed to know it all, and be resilient; how can I admit to emotional pain?’.

‘Psychiatrists are not even “real doctors’. “I will now be taking “those” pills?’ And on and on it goes. Unfortunately, the more senior and respected you are, the more difficult it becomes to seek care for emotional problems.”

 

To be continued next week.