It's Okay Not To Be Okay - My Hypocritic Oath
It’s incredible how powerful a preventative health encounter can be for patients; truly, it is an opportunity for patients to engage in self-reflection, often discovering ailments or syndromes unbeknownst to their conscious. Patient Z, a 50-year old female, was no exception to this phenomenon. As I explored her current health concerns, it became apparent that she had experienced myriad stressors since her last visit. Mrs. Z’s father had passed away over the summer; shortly after his death, her nephew died by suicide. Stir these grievances into a simmering pot of work stress, and a recipe for a wounded psyche en-stews (Are play-on-words acceptable? I hope so!) As I observed her mannerisms throughout our interaction, I made note of her fidgeting legs, her tendency for circumferential thinking, and her vague complaint of neck stiffness. The mesmerizing rhythm of her history unraveled, and I had seen this flurry of foxtrot symptoms before. Despite my aversion for scales in diagnosing psychiatric conditions, I printed a GAD-7 to confirm my suspicions; its 83% sensitivity and specificity (Plummer et al., 2016) serving true: patient Z was suffering from Generalized Anxiety Disorder (GAD).
I could wax poetic about promoting mental health screening in a primary care setting, or engage in a tasteful but poignant monologue about increasing access to mental health resources; both of which I’ve admittedly done before. But this reflection isn’t about anxiety detection, or resource allocation, or barriers to care. Rather, this piece is a realization of my own hypocrisy – the recognition of myself in a patient’s ailments, spewing off the latest and greatest of coping strategies, all of which I have failed to maintain for my own well-being. Alas, my elusive title is finally contextualized: I hope to explore the heavily engrained notion that physicians are infallible, and just how detrimental this belief is to our profession.
A 2016 Systematic Review conducted by Puthran et al. indicated that 28% of medical students ALONE meet criteria for depressive symptoms; only 12.9% of these students chose to seek help. Nearly 35% of staff physicians also don’t seek help, citing the primary reason for fear of stigma or repercussions on their professional licensure (Mehta & Edwards, 2018). Medical students, similarly, avoid treatment due to worries of jeopardizing professional advancement. In addition, students feel as though they will be an embarrassment, or perceive mental illness as a flaw in brain character, rather than in brain chemistry (Mehta & Edwards, 2018). The stigma of mental illness continues to radiate within the medical profession. As Adam Hill (2017) so eloquently wrote, “Indeed, we are ashamed not only of the condition but of seeking treatment for it, which our culture views as a sign of weakness.” If a physician dies from cancer, we would never question their resilience or “toughness”. However, Hill (2017) describes an instance after a student died by suicide, wherein commentary of “We were all worried that they wouldn’t be strong enough to be a doctor” pierced his eardrums.
I have always been an advocate for mental health eradicating stigma. I’ve spoken about my personal journey at nursing conferences, spearheaded the integration of the Bell Let’s Talk Campaign into nursing schools across the country, and now have brought that passion here to Queen’s. Last year, we hosted Queen's Medicine's first-ever Mental Health Open Mic Night, where, in a raw and jarring fashion, I disclosed my story of trauma and suffering with over 50 of my classmates. Yet here I am, in the middle of my Family Medicine rotation, terrified to take an afternoon off, for reasons not unlike those stated above. Alas, self-reflection, be it voluntary or a component of mandatory writing, illuminates a painfully necessary truth – I have come immensely far, but have not reached my summit. And until I can practice what I boastfully preach, I remain a hypocrite.
This is Alexandra Morra's perspective, a third year medical student at Queen's University.
References:
Hill, A. B. (2017, March 23). Breaking the stigma - A physician’s perspective on self-care and recovery. New England Journal of Medicine, Vol. 376, pp. 1103–1105. https://doi.org/10.1056/NEJMp1615974
Mehta, S. S., & Edwards, M. L. (2018). Suffering in Silence: Mental Health Stigma and Physicians’ Licensing Fears. American Journal of Psychiatry Residents’ Journal, 13(11), 2–4. https://doi.org/10.1176/appi.ajp-rj.2018.131101
Plummer, F., Manea, L., Trepel, D., & McMillan, D. (n.d.). Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. General Hospital Psychiatry, 39, 24–31. https://doi.org/10.1016/j.genhosppsych.2015.11.005
Puthran, R., Zhang, M. W. B., Tam, W. W., & Ho, R. C. (2016). Prevalence of depression amongst medical students: A meta-analysis. Medical Education. https://doi.org/10.1111/medu.12962
It’s incredible how powerful a preventative health encounter can be for patients; truly, it is an opportunity for patients to engage in self-reflection, often discovering ailments or syndromes unbeknownst to their conscious. Patient Z, a 50-year old female, was no exception to this phenomenon. As I explored her current health concerns, it became apparent that she had experienced myriad stressors since her last visit. Mrs. Z’s father had passed away over the summer; shortly after his death, her nephew died by suicide. Stir these grievances into a simmering pot of work stress, and a recipe for a wounded psyche en-stews (Are play-on-words acceptable? I hope so!) As I observed her mannerisms throughout our interaction, I made note of her fidgeting legs, her tendency for circumferential thinking, and her vague complaint of neck stiffness. The mesmerizing rhythm of her history unraveled, and I had seen this flurry of foxtrot symptoms before. Despite my aversion for scales in diagnosing psychiatric conditions, I printed a GAD-7 to confirm my suspicions; its 83% sensitivity and specificity (Plummer et al., 2016) serving true: patient Z was suffering from Generalized Anxiety Disorder (GAD).
I could wax poetic about promoting mental health screening in a primary care setting, or engage in a tasteful but poignant monologue about increasing access to mental health resources; both of which I’ve admittedly done before. But this reflection isn’t about anxiety detection, or resource allocation, or barriers to care. Rather, this piece is a realization of my own hypocrisy – the recognition of myself in a patient’s ailments, spewing off the latest and greatest of coping strategies, all of which I have failed to maintain for my own well-being. Alas, my elusive title is finally contextualized: I hope to explore the heavily engrained notion that physicians are infallible, and just how detrimental this belief is to our profession.
A 2016 Systematic Review conducted by Puthran et al. indicated that 28% of medical students ALONE meet criteria for depressive symptoms; only 12.9% of these students chose to seek help. Nearly 35% of staff physicians also don’t seek help, citing the primary reason for fear of stigma or repercussions on their professional licensure (Mehta & Edwards, 2018). Medical students, similarly, avoid treatment due to worries of jeopardizing professional advancement. In addition, students feel as though they will be an embarrassment, or perceive mental illness as a flaw in brain character, rather than in brain chemistry (Mehta & Edwards, 2018). The stigma of mental illness continues to radiate within the medical profession. As Adam Hill (2017) so eloquently wrote, “Indeed, we are ashamed not only of the condition but of seeking treatment for it, which our culture views as a sign of weakness.” If a physician dies from cancer, we would never question their resilience or “toughness”. However, Hill (2017) describes an instance after a student died by suicide, wherein commentary of “We were all worried that they wouldn’t be strong enough to be a doctor” pierced his eardrums.
I have always been an advocate for mental health eradicating stigma. I’ve spoken about my personal journey at nursing conferences, spearheaded the integration of the Bell Let’s Talk Campaign into nursing schools across the country, and now have brought that passion here to Queen’s. Last year, we hosted Queen's Medicine's first-ever Mental Health Open Mic Night, where, in a raw and jarring fashion, I disclosed my story of trauma and suffering with over 50 of my classmates. Yet here I am, in the middle of my Family Medicine rotation, terrified to take an afternoon off, for reasons not unlike those stated above. Alas, self-reflection, be it voluntary or a component of mandatory writing, illuminates a painfully necessary truth – I have come immensely far, but have not reached my summit. And until I can practice what I boastfully preach, I remain a hypocrite.
This is Alexandra Morra's perspective, a third year medical student at Queen's University.
References:
Hill, A. B. (2017, March 23). Breaking the stigma - A physician’s perspective on self-care and recovery. New England Journal of Medicine, Vol. 376, pp. 1103–1105. https://doi.org/10.1056/NEJMp1615974
Mehta, S. S., & Edwards, M. L. (2018). Suffering in Silence: Mental Health Stigma and Physicians’ Licensing Fears. American Journal of Psychiatry Residents’ Journal, 13(11), 2–4. https://doi.org/10.1176/appi.ajp-rj.2018.131101
Plummer, F., Manea, L., Trepel, D., & McMillan, D. (n.d.). Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. General Hospital Psychiatry, 39, 24–31. https://doi.org/10.1016/j.genhosppsych.2015.11.005
Puthran, R., Zhang, M. W. B., Tam, W. W., & Ho, R. C. (2016). Prevalence of depression amongst medical students: A meta-analysis. Medical Education. https://doi.org/10.1111/medu.12962
