Doctors, like patients, not immune to depression

Qn. “I recently witnessed the intense work medics do in hospital and I was left wondering if doctors get depressed by the chaos they go through trying to save lives”

Sadly doctors get depressed just like any other human being. Indeed, many first generation doctors died of various mental health problems including several who literally drank themselves to death. As a young medical student in the 70s, a number of my teachers drank so heavily that they trembled in operating theatres.

To control the tremors one kept spirits near him all the time. Later, and as we have all moved on, a number of colleagues who are older, and some younger than me have fallen by the wayside. Things do not seem to be changing and rates of mental illness among doctors is a matter of concern all over the world.

In a study among medical students a few years ago, Prof Lukoye Atwoli found high rates of mental illness. In his sample, more than 20 percent of the medical students had symptoms of Attention Deficit Hyperactivity Disorder (ADHD). Other conditions were also present.

A psychiatrist recovering from a serious mental illness recently wrote about a conversation she overheard between two of her patients. Of her, they were saying, “she seemed more depressed than me.” Another group was heard saying, “she was so stressed, she didn’t listen or care what I said.”

Other recent studies indicate that 10-20 percent of doctors will suffer from depression at one time or other in their lives. It is also known that the rate of suicide among doctors is higher than those in the general public.

A group of experts on the mental health of doctors wrote of us, “We are not super human; in fact we are quit messed up.”

Doctors are known to suffer from depression, anxiety, burnout, prescription drug abuse as well as abuse of alcohol. Many of these problems are made worse by the fact that the long hours doctors work lead to difficulties within the family. Many are accused of neglecting spouses and children. There are many doctors who are very good and bright and funny at the workplace but turn out to be aggressive monsters at home.

It is often said that doctors are the worst patients and in many instances this is true. Nairobi is full of stories of senior doctors who have in the last few years nearly died because they were treating themselves.

Another doctor suffering from depression had this to say of himself, “I had the classical symptoms of depression, early morning awakening (3am), poor concentration and appetite, loss of enjoyment of life, tearfulness, irritability as well as tiredness. Because I was functioning (so I thought) and was going to work, I did not acknowledge that I was clinically depressed and possibly a danger to my patients.”

Doctors with mental illness cannot only be a danger to their patients but also to their own careers.

So, you might ask, what are the drivers of the poor mental health of doctors? There are many reasons for this observation but some of them, as you point out, are related to the many hours they have to work, the stress of doing the jo, for instance breaking bad news of death or an operation gone wrong, as well as the high expectations of family and society placed on doctors.

Many people go to the practice of medicine because they are by nature perfectionists. They like things that go in a particular organised way.

They criticise themselves a great deal when things go wrong even if it is not their fault. Anyone who has seen a plastic or vascular surgeon at work will understand this latter sense of the need to be exact.

The other problem that we live with is stigma. When a doctor develops diabetes or hypertension, everybody comes to know about it and are happy to cover them. If one becomes depressed, then it is as though they brought the condition unto themselves or that somehow they are weak or lazy or in some other way lesser human beings.

In recognition of the needs of doctors, the Kenya Psychiatric Association in conjunction with Chiromo Lane Medical Centre have started to look into the matter of the health of doctors, starting with psychiatrists themselves.

This is an important subject not only for the doctors but for their patients as well.