(Content warning… depression, briefly mentions suicide)
Hi and welcome. Tell us a bit about yourself.
Professionally, I’m a Pediatric Intensivist, leader of wellbeing and professional development in graduate medical education, speaker, writer, and advocate for healthcare worker wellbeing. Outside of work, I’m an amateur chef, bibliophile, and Peloton-enthusiast who lives in Michigan with my supportive husband, adorable son, and dog. Having navigated recovery from burnout myself (twice), my work emphasizes the importance of healthcare worker wellbeing by linking current data and personal stories as a physician
navigating the intersection of work, home, community, and self.
In a recent tweet, you quoted 50% of physicians reporting work-related distress. How do you envision this trend changing, based on the current healthcare climate?
Unfortunately, unless something in healthcare changes radically, I see this trend continuing to worsen. In the 2023 Medscape survey on physician burnout, 53% of responding physicians reported burnout compared to 42% in 2018. And a quarter of Medscape survey respondents reported depression. As someone who experienced both of these while I was in pediatric critical care fellowship prior to the pandemic, it is not surprising to me that the number of struggling physicians and other healthcare workers is rising.
Especially in employed-physician models like the one in which I work, physicians are asked to do more with less: see more patients, spend more time completing documentation, answer more inbox messages, etc. And they are doing it with less help from ancillary staff members who previously helped to offload parts or all of these tasks. We know from the available data that increasing demands on people while decreasing resources leads to higher levels of distress and emotional exhaustion. Ultimately, this will likely lead to more physicians leaving the workforce and will only increase the demand on those who stay.
You also ask your audience to “drop the shame” around this distress conversation. In your experience, how have colleagues been shamed?
A great starting place to understand the pervasiveness of shame in healthcare is the recent 10-part podcast series by The Nocturnists: Shame in Medicine: The Lost Forest. By combining available data with the stories of 200+ healthcare workers, it shows that healthcare workers feel shame related to their personal identities, making mistakes, litigation, not knowing the answers, and, especially, when we need help.
As physicians, we often feel like we are the helpers, not the ones who should need help, and we are often unaware of the struggles of those around us. When I was experiencing a major depressive episode in fellowship, I had to diagnose myself because no one around me noticed. This led to a significant delay in diagnosis and treatment. And, when I did finally seek help, the first person I told validated that I should get help but stated they didn’t understand why it was happening to me. They actually said something that boiled down to, “I didn’t think to check on you because I didn’t think this would happen to someone like you.”
That comment made me feel isolated and like an anomaly when, in reality, the available data show that one-third of medical trainees experience depression! As leaders in medical education, we play a role in shaming trainees in distress by the stigmatizing language that we use. And, even if we do not work with trainees, a significant number of physicians shame their colleagues by implicitly believing or explicitly saying that people who struggle are weak. These people do not understand that the conditions of working in healthcare (sleep deprivation, stress, high-stakes environment, etc.) directly result in physician and other healthcare workers’ distress.
As an individual, I have had to work through the stigma I have experienced internally and externally in order to get better.
You’ve mentioned no longer being terrified of being judged – can you give our readers a few tips on how you managed to push past that fear?
For me, saying that I experienced burnout was much easier than saying I experienced a major depressive episode, took medication, and went to therapy. Culturally, it seems more acceptable, especially since the term ‘burnout’ made its way into the lay media during the pandemic. Talking about depression has never really been acceptable in my family even though numerous members of it have experienced mental illness, and it still seems less acceptable in healthcare environments as well.
When I first started disclosing about my experience with depression, it was only to the pediatric trainees who were participating in the post-ICU debriefs that I help to facilitate. I thought it might be helpful for them to hear from someone who experienced it and recovered, and I was right.
But a challenging thing happened next: they kept asking me to talk about it more publicly. They said that more trainees needed to hear from attendings in so-called ‘tough’ specialties like pediatric critical care medicine so that they did not feel so alone and knew it was ok to get help. I knew they were right, but it was terrifying to me as an extremely private individual.
So, I started small. I wove parts of the story into conversations I had more publicly with trainees and colleagues throughout my workplace. I was intentional about why I was sharing: to help others and to encourage them to seek help. I created boundaries around what I would share, with whom, and when. I discovered that being vulnerable and meeting my goal did not require me to share everything, and that helped me. The feedback and support of those around me helped me feel safe in continuing. And the stories shared with me by my colleagues in return made me know that I had to keep going.
“I was intentional about why I was sharing: to help others and to encourage them to seek help. I created boundaries around what I would share, with whom, and when.”
The ultimate test of my courage came by giving Grand Rounds at my own institution on healthcare worker distress. In it, I shared about my depression diagnosis and the passive thoughts of suicide I had (but did not recognize) while I was a fellow. After the talk, the first person to speak was a trainee whose friend, a trainee at a different institution, had died by suicide two days before. For me, this was a sign that talking about this will be something I have to do until physicians are no longer dying by suicide at a rate of over one per day.
I waited for a backlash from people after that talk. Would someone ridicule me? Take away my license? Tell me they did not want me to take care of their child?
It never came. What did come was support, kudos, stories from people struggling who had felt seen, and invitations to numerous other talks because people at other institutions want to hear the message.
I waited for a backlash from people after that talk. Would someone ridicule me? Take away my license? Tell me they did not want me to take care of their child? It never came. Click To Tweet
So, I cannot give people an easy list of tips for this. But I can tell them that being in charge of my own narrative is important. I am not weak because I struggled. I am strong because I struggled, asked for help, accepted the help, and experienced post-traumatic growth that has compelled me to pursue work that is extremely meaningful to me.
As Eleanor Roosevelt said, “Do one thing every day that scares you.” With that, you will grow into a more authentic version of yourself who is living the life you desire.
Does Twitter offer a useful space for physicians experiencing distress?
Despite the data showing how social media can be harmful for mental health, Twitter has been extremely useful to me. It has allowed me to connect with people doing work similar to mine. And many of those people are a big reason I persevered through my fear.
Twitter and other social media platforms can be beneficial when we use them to really connect with people, not to gawk, rant, or compare. Social media may allow some anonymity for people which lets them be more real. I have seen this with my own connections, some of whom use anonymous accounts to follow my tweets on wellbeing because they do not feel supported in their own workplaces or safe enough to use their real names.
“As Eleanor Roosevelt said, “Do one thing every day that scares you.” With that, you will grow into a more authentic version of yourself who is living the life you desire.”
Are there other social media platforms you’ve used, and do you find those useful?
I have used Facebook groups to connect with other female physicians about Peloton, PICU, and motherhood and have found them useful related to these specific topics because they create community.
Instagram has been a good way to connect with friends and coworkers, and I recently started a professional account, LifeandPICU, to connect with people as I grow my Substack publication, Humans Leading. I’m looking forward to seeing how the platform works for this compared to Twitter.
Anything you’d like to leave us with?
Mostly, I want physicians to remember that they are human beings with the same needs as other people. We work hard, and we deserve rest and fulfillment in our lives and careers. To anyone out there who is struggling, you are not alone, and you deserve help. This help can look like therapy, medication, coaching, connecting with friends, time away from work, a career change, etc. It is not an easy process to work through burnout or depression, but it is possible.
Great job Dr. Bybee! I have had the same experience of awaiting a professional backlash after writing my memoir on having mental illness, but other medical professionals have been more supportive and relieved to hear they are not the only ones suffering. Thank you!