By Michael F. Myers
Yes.
Yes, but not “psychotherapy” as classically defined, a process that only works if there is a good fit between the two parties and it is voluntary.
A meeting with a psychologist could be embedded into orientation. After that, periodic visits should be encouraged but not mandated. This should be seen as part of general wellness and health care and would offset a stigmatizing mindset that implies some residents will be fine, whereas others will need therapy. This process could continue through the trainee’s residency if he or she finds it helpful.
Rates of burnout, a systems problem, are very high among trainees today, leading some to wonder whether we need to go a step further than just advising folks to see a therapist if they’re having problems. Trainees must not blame themselves. They are doing their best to cope with a hugely challenging medical system of education and patient care.
Generally, I have found that medical students and residents will admit to burnout much more readily than they would admit to depression. When a doctor says they are burned out, they may say, “I’m working so hard, this has been an awful rotation,” or, “The place where I’m training doesn’t really care about us.” These situations would cause burnout in any hardworking physician who lacks personal agency, or a voice in their training.
It’s very rare to hear a doctor say, “Yes, I thought I had burnout, but I actually went to a psychiatrist and she diagnosed me with major depression. I’m now taking an antidepressant and getting some good psychotherapy.” Physicians are very reluctant to disclose that, unfortunately, because we haven’t fully eliminated judgment and discrimination in medical training.
As psychiatrists working in this area, we take this very seriously, because we don’t want someone with depression to slip through the cracks and not get the proper treatment.
I am part of the “Zero Suicide” movement, the goal of which is to eliminate suicide in health care settings. However, we understand that this is an aspirational goal and that suicide can stem from a lack of effective care. We support steps that healthcare organizations can take to prevent suicide among their patients. We could extend that to trainees. All incoming residents and fellows could have a sit-down with their health team, including a primary care physician, psychologist, nutritionist and perhaps someone trained in mindfulness meditation or yoga. It could include all kinds of approaches that are holistic in their orientation — why wait until something happens to provide these services?
Some centers now give standard short psychological tests, like the Patient Health Questionnaire, to residents at the beginning, which they repeat at 3 or 6 months. Hopefully, physicians feel good about this, like they’re working in a setting that is watching over them.
When you make a mental health visit mandatory at the beginning of residency, the message you give is, “Training in medical school and residency can be stressful. We care about you. You’re going to be with us for 2, 3 or 4 years, and we want you to thrive here.”
—–
Sources: Michael F. Myers | Healio
Michael F. Myers, MD, is professor of clinical psychiatry in the department of psychiatry and behavioral sciences at SUNY Downstate Medical Center. He can be reached at 450 Clarkson Ave., Box 1203, Brooklyn, NY 11203; email: michael.myers@downstate.edu. Disclosure: Myers reports no relevant financial disclosures.
