Bagaimana Seharusnya Saya Mengatasi Depresi di Sekolah Medis?

From Medscape Med Students > Ask the Experts (Tanya pada Ahli)

How Should I Deal With Depression in Medical School?

Sara Cohen, MD

Authors and Disclosures

Posted: 08/31/2011

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Pertanyaan

Saya sudah merasa tertekan belakangan ini. Apakah ini umum di sekolah kedokteran? Apa yang harus saya lakukan?

 

Jawaban dari Sara Cohen, MD Anggota Departemen Kedokteran Fisik dan Rehabilitasi, Universitas Harvard; , Departemen Kedokteran Fisik dan Rehabilitasi, VA Boston Healthcare System, Boston, Massachusetts, Department of Physical Medicine and Rehabilitation, Harvard University; Fellow, Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, Massachusetts   Pelatihan medis bisa sangat stres. Banyak siswa datang ke sekolah kedokteran sebagai mahasiswa terbaik di kelas kuliah mereka dan terkejut menemukan diri mereka di tengah pak ... atau lebih buruk, hampir Scraping oleh. Tahun-tahun praklinis membutuhkan mempelajari terus-menerus, yang kadang-kadang dapat menyebabkan isolasi sosial. Tahun-tahun klinis tidak lebih baik, antara jam panjang, kurang tidur, dan berdiri di tempat selama berjam-jam pada waktu memegang retractor a. Banyak dokter yang hadir masih berlangganan "mucikari", atau meminta mahasiswa kedokteran pertanyaan sulit di depan rekan-rekan mereka dan memalukan mereka jika mereka tidak mampu menjawab dengan benar. Medical training can be very stressful. Many students come to medical school as the top student in their college class and are shocked to find themselves in the middle of the pack...or worse, barely scraping by. The preclinical years require constant studying, which can sometimes result in social isolation. The clinical years are not any better, between the long hours, lack of sleep, and standing in place for hours at a time holding a retractor. Many attending physicians still subscribe to "pimping," or asking medical students difficult questions in front of their peers and humiliating them if they are unable to answer correctly. Tidak heran bahwa 15% -30% diperkirakan dari mahasiswa kedokteran dan penduduk menderita depresi. Bahkan lebih menakutkan, 11% mahasiswa kedokteran telah melaporkan keinginan bunuh diri dalam satu tahun terakhir, yang merupakan penyebab utama kematian pada populasi setelah kecelakaan. It's no wonder that an estimated 15%-30% of medical students and residents suffer from depression. Even more frightening, 11% of medical students have reported suicidal ideation within the past year, which is the leading cause of death in this population after accidents. Selain itu, hampir setengah dari mahasiswa kedokteran memiliki gejala "burnout", yang meliputi kelelahan emosional, detasemen, dan rasa rendah prestasi. Burnout mempengaruhi perawatan pasien juga: studi menunjukkan bahwa siswa dengan burnout lebih mungkin untuk berbohong tentang tes laboratorium pasien atau mengembangkan sikap altruistik kurang terhadap pasien mereka. Moreover, nearly half of medical students have symptoms of "burnout", which includes emotional exhaustion, detachment, and a low sense of accomplishment. Burnout affects patient care too: studies suggest that students with burnout are more likely to lie about a patient's laboratory tests or develop less altruistic attitudes toward their patients. Depresi adalah topik sensitif di antara peserta pelatihan medis. Mahasiswa menghindari pelaporan gejala mereka karena takut muncul lemah di depan rekan-rekan mereka, atau karena mereka khawatir bagaimana catatan kesehatan mental dapat mempengaruhi karir mereka. Pada saat yang sama, peserta pelatihan memiliki pengetahuan dan akses ke sumber daya medis yang dapat memfasilitasi bunuh diri. Ada banyak cerita tentang dokter menggunakan obat-obatan dari rumah sakit mereka untuk melakukan bunuh diri. Depression is a sensitive topic among medical trainees. Students avoid reporting their symptoms for fear of appearing weak in front of their peers, or because they worry how a mental health record might affect their career. At the same time, trainees have both knowledge and access to medical resources that can facilitate suicide. There are many stories about physicians using medical supplies from their hospitals to commit suicide. Jika Anda seorang mahasiswa kedokteran atau penduduk yang merasa tertekan, ingatlah bahwa Anda tidak sendirian, bahkan jika Anda pikir Anda. Saya selalu kagum pada keterampilan coping dari teman sekelas saya sekolah medis, sampai beberapa malam diskusi on-call ketika saya menemukan bahwa sejumlah mengejutkan mereka sedang mengunjungi klinik kesehatan mental dan mengambil antidepressants. Mahasiswa kedokteran dan penduduk diharapkan untuk menyembunyikan kelemahan mereka, yang menghambat mereka dari berbagi gejala mereka mungkin akan mengalami. Namun, Anda harus tahu bahwa tidak peduli seberapa puas Anda pikir Anda, ada beberapa orang lain di kelas Anda yang merasakan hal yang sama. If you are a medical student or a resident who is feeling depressed, remember that you are not alone, even if you think you are. I was always amazed at the coping skills of my medical school classmates, until some late-night discussions on-call when I discovered that a surprising number of them were visiting mental health clinics and taking antidepressants. Medical students and residents are expected to hide their weaknesses, which discourages them from sharing symptoms they might be having. However, you should know that no matter how unhappy you think you are, there are several other people in your class who feel the same way. Ada beberapa cara Anda dapat mencegah atau memerangi kelelahan sendiri. Dukungan sosial dari rekan-rekan, teman, keluarga, dan lain-lain yang signifikan adalah penting untuk menjaga kesehatan mental yang baik. Latihan fisik sering mendapat diabaikan selama pelatihan medis tapi bisa sangat efektif dalam meningkatkan suasana hati. Akhirnya, Anda bisa melihat stres mengurangi langkah-langkah seperti meditasi, yoga, teknik relaksasi, dan hobi. Strategi-strategi ini tidak bekerja untuk semua orang, tetapi mereka adalah cara-cara yang aman dan mudah untuk mengurangi kelelahan. Jika Anda memiliki depresi serius, namun, intervensi ini tidak mungkin bisa membantu. Anda mungkin memerlukan perawatan profesional, terutama jika ini bukan episode pertama Anda atau jika Anda memiliki riwayat keluarga depresi. There are ways you can prevent or combat burnout on your own. Social support from peers, friends, family, and significant others is crucial to maintaining good mental health. Physical exercise often gets neglected during medical training but can be very effective in improving mood. Finally, you can look into stress-reducing measures such as meditation, yoga, relaxation techniques, and hobbies. These strategies don't work for everyone, but they are all safe and easy ways to reduce burnout. If you have serious depression, however, these interventions might not help. You may need professional treatment, especially if this is not your first episode or if you have a family history of depression. Yang paling penting bagi seorang mahasiswa kedokteran tertekan lakukan adalah untuk mencari pengobatan! Meskipun ada kasus diskriminasi terhadap dokter yang mencari perawatan kesehatan mental, depresi berat yang tidak diobati dapat memiliki efek lebih buruk pada kemampuan Anda untuk merawat pasien dan pada karir Anda. The most important thing for a depressed medical student to do is to seek treatment! Although there are instances of discrimination against physicians who seek mental health treatment, untreated major depression can have much worse effects on your ability to care for patients and on your career. Mencari bantuan kejiwaan ini tidak berarti jarang di antara peserta pelatihan medis baik. Sekolah kedokteran saya memiliki seorang psikiater yang berfokus terutama pada penyediaan terapi untuk dokter dan berpengalaman dalam masalah-masalah yang sering mempengaruhi mahasiswa kedokteran. Seeking psychiatric help is by no means rare among medical trainees either. My medical school had a psychiatrist who focused primarily on providing therapy to physicians and was well versed in the issues that commonly affect medical students. Depresi adalah suatu masalah yang umum dan hasil depresi yang tidak diobati dapat menjadi tragis, jadi jika Anda merasa Anda mengalami gejala depresi serius sangat penting bahwa Anda mencari pengobatan profesional secepat mungkin. Depression is such a common problem and the results of untreated depression can be tragic, so if you feel you are having symptoms of serious depression it is crucial that you seek professional treatment as soon as possible. Print This Email this Medscape Med Students © 2011 WebMD, LLC

Bunuh Diri Dokter

Physician Suicide 

Bunuh Diri Dokter

• Author: Louise B Andrew, MD, JD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...

Updated: Mar 8, 2012

• Gambaran umum

• Depresi pada Dokter

• Masalah Dengan Mengobati Depresi Dokter

• Depresi pada Trainee Medis

• Pendidikan dan Sumber Daya

• Semua

Referensi

• Overview
• Depression in Physicians
• Problems With Treating Physician Depression
• Depression in Medical Trainees
• Education and Resources
• Show All

References

Tinjauan

It has been reliably estimated that on average the United States loses as many as 400 physicians to suicide each year (the equivalent of at least 1 entire medical school class).

Sadly, although physicians globally have a lower mortality risk from cancer and heart disease relative to the general population (presumably related to self care and early diagnosis), they have a significantly higher risk of dying from suicide, the end stage of an eminently treatable disease process. Perhaps even more alarming is that, after accidents, suicide is the most common cause of death among medical students.

In all populations, suicide is usually the result of untreated or inadequately treated depression, coupled with knowledge of and access to lethal means.^[1] Depression is at least as common in the medical profession as in the general population, affecting an estimated 12% of males and 18% of females. Depression is even more common in medical students and residents, with 15-30% of them screening positive for depressive symptoms.

However, because of the stigma often associated with depression, self reporting likely underestimates the prevalence of the disease in both of the above populations. Indeed, although physicians seem to have generally heeded their own advice about avoiding smoking and other common risk factors for early mortality, they are decidedly reluctant to address depression, a significant cause of morbidity and mortality that disproportionately affects them. (Depression is also a leading risk factor for myocardial infarction in male physicians.)^{[2, 3, 4, 5, 6, 7, 8, 9]}

Perhaps in part because of their greater knowledge of and better access to lethal means, physicians have a far higher suicide completion rate than the general public; the most reliable estimates range from 1.4-2.3 times the rate in the general population. Although female physicians attempt suicide far less often than their counterparts in the general population, their completion rate equals that of male physicians and, thus, far exceeds that of the general population (2.5-4 times the rate by some estimates).^{[10, 11]}

A reasonable assumption is that underreporting of suicide as the cause of death by sympathetic colleagues may well skew these statistics; consequently, the real incidence of physician suicide is probably somewhat higher.

The most common psychiatric diagnoses among physicians who complete suicide are affective disorders (eg, depression and bipolar disease), alcoholism, and substance abuse. The most common means of suicide by physicians are lethal medication overdoses and firearms.

Depression in Physicians

Physicians are demonstrably poor at recognizing depression in patients, let alone themselves. Furthermore, they are notoriously reluctant to seek treatment for any personal illness. Research suggests that 1 in 3 physicians has no regular source of medical care.^[12]

Reluctance to recognize depression in a colleague is a tendency shared and imposed by other physicians, who may be well intentioned, chronically emotionally distanced, and/or feeling temporarily vulnerable themselves. Even when healthy, physicians find it difficult to ask for help of any kind. When they are depressed and feeling less than adequate, they find it even more difficult—and when they do bring themselves to ask, they sometimes find that the help they need is remarkably difficult to obtain.

To some extent, however, physicians’ reluctance to reach out is self-imposed. They may feel an obligation to appear healthy, perhaps as evidence of their ability to heal others. Inquiring about another physician’s health can shatter this mutual myth of invulnerability, and volunteering assistance may seem like an affront to a colleague’s self-sufficiency. Thus, the concerned partner may say nothing, while wondering privately if the colleague has become impaired.

Unconsciously defending against this painful vulnerability, colleagues or significant others may fail to notice significant depression or withdrawal, attributing behavioral changes instead to stress or overwork. Nearly every article about a physician’s suicide contains a quotation from some close contact, occasionally a spouse, saying something like, “I never had any idea that he/she was suffering.”^[13] Of course, many physician obituaries omit the fact that the “sudden death” was a completed suicide.

Depressed physicians who do reach out may find that they receive only limited understanding or sympathy from colleagues. There is no specialized training for a physicians’ physician. Most physicians either shrink from this role or perform it poorly.

For many experiencing depression, the early symptoms are physical. A physician unable to diagnose his or her own symptoms commonly feels incompetent. To admit one’s inability to diagnose oneself to another colleague is to admit failure. When this admission is met with avoidance, disbelief, or derision by a reluctant treating physician, it can only reinforce a depressed physician’s feelings of worthlessness and hopelessness.

Physicians find it painful to share their experience of mental illness with others and know that doing so is somewhat risky; therefore, published accounts of physician depression are nearly impossible to find. However, in the author’s experience, private consultations with a trusted counselor reveal that symptoms of depression are surprisingly common among physicians.

Marriage is generally considered to be an effective buffer to emotional distress. Whether the incidence of divorce is higher among physicians than among the general population is not known, but marital problems are common, perhaps in part because of the tendency of physicians to postpone addressing marital problems and to avoid conflict in general.^[14] Marital problems, separation, or divorce can certainly contribute to depressive symptoms, which can increase the likelihood of suicidality if unaddressed.

Litigation-related stress can precipitate depression and, occasionally, suicide.^{[15, 16]} The suicide note of a Texas emergency physician, written the day after he settled a malpractice case, read, “I hope that my death will shed light on the problem of dishonest expert testimony.”^[17] Some physicians have completed suicide upon first receipt of malpractice claims, after judgments against them in court, or after financially motivated, but unjust, settlements foisted upon them by a malpractice insurer solely in order to cut the insurer’s losses.

Other physicians have attempted or completed suicide in response to employment discrimination relating to judgments or settlements or upon the realization that they are no longer able to practice because of discrimination by liability insurers who refuse to insure them because of past judgments or settlements or because of licensure limitations.

Depression in Medical Trainees

Prospective medical students and residents are extremely unlikely to report a history of depression during highly competitive selection interviews. The prevalence of depression in these populations and in medical student and postgraduate trainees is unknown, but it is estimated to range from 15-30%.^[28] After accidents, suicide is the most common cause of death among medical students.

One report has suggested that depression is not uncommon in pediatric residents (up to 20% self reported in 3 programs). This preliminary study found that residents who experienced depression may be as much as 6 times more likely than nonaffected controls to make medication errors.^[29] Other studies have confirmed the association of depression with self-perceived medication and other errors.^[30]

Stressful aspects of physician training—such as long hours, having to make difficult decisions while being at risk for errors due to inexperience, learning to deal with death and dying, frequent shifts in workplace, and estrangement from supportive networks, such as family—could add to the tendency toward depressive symptoms in trainees.

Harassment and belittlement by professors, higher-level trainees, and even nurses contribute to mental distress of students and development of depression in some.^[31] Even positive workplace changes, such as translocations to secure further training or job advancement, can contribute to job-related stress.

A few schools are implementing programs to recognize and deal with depression and other stresses in medical trainees.^[32] The American Foundation for Suicide Prevention has created a video on the topic for physicians and other medical trainees.^[33]

Education and Resources

Depression, like substance abuse, is not only more common in physicians than in the general public but also more readily treatable as a rule. This is because of physicians’ strong self motivation to continue successful pursuit of a professional calling, which is an important source of their self-esteem.

More education is needed regarding this disease and its disproportionate and needless toll on the medical profession, beginning in the earliest stages of physician training.^[34] In addition, there is an urgent need to change the attitudes of those in health care (including those in the regulatory system), as well as the attitudes of the general public, toward mental illness. Such changes might encourage physicians to be more receptive to a diagnosis of depression and enable them to feel free to seek treatment without the fear of repercussion.

Physicians themselves need to be aware of the existence of physician health programs in nearly every state and province, which allow a physician who is compliant with treatment to avoid disclosing depression or other stable illnesses that do not interfere with ability to practice to licensing authorities.^[35]

The American Medical Association has a 2009 directive from its House of Delegates to work with the Federation of State Medical Boards and Federation of State Physician Health Programs to study barriers to effective utilization of physician health programs, including confidentiality safeguards, and to educate members and others regarding the relationships between state licensing authorities and physician health programs.

For further information and resources related to physician depression and suicide, consult the American Foundation for Suicide Prevention (at www.afsp.org) and Black-Bile (at www.black-bile.com). (The latter Web site is named for the English translation of the Greek words melas [black] and khole [bile], from which the word melancholy is derived.) Information on litigation-related stress, along with related materials and resources, can be found at www.mdmentor.com.