Central PA Medicine - Spring 2017 - 9

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ears ago, during my training, a
mentor of mine commonly would
reminisce about the "days of the
iron men"-a time when the doctor
could work days and nights on end, rarely
sleep, eat only when absolutely necessary,
and stomp out sickness regardless of the
extent of the malady. The body and mind of
the physician were invincible; super-human.

under-estimated due to coroner reports of
the deaths of colleagues as unintentional
when likely they were. Furthermore, the
odds of completing a suicide attempt are
much higher for physicians because sadly,
we are better at it due to our knowledge
of drugs and the human body.

to brood, suffer silently, self-medicate,
destroy our relationships and die instead.

The same article reviewed studies that
physicians are more likely to have traits
I latched onto the idea, seeing myself of dependency, pessimism, passivity and
as one of those ancient medical "gods." self-doubt. Add in perfectionism, and an
Furthermore, I frowned upon those that unforgiving attitude, and it becomes obviwould let illness keep them from showing ous that we are poised for self-destruction
up in the morning or succumb to any form and the destruction of those around us.
of psychological weakness. Outside stressors To throw gas on the impending fire, our
should be unable to penetrate our psyche. colleagues, due to the same traits within
Physician burnout is absolute nonsense.
themselves, are less likely to be forgiving
of others' frailties and mistakes.
Yes, it was a rude awakening. I am
not sure if it was the extreme depression
or anxiety that I would feel when there
was a poor outcome in the OR; or the
realization that I was a potential danger
to patients when I was suffering from a
fever, light-headedness or pain. Regardless,
I know now there are no iron men, iron
women, or iron anything.

I don't think "hardening" ourselves to the
suffering we are exposed to in medicine is
adequate or even effective. First, we need
to be less critical and more forgiving of
ourselves and others around us. We need
to be open to accepting and giving help
when it is obviously needed, without judgment. We cannot turn a blind eye to those
within our ranks in obvious need. There
are signs of an increased understanding
of this within training programs with the
limiting of resident work hours and opening
up better communication between trainees
and instructors.

Physicians are sufferers of all the same
physical and psychological illnesses as
"normal folks." Doctors have a high likelihood (in most cases higher than the general
population) of depression, alcohol and
drug abuse, poor marriages, and suicide.
An article from 2000 entitled "The Painful
Truth: Physicians Are Not Invincible" described the suicide rate among physicians
as greater than two times the rate of the
general population (four times more for
women), and the yearly numbers are the
equivalent of one to two average-sized
medical school classes. Can that be correct?
We need a of couple medical school classes
per year just to keep up with the attrition
rate due to doctors killing themselves! I
have to believe that the increased stress
since 2000 with changing payment models,
HIPAA, all that comes with EMR, the institution of the ACA, and so on hasn't made
the statistics any better. In fact, more recent
studies show this to be true, and it may be

Physicians are
sufferers of
all the same
physical and
psychological
illnesses as

"normal
folks."

What can we do?

Also, every state, whether through medical societies or government agencies, has
programs for "impaired physicians." Your
first thought when faced with a colleague's
near-miss or mistake is to think "I've done
that." Accept the fact that the blood pressure
dips to its lowest, the heart rate tanks and
the patient chooses to move and spit out
their airway device usually at the time a
colleague enters the room; and they don't
think less of you.

So, who was that individual that would
reminisce about the days of the iron men?
That was Michael T. Snider, MD, PhD.
Although I may not agree with him about
the once existence of iron men; he is a
mentor, role model, scholar and exceptional
physician. As an educator, he looked at those
Many times, I have heard an anes- less than adequate as potential superstars
thesiologist describe a student, resident, and made them superstars. He taught me
or even partner as less-than-adequate that perfect may be unachievable; accept
because they "almost gave vecuronium failure; but strive to continue to learn and
instead of neostigmine" or even "gave advance myself and others.
ephedrine instead of phenylephrine when
the heart rate was 99." Our over-critical
nature of ourselves and our associates has
led to an inability to admit, discuss and
seek help for our health issues whether
physical or psychological. So, we choose
Central PA Medicine Spring 2017 9

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