Chinese doctors, can't cure their own depression?

In the documentary "How We Fight Depression," Sun Xinyu, chief physician of Peking University Sixth Hospital, recalls a past twenty years ago.

At that time, the deputy chief physician of the Department of Neurology of a famous hospital in Beijing found Sun Xinyu and said that he was not sleeping well and wanted to prescribe some medicine. Sun Xinyu wondered, the doctors in the gods can prescribe their own medicines, how can they come to the psychiatric clinic to prescribe drugs? The director explained that he wanted to try if there was a better drug.

Sun Xinyu opened a list of benefits, exchanged a few words of greeting with him, and said goodbye. Half a month later, Sun Xinyu went to Kunming to attend an academic conference and exchanged with peers in the outer courtyard to learn that he had committed suicide.

"I was confused at the time," Sun Xinyu said, "why didn't I ask him a few more words at that time, why did I run to see me when I couldn't sleep, why didn't my family accompany him?" This matter sank into my heart, and it still hurts. It was a failure for me to be a doctor. ”

Behind this story is an untold fact – doctors can be depressed too. This fact is like an elephant in a house, it is there, everyone can see it, but it goes around.

The American Psychiatric Association (APA) released a set of data at its 2018 annual meeting: In the United States, the suicide rate of doctors is more than twice that of the general population, and this figure is the highest in almost all occupations.

In China, there are currently no relevant data. However, a psychiatrist who has been practicing for more than two decades mentioned to Eight Points that two of the doctors he knew alone had committed suicide.

In the "Report on the Development of National Mental Health in China", it is mentioned that 27.7% of medical workers may have depressive tendencies, of which more than 1/10 of doctors have a higher risk of depression.

A study of more than 30,000 Chinese medical students at the West China Hospital of Sichuan University showed that among Chinese medical students, the incidence of depression, anxiety and suicidal ideation was 29%, 21% and 11%, respectively.

In that article, the authors also mentioned that for students majoring in health-related disciplines, psychological problems can lead to many adverse personal and professional consequences – "they not only impair the quality of life of these medical students, increase the risk of suicidal ideation, but also reduce academic performance, professionalism, and compassion for patients."

Image from Visual China

Even without considering extreme events such as doctor suicide, the fact that doctors' psychological state is worrying is greatly reducing the quality of medical services that ordinary people can enjoy.

Wang Danzhao, a Chinese psychiatrist practicing in the United States, also mentioned that this psychological and emotional sub-health state, which interacts with the doctor's burnout and exhaustion, directly affects the quality and safety of the doctor's service, "You may show impatience with the patient, obviously affecting the quality of medical services provided, and even prone to errors, resulting in unexpected medical accidents ..."

Fatal concern: Why don't they go to the doctor?

Although various data surveys show that doctors are at high risk of depression, in reality, this group is "invisible".

In response to this contradiction, a number of senior psychiatrists told Eight Point Jianwen that they had heard many times that their peers were suffering from depression, but few people came to see them.

Sick doctors are afraid that their condition will be known to the hospital, and they will lose the opportunity to promote and lose their decent jobs. Just imagining the different eyes of your colleagues can make them terrified.

A psychiatrist told us that two of his patients were transferred by the hospital, "one went to the library, one went to the laundry room... When he found that he had mental problems, the hospital did not dare to let him see a doctor again and go to the operating table."

Of course, the psychiatrist immediately mentioned that with the current shortage of people in the hospital, it is not very common for a doctor to be completely transferred to an idle post. But in any case, a diagnosis of mental illness can hinder the development and promotion of a doctor, and "the leader will certainly not dare to entrust important work to a person with mental illness."

Wang Danzhao talked about the treatment of foreign countries: the employee psychological assistance program (EAP) evaluates the situation of their mental illness, and whether it will affect the work as a criterion for whether they need to be transferred.

Professor Liu Zhihong, a psychotherapist at the Hangzhou Branch of Kangning Hospital affiliated to Wenzhou Medical University, believes that "if you are sick, you can treat the disease, and if you are cured, you can return to your post." He introduced that early intervention for depression "can achieve clinical cure."

However, Liu Zhihong has to admit that this stigma of mental illness among doctors is very common, even in the early stage of the epidemic in Wuhan, this concern also exists.

Liu Zhihong, who was stationed in Wuhan as the first batch of psychotherapists in the medical team to aid Hubei, mentioned that in Wuhan in early 2020, the doctors were under great pressure, and many people could not sleep all night, so they asked (the psychiatrists accompanying the team): "I can't sleep, do you have medicine?" He would also add, "I have no psychological problems."

"They will repeatedly emphasize not to tell the team, the ostensible reason is that they are afraid of causing trouble to the team, but in fact, they should also be afraid that others will look at themselves differently, and even worry that the assessment of their abilities by leaders or colleagues will weaken or decrease."

Under normal circumstances, many doctors respond to mental illness by delaying treatment, even if they know in their hearts that they need to receive treatment; others deliberately avoid their hospitals, go to the outside hospital or even hide their identities to see a doctor, and even dare not pay with medical insurance.

Wu You (pseudonym), a psychiatrist from Shanghai, mentioned a chief doctor he had known since his internship — a "goddess of high coldness" who spoke elegantly and became a deputy high at a young age. The goddess usually does not smile, and the only drawback is that her temper is somewhat poor.

A few years ago, the director, who had not been in contact for many years, suddenly found Wu You, saying that his father-in-law was old and had a bad sleep, considering depression, and consulting a diagnosis and treatment plan. Two days later, she came to the door again and confessed that the person who was depressed was actually herself, who had been ill for many years and was never willing to face it.

The director told him that he felt disgusted and often wanted to commit suicide, which was very painful. Fearing that his condition would be known and did not want to leave any medical records, he asked Wu You for help.

Wu You helped her through the back door and issued a treatment order for electroconvulsion and medication. After getting the medicine, she broke off contact with Wu You.

What impressed Wu You even more was a brother who was also a psychiatrist.

The brother is also a psychoanalyst, talented, born in a family of intellectuals, his parents hope to rely on him to buy a house and return to Shanghai. After graduation, the brother was unfortunately assigned to a marginal department of a branch hospital, "it is difficult to receive patients, even the director can not eat enough."

At some point, because of the financial pressure of the family, the pressure of replacing the house, and the hopelessness of promotion, the brother had symptoms of depression and tried to cut his wrists to commit suicide.

However, after the incident, the hospital leaders transferred the master brother to a more idle post. As a result, his brother's financial situation became more and more difficult, and a year later, he hanged himself and passed away.

Most of the time, this fear of affecting career development makes doctors silent, even if they have the courage to seek treatment, they always downplay the condition, and the weak call for help makes it impossible for professionals to recognize, and in this case, there is the situation of the doctor and patient sun Xinyu encountered mentioned at the beginning of this article.

A doctor suffering from depression confessed to Eight Point Kenwen that when depression comes to him, it is difficult to face it, afraid that others will know and do not want to be treated specially.

"According to my observation, most of the people who can talk about this matter have achieved some work achievements or social status, such as being deputy senior, associate professor or professor. Their depression is a thing of the past. No longer bothered by it, they will share their past experiences and stand at a certain distance to examine themselves. When there is no risk, doctors can be more honest. The doctor said.

Doctors with chinese characteristics of depression

In the Report on the Development of National Mental Health in China (2018-2019), it was mentioned that the mental health level of medical workers is generally low, and psychological problems such as anxiety, depression and paranoia are prominent, especially among surgeons, emergency department doctors, pediatricians and nurses.

A screening of the psychological condition of the chief resident physician of a third-class hospital in the north showed that those young doctors who needed to be on call 24 hours a day and were in the period of professional transformation had a detection rate of 78.3% of depressive symptoms, 73.9% of anxiety symptoms, and 100% of sleep disorders. Despite the small sample size, the data is still shocking.

Because of the high intensity of work and the constant stress state, the mental health of health care workers is not optimistic from a global perspective. In China, a lot of Chinese characteristics have been added to this issue.

In the aforementioned west-china medical university study, it was mentioned that the current state of China's medical education system and health care work environment is different in some ways compared with the West or other Asian countries. "In addition to the fact that china has a large number of patients and a relatively small number of doctors, so there is a greater workload, in addition to the fact that in China, the unstable relationship between patients and doctors often leads to workplace violence, and patients are often the perpetrators."

Tang Wei, director of the Department of Psychiatry at Corning Hospital affiliated to Wenzhou Medical University and leader of the key discipline of women's psychiatry, told Eight Point Jianwen that an obstetrician who had followed him for three or four years of treatment was one of the causes of depression was doctor-patient disputes.

After the two-child policy was liberalized, the obstetrician met an elderly couple who wanted to have a boy. They said that the results of many B ultrasound examinations were boys, but after delivering the baby, they found that it was a girl, thinking that the obstetrician had secretly changed their child, so they came to the hospital to make trouble.

The obstetrician was very aggrieved, in a worse state, and was very nervous as soon as he got on the operating table. After years of treatment in Tang Wei's office, the doctor still couldn't overcome the tension and anxiety when she went to the operating table, and through communication with the hospital, she was transferred to another post.

"In fact, it is a pity that the hospital is particularly short of people now, such a dry doctor, if it is not really impossible, the hospital will certainly be reluctant to let her not go to surgery." Tang Wei said.

"Our doctors have a huge workload, the quality of life is not so high, and our culture is often a bit of medical trouble, hospital violence, these situations, it is easy to reduce their sense of value, triggering denial of themselves, doubts, and some other depressions..." a senior psychiatrist told Eight Point Kenwen.

As a doctor, it is difficult to obtain a sense of accomplishment clinically, and turning to peers, it is the harsh pressure of promotion.

A psychologist at Zhongshan Hospital affiliated to Fudan University believes that the circle of doctors is too inward-looking, and the mental pressure of promotion is the greatest, and it is necessary to take into account both clinical and scientific research. In recent years, the number of medical students who come to the hospital due to psychological problems has gradually increased, and scientific research results, applications for insurance research and job search have become factors that lead to anxiety and depression among medical students.

A doctor mentioned that two of his colleagues who had been promoted to chief physician were squeezed out by young people during a competition, mainly because although they had rich clinical experience, they were not good at doing scientific research, and then went to a very idle place, which also meant that their careers were no longer possible to go up.

"Clinical pressure is already very high, to be promoted, but still need to find time to come out to check the literature, take credits, write articles," the doctor explained.

Another doctor simply said that the requirements of China's medical system for doctors' scientific research results are also an important accomplice to doctors' anxiety and depression.

"In foreign countries, there may be scientific research tasks in teaching hospitals, and other doctors can concentrate on clinical practice." In China, even if it is a local hospital, a hospital in the district and county, when promoted, a very important requirement is to do scientific research. He believes that many doctors are not fully trained in scientific research, or their energy is simply not enough, at this time, scientific research has become an important straw that crushes them.

In a survey of more than 20,000 doctors in 136 top three hospitals, a survey of more than 20,000 doctors in 136 tertiary hospitals showed that only one-third of doctors rated their mental health as "good." For such a common doctor's poor mental state, we can list a series of reasons, however, specifically separating the source of a doctor's depression is almost an impossible task.

"If a person is mentally unhealthy, there are many possible triggers, and a pluralistic all-round perspective is needed to look at these problems." Liu Zhihong explained to Eight Points.

"Psychology is really very complicated, it is not a single line of logic to be able to explain some phenomena, unlike colds, or even new crown, can be attributed to the virus, forming a single line of logic." Many times, these factors, each of which is taken out alone, is not a thing, but multiple factors are superimposed together, and the situation is different. ”

In fact, in medscape's survey of more than 10,000 U.S. doctors, "serious bureaucracy" was the number one option for physician burnout.

A psychiatrist once confessed to Eight Points that the hospital is a very bureaucratic institution. Many doctors find the system rigid, lacking in humanity, and prone to political depression. Everyone has a habitual complaint about the system, thinking that there will be no leader who can change the spring and rain, pay attention to the subtle needs of doctors, and change the status quo is not very promising, and then, even the expression is too lazy to express.

A study published by Mayo Clinic showed that the most effective way to alleviate physician burnout is organizational change rather than individual change.

Depressed doctor, who will catch up?

For the pressure borne by doctors, a psychiatrist explained with his finger: "The problems that doctors are now encountering in the unit are scientific research pressure, clinical pressure, pressure on the entire health system and so on. And once these stresses exceed the threshold, various emotional disorders manifested as depression, anxiety, and so on arise.

For these abnormal conditions in their own body that dare not show people, more often, the sick doctor will choose to self-treatment.

Yao Guizhong, former vice president of Peking University Sixth Hospital and chief physician of the Department of Psychiatry, told Eight Point Jianwen that he has been practicing for more than 30 years and rarely receives doctors with mental illness in the examination room. But he learned that the percentage of healthcare workers who take sleeping pills or medications to treat depression is significantly higher than the average person.

Yao Guizhong analyzed that this is because doctors can rely on professional knowledge to carry out self-treatment, and their access to drugs is also very extensive. Some people are cured by medication and do not need to see a doctor.

Guan Ruiyuan, director of the Department of Medical Psychology at Peking University's School of Medical Humanities, mentioned some of the situations she had heard of, and many medical staff had some physical symptoms related to stress and psychological factors, such as neurodermatitis, allergic purpura, stomach ulcers and even infertility. Some medical staff are also privately taking anti-anxiety, anti-depression and other drugs for a long time, but few people really come to psychological centers or psychological clinics for help.

However, if you only focus on biological treatment, you can't solve many mental and psychological problems.

"Knowing too much about (biological) medicine sometimes limits yourself to actually seeking psychological help." Guan Ruiyuan believes that if doctors do not mediate stress, cannot handle their relationships with colleagues, leaders, and family members, and do not change their behavior patterns such as stress coping, even if drugs can temporarily control symptoms, mental illness will still exist.

On the other hand, the current lack of mental health in medical education exacerbates this situation.

Guan Ruiyuan told Eight Points Kenwen: "Many doctors are very familiar with this part of physical health, but they still lack the ability to identify mental health problems." As a result, many doctors "have some symptoms that may be depressed, but they are not aware of it, they do not know that they are depressed, they may just think that the patient is not good for him, or they are not capable enough..."

In this case, "if the medical management system can provide care and support, improve the accessibility of medical staff to access psychological services, such as opening a medical psychological support hotline, pushing mental health knowledge links, and regularly carrying out Balint group activities, these methods can effectively alleviate some of the tension and pressure of medical staff." Guan Ruiyuan said.

Yao Guizhong also mentioned that in foreign countries, hospitals need to set up psychological counselors or psychological experts, who are responsible for some psychological counseling for medical staff. In China, the current department of psychology is aimed at patients, and there is not much intervention in the psychological problems of the medical staff of this hospital.

In fact, some hospitals in Shanghai and Hangzhou have already launched The Balint Group project.

A participant in the Balint group at Zhongshan Hospital explained to Eight Points that it was a group project for the prevention and intervention of the mental health of medical staff, which "can indirectly reflect the doctor's situation, and if the host finds potential symptoms, he will recommend the doctor to see the doctor", and even, "the leader of the nursing department accompanied him to see the patient and also granted sick leave."

However, it has also been mentioned that Balint can only be used as an early prevention, and "generally if you are really depressed, you will not report to Balint" case.

So, what is a timely and effective intervention?

L, a doctor who works at a well-known psychiatric hospital, shares her own experience of depression with Eight Point Kenwen.

A few years ago, when she stood by the balcony window of her dorm room on the fifteenth floor for the second time and had a strong urge to jump, she sent a message to her best friend, "Mainly for fear that the other party will be traumatized by this matter, to explain my behavior is my own choice." ”

Her friend, who was a surgeon, immediately called and after persuasion, left her 4 emergency phone numbers in case she couldn't be contacted during the operation.

With the encouragement of his friends, L found a superior doctor who was familiar with him. The teacher told her, "This is a very valuable experience, you look at you, and later when you talk about his pain to the depressed person, you can say: I understand your feelings." We tell the patient to understand, that is not really understanding, you are different"...

Years passed, and in retrospect, L couldn't help but sigh: "Although I carried it for half a year before I really began to receive standardized treatment, the people around me provided very professional support in a very short period of time." This played a big role in the control of my depression. ”

Over the years, she insisted on regular follow-up visits and medications, during which time she successfully obtained a doctorate in psychiatry and stayed in the hospital. In addition to her clinical work, she also continues to conduct research related to depression, hoping to do more for people with depression.

"Maybe one day, when I get to vice-seniority, I will make my story public," L said, at that time, "I really accepted my illness and accepted my shame." ”

Written by Shi Chenjin and Li Shanshan

Li Shanshan 丨 responsible editor

This article was first published on the WeChat public account "Eight Points Health" (ID: HealthInsight)

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