Expert Consult

By Shannon Scott-Vernaglia, MD

Published November 16, 2022


Whether you are a student, resident, or faculty member, no doubt you have attended obligatory talks on well-being and burnout. The attention to high rates of burnout in the U.S. health care workforce, and its unsurprising increase during the pandemic, has been beneficial, but concerns have been raised that the focus on burnout detracts from important discussions about mental health conditions such as depression, anxiety, and suicidality (see the recent Perspective in NEJM by Srijan Sen).

Unfortunately, depression, anxiety, and suicidality bear a heavier cloak of stigma than burnout, with a stated or unstated implication that these mental health conditions reflect personal weakness. In truth, mental illness is common among clinicians, and we need to talk about it so that it is easier to acknowledge when we or someone else needs help.

Mental illness has nothing to do with weakness. Working in health care is challenging. No matter the setting, we bear witness to human suffering, and as we seek to alleviate that suffering, we carry our humanity with us. We cannot always "fix" things, no matter how much we may want to, and sometimes we make mistakes. Having already sacrificed personal time and sleep for our work, it can be hard to find time for the practices that keep us grounded and refreshed, such as reflection, exercise, and even healthy eating.

Like many people, clinicians and nonclinicians alike, I experienced a paralyzing episode of major depression that turned my life upside down. Perhaps it started as burnout, and it certainly had underpinnings of moral injury, but the actual triggers became irrelevant when I had to hide behind closed doors to cry or found it difficult to even get out of bed.

During this time, I experienced an overwhelming sense of loneliness and shame. I found some relief from reading narratives written by clinicians, including trauma surgeon Michael Weinstein, pediatric palliative care physician Adam Hill, and internal medical resident (at the time) Colleen Farrell. These narratives helped normalize my experience. Ultimately, reading an essay by then-student Michael Rose inspired me to write about my own experience.

If you are struggling, I hope the words of these, and other clinicians help you realize that you are not alone. Each narrative is told through the lens of recovery, reminding us that there is hope, even when you feel hopeless. Seeking treatment is the first step toward reaching that shore of recovery yourself.

Get help! As a longtime residency program director, I know educational leaders want to help and support you. Consulting with chief residents, program directors, deans of student life, and others is often the best initial step to accessing support. Understandably, it may feel overwhelming to seek out those in charge. So be aware of the following important local and national resources:

  • Your PCP: Occasionally we clinicians forget how valuable our own doctors can be! Reach out to your PCP to help you decipher what’s going on. Your PCP might help you consider medication or make key referrals to therapists.

  • Employee Assistance: Most medical systems have an employee assistance program designed to support staff in need. EAPs provide confidential services, sometimes on-site, or can provide referrals.

  • Student Health Services: If you are at a medical school, the university likely has medical evaluation and counseling available through student health services.

  • The Emotional PPE Project: This amazing free program emerged early during the Covid-19 pandemic to address the overwhelming stress of providing care. The program connects health care workers with licensed mental health clinicians to receive free counseling sessions.

  • NAMI: The National Alliance on Mental Illness website provides additional information and resources. They also have a HelpLine: 1-800-950-NAMI (6264).

If you are worried about a colleague: Sometimes we’re worried about the mental health of a friend or colleague, but the culture of medicine suggests that we shouldn’t "interfere." Or maybe a depressed colleague is skilled at deflecting a superficial "How are you?" Identification, engagement, and referral are critical concepts in suicide prevention that can be useful to keep in mind when trying to help someone who is struggling. (See The Case of the Resident-at-Risk from Academic Life in Emergency Medicine for a discussion of these concepts.)

The following is a summary of identification, engagement, and referral:

  • Ask: If you’re worried, let your friend or colleague know, and ask how they are doing. Sit, make eye contact, show that you care and that you’re not looking for "I’m fine." Sometimes, it may be appropriate to come back and ask again.

  • Listen: We are trained listeners, but often our inner fixer fights for airtime. When talking with a distressed colleague, listen deeply, without intent to fix. Validate the feelings they are expressing, and reflect back what you are hearing (e.g., "It sounds like this has been a really challenging time for you").

  • Refer: Do not try to be your friend or colleague’s clinician — it’s not your job to diagnose or treat them. If you are concerned, do not worry alone. Ensure your friend’s safety and help connect them with educational leadership or other resources mentioned above.

Sometimes, just sitting with the suffering of another is the most important action you can take. The time you spend bearing witness and showing someone that you care is time incredibly well spent. Plan to reconnect and check in again after a short period.

The joys of medicine are many, but the risks to our own mental health are not insignificant. We need to normalize that "it’s OK not to be OK" and recognize that seeking treatment for mental illness is a sign of strength. If you are suffering, you are not alone, you are worthy, and you deserve treatment.

If you are concerned about your mental health, please reach out to your physician. If you are contemplating suicide, please call the National Suicide Prevention Hotline by dialing 988 from any phone in the United States or call 911 to be brought to your nearest emergency department.

Shannon Scott-Vernaglia, MD, is Associate Chief for Pediatric Clinical Faculty Development, MassGeneral Hospital for Children; Assistant Professor of Pediatrics, Harvard Medical School; Senior Reviewer for NEJM Knowledge+, and Senior Editor for NEJM Resident 360 Pediatrics