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On the unofficial start of #residency, here's what I've learned about the crisis of #mentalhealth and #suicide for docs in training.

At the end, I'll share solutions #meded #medtwitter 1/
We think about #depression as an individual problem, but this is a systems problem. Med students are healthier than their peers. Training makes them sick. 2/
At any point in time, 1 in 4 med students is depressed and 11% have contemplated suicide. Only 1 in 6 get help, largely because they fear discrimination. 3/
Things probably peak in third year, when responsibilities increase and many students are bullied and abused. 3/
It does get better in the fourth year. But then it gets much worse in residency. 4/

@afspnational @PCareProgress @HMSPrimaryCare @arghavan_salles
At the beginning of residency, less than 4% of residents screen positive for depression. By the end, more than 40% do. That's a 10 fold increase IN JUST THE FIRST YEAR. 5/
And after training our risk of depression, substance abuse, and suicide remains elevated for the rest of our lives. 6/
You can see from this graph: depression among med students and doctors is common, predictable, and largely a result of our environment. 7/
If you really think about the life cycle of depression for docs, it should be clear: Depression and Suicide are occupational hazards of medical training. #meded #medtwitter @GavinPrestonMD 8/
(You can also understand why people hate #resilience and #wellness lectures: they make it seem like you're just not trying hard enough to be well in a very toxic environment. see @stevendtate )
We know not only that the rates of depression for docs in training are incredibly high, but that they're actually increasing over time. Why? 9/
If you finished training 20 years ago, this is probably baffling to you. I've heard from many in positions of power that we have it much easier now. We don't. Things are unquestionably harder for residents now. 10/
Admissions are up. Length of stay is down. Documentation is out of control. Work hours did not make this problem go away because they never addressed the problem of work compression. 11/
Residents are doing: 1) More tasks. 2) Spending more time on the computer and less time with sicker patients, and 3) trying to keep up with a field of knowledge that is changing at an unprecedented rate. 12/
In 1980 you had 7 years to catch up. In 2020? 73 days. The doubling time of medical knowledge alone should have revolutionized the way we train doctors. But it hasn't. 13/
And when budgets are cut, residents fill in the gaps. They are the duct tape of the hospital, and their education is often an afterthought. 14/
We often talk about how stigma keeps residents from accessing care, which is true. But more than that, I hear stories of residents asking for help they aren't getting. 15/

(you can hear a few here: )
Sometimes they have to "ask their program director for permission," are made "to work an extra day for leaving for an hour," or are told "you're not sick enough to be depressed, because your work is fine." 16/
These are the kinds of barriers that keep people from accessing care and lead to our appalling suicide rate in medicine. 17/
It doesn't have to be this way. There are best practices for helping sick trainees, and I'll share them now. 18/

@JulieSilverMD @SpringateMD @arghavan_salles @StudentDrKendra @studentdoctor
Have regular debriefing sessions, without administrators present, like the Stanford Balance in Life Program. 19/

Identify mental health professionals who can serve as liaisons to connect residents to care. People who evaluate residents in any way cannot effectively do this. 20/
Help residents coach each other. There is nothing more effective than hearing, "I was sick, and I got better. These people helped me and they can help you too." 21/
Get rid of discriminatory questions on licensing applications. There is no evidence they help, and by discouraging help-seeking, they're actually killing docs and making things harder for their patients. 22/
@afspnational @acmge @thefsmb @theNAMedicine labblog.uofmhealth.org/industry-dx/st…
Tell family members the truth: that their loved one is likely to get sick during their training and they should keep an eye out for the signs. 23/
Let students and doctors know that illness makes you a better healer, as long as you have the courage to get better. 24/24
Much love, good luck. If you want to see my keynote on depression in medical training, here is the link:
Citation: Poorman, Elisabeth. “No Longer Suffering in Silence: Depression as an Occupational Hazard of Medicine.” Keynote Address. Committee for Interns and Residents National Conference, 19 May 2018, D.C.
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