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Treat the Others, Treat Yourself: Mental Health Considerations Among CliniciansOpen Access

Voices of Cardiology

J Am Coll Cardiol Case Rep, 1 (1) 79–80


On a busy Friday night, I was called to see a middle-aged gentleman in the emergency department. When I first saw him, he was laying on the couch, a tall, slim man with dark long hair and dressed in elegant pajamas. He was accompanied by his brother, a surgeon, who explained to me the sad story of his brother, a well-known professor of psychiatry who was at the pinnacle of his clinical and academic career. The gentleman was found unconscious on the floor of his room with empty bottles of antianxiety and antidepressant medications in what was obviously a suicide attempt.

The successful physician, known for teaching his students about depression and mental illness and adept at treating his patients who had such disorders, tried to end his life. I envisioned his life as an astute physician who shines while teaching in the daytime in the lecture rooms and in the hospital wards treating his patients, yet when the night comes, he starts facing his complex mental reality and struggles with his own demons. Is it in his genes? Personal problems? Work pressures? Who knows! And sadly saying, does anyone care? It struck me to the core thinking of the complexities of our lives as doctors and how sadly the public is becoming silent and nihilistic toward doctors’ well-being and mental health.

My daily practice focuses on adult intensive care, and in my typical working day, I have to keep up with all the clinical and nonclinical tasks at hand, including ensuring the safety of my patients, respecting every person I meet, dealing with challenging colleagues and patients, continuing to develop myself in my area of expertise, and tolerating the unavoidable stresses of working in an acute medical setting wherein the tiniest error can risk a patient’s life. At the same time, I have to keep my sanity, solemnity, and self-control. Peer support and senior support are paramount in helping this process, yet there should be wider social and legislative support at the higher administrative levels in health care, as well as a broader social recognition of the increasing stresses that doctors face.

Since the dawn of civilization, the medical profession has been serving humankind, and doctors historically have been seen as the “healing hands of God,” closer to divine than any other professionals. Over the past 30 years, since health care was transformed into an industry and adopted business models, this perception has changed drastically. The societal view of doctors has largely changed from “the healing hands of the divine” to “employees.” However, few other professions bear such responsibility, accountability, and daily stresses. In Ancient Egypt, the first physician, Imhotep, was the chancellor to the pharaoh Djoser, and he was considered on par with the members of the royal circle. In modern Egypt and until the 1960s, doctors were often called by the public Hakeem, meaning “wise.” referring to the high honor, protection, and respect they had from all layers of the society.

Two years after that night in the emergency department, I received a sad call informing me that the psychiatrist had ultimately been successful at ending his life. His body could not tolerate the lethal dose of anxiolytics and antidepressants that he had consumed on a given evening, a brutal end to a man who was well known as polite, successful, cheerful, humble, confident, and highly competent professionally. He was found dead in his bed with no note left behind, only a wife and 3 children. I have since imagined that he may have wished to write the words, “I wish I had lived in a more understanding, forgiving, supportive world.”

Medical Profession, Mental Health, and its Relation to Burnout

Doctors are more likely than any other professionals to have mental health problems, according to the British Medical Association Doctors’ Health Matters, probably because of long working hours, the pressure they face in their work, and demanding lives. The modern health care systems place tremendous burdens on health care professionals. Although patient outcomes and safety standards have dramatically improved over the past 50 years, the forgotten dark side is the increasing incidence of depression, mental illness, and suicide among doctors, especially the successful ones. The public often see doctors as happy, successful, rich, and probably trouble-free. Sadly, doctors who kill themselves are mostly those who appear confident, happy, and upbeat. The false cultural perceptions of the modern health care system play a role in doctors’ ongoing stressful lives. Health care organizations often use the words “burnout” and “resilience” as finger-pointing against doctors while deflecting their own responsibility not only for patients’ safety but also for health care workers’ well-being. The situation is even worse in developing and poor countries, where doctors can be bullied or harassed by dissatisfied families and where they cannot keep up with their daily financial burdens.

Particularly within cardiology, which has developed into a highly competitive subspecialty—and in which fellows in training are aiming for clinical and academic excellence, this high sense of responsibility coupled with the sensitive balance between work and life may generate a lot of pressure and as a result drive them to despair.

What Is the Solution?

The ways of managing burnout and addressing mental health considerations involve a complicated assessment, which is one of the foci of the “Voices in Cardiology” section of JACC: Case Reports. Certainly, one of the main life lessons of the medical profession and the transition from a fellow in training to a senior physician is to speak up and address your concerns. Please speak up within your institution, if you feel the pressures building beyond your control. Furthermore, nowadays there are specialist teams in academic centers that can address burnout or bullying and provide help when needed.

Additionally, through “Voices in Cardiology,” we encourage you to speak up. We wish to embrace your concerns and find solutions together. Through stories such as the one here, we should strive to support each other. The answer is out there—through our patients, through our family, through ourselves.


Dr. Aboumarie has reported that he has no relationships relevant to the contents of this paper to disclose.