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THE STRESS OF RESIDENCY – RECOGNIZING THE SIGNS OF DEPRESSION AND SUICIDE IN YOU AND YOUR CO-RESIDENTS Mark S. Hochberg, M.D., Russell S. Berman, M.D., Adina L. Kalet, M.D., Sondra R. Zabar, M.D. and H. Leon Pachter, M.D. Department of SurgeryNew York University School of MedicineMarch 24, 2012

stress and surgical practice
STRESS AND SURGICAL PRACTICE
  • Study in American Journal of Surgery 2006 (presented at ASE 2005)
    • Found stress a significant threat to surgeons
    • Coping strategies not effectively taught during training
    • Specific training interventions for stress are routine in the military, aviation and professional sports
goals and objectives of this report
GOALS AND OBJECTIVES OF THIS REPORT

Do our residents know the signs/symptoms of stress: depression and suicide?

Can these learners recognize these signs/symptoms in themselves and colleagues?

Can our SPICE* professionalism curriculum effectively teach these concepts – and have the knowledge retained by the residents?

*Surgical Professionalism and Interpersonal Communication Education

signs of depression
SIGNS OF DEPRESSION

If over a period of 2 weeks have you or a fellow resident:

  • Had little interest or pleasure in doing things and/or
  • Felt down or hopeless
  • If yes to either …. DEPRESSION is occurring and you must take action
signs of concern for physician suicide
SIGNS OF CONCERN FOR PHYSICIAN SUICIDE

Diagnostic criteria:

  • More than two weeks of sadness – “life is not worth living”
  • Psychomotor depression – cannot get out of bed or accomplish routine tasks of living
  • Does not derive pleasure from any activity for two weeks
  • Access to firearms
  • Suddenly does not show up to work
sample test questions
SAMPLE TEST QUESTIONS
  • An acquaintance tells you that she recently watched a TV program about physician suicide. She then asks you how much greater the risk is for female physicians?

b. 40%

c. 100%

d. 130%

  • e. 200%

a. 10%

  • Of the following what is the most worrisome sign that a resident is suicidal?
  • a. Persistent sadness for 5-7 days
  • b. Diminished interest in surgery
  • c. Ignoring the routine tasks of daily life – grooming, etc.
  • d. Picking fights with medical students and staff
  • e. Dumped unceremoniously by the “love of your life”
  • In terms of substance abuse, which one of the following suggests an imminent problem?
  • a. Seems exhausted at morning rounds (after a night off)
  • b. New risky behavior (e.g. multiple sexual partners)
  • c. Seems to be “bulking up” biceps without requisite time at gym
  • d. Seems to be on top of every patient detail and never sleeps
  • e. At resident interview night, you notice a resident colleague taking three shots
  • Chances you as a surgeon will be divorced from your first spouse?

a. <30%

b. 30-40%

c. 40-50%

d. 50-60%

  • e. >60%
physician suicide profile of the vulnerable resident

http://www2.aaos.org/aaos/archives/bulletin/apr06/fline6-1.gifhttp://www2.aaos.org/aaos/archives/bulletin/apr06/fline6-1.gif

PHYSICIAN SUICIDEProfile of the Vulnerable Resident
  • Sense of inadequacy, failure to help patients, failure to live up to expectations
  • Making a mistake that causes a patient’s death – personal guilt
  • Being single and having no children is linked to higher physician suicide rates
  • Being alone in a new high

stress environment with little

support

physician suicide
PHYSICIAN SUICIDE
  • Annually 30,000 suicides in United States – roughly 1 per 8,000 population
  • Physician suicide 40% higher in male physicians than the general male population, and 130% higher in female physicians
  • Unfortunately, residents/physicians are far more effective in carrying out suicide than the general population
coping strategies for the stress of surgery
COPING STRATEGIES FOR THE STRESS OF SURGERY
  • Early recognition of risks
  • Stopping and standing back
  • Control of self: physical relaxation, self talk, leaving the hospital behind
  • Control of situation: reassessment, decision making, team communication and leadership
what our residents need to understand
WHAT OUR RESIDENTS NEED TO UNDERSTAND
  • You are vulnerable
  • Your family is vulnerable
  • Your marriage is vulnerable
  • Getting help is a sign of strength
  • Surgeons seek help too late – usually after irreversible events have occurred
  • Never forget your real priorities