Care for the caregiver

Some very fascinating journal articles have been written over the past few years clearly documenting the increase risk of clinical depression and suicide attempts by medical residents.  When a young person enters medical school he/she has a depression rate similar to the general population. By the time that student becomes a resident, he/she have a much higher rate compared to their peers with one study reporting that 20% of 123 pediatric residents at 3 U.S. children’s hospitals were depressed. These depressed residents made 6.2 times more medication errors than did their non-depressed peers. http://Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336:488-491.

The long hours, sleep deprivation, social isolation and the (often self imposed) pressures of having to be perfect all the time are a recipe for disaster. Far too often we are expected to divest ourselves from the processing of emotional tragedies. I remember one of my attending who after being told of a patient’s death by a visibly distressed resident , casually shrugged his shoulders and said “hospitals are for the living”.

Yesterday during one of our group discussions, people went around the room discussion the first time they were involved in the death of a patient. The different stories told were poignant and extremely emotional. Some of these stories were quite recent while others happened years ago. The unifying trait in all of the stories was the raw emotion and pain in the voices of the speaker. Every story told ended the same way…  “and then I just went back to work.”  Years later it is entirely evident that these wonderful caring people are still hurting. As a profession we are failing. We are eating our young with the perverse attitude that it will build a thick skin and make you a better doctor. We are not robots. We need to be able to talk through and emotionally process the emotional barrage we are exposed to daily. My hospital does have a care for the caregiver program set up; few know about it and even fewer have taken advantage of it. Knowing what I know now I will make it a priority to have a care for the caregiver referral option placed in our online event reporting system.

On a side note the thing that bothered me the most during this session was that for some reason I could not remember my first patient who died. I remember many death certificates I have done over the years but I have no specific recollection of my first. I do not know if my mind has blocked it out as a defense mechanism or it simply did not register as a significant event. Hours later its still bothering me…