PracticalDermatology

Having been postponed for a year due to the COVID-19 pandemic, the rescheduled 2020 Summer Olympic Games that took place in Tokyo, Japan this summer brought numerous medals, tears, triumphs, and the importance of mental health to the forefront of discussion among athletes and non-athletes alike. Simone Biles, the most accomplished gymnast of all time, made a courageous choice to protect herself above earning medals, many of which were expected to be gold. As a retired collegiate gymnast, I am grateful that the world’s greatest in my sport has shed light on a topic too taboo to discuss for far too long, and I feel it’s time we discuss it openly in medicine. If only we can muster the same courage as Ms. Biles and many others who have shined a spotlight on mental health.

While I know the vast majority reading this have never attempted a “double-twisting double back” off a balance beam, we have all seen patients in the clinic and completed therapeutic procedures many times without even thinking about it. Providing patient care is second nature and routine. We have all likely experienced those long days in clinic when, despite feeling mentally and sometimes also physically exhausted, we push through, anyway. In gymnastics, the “twisties” is a well-known term that refers to the sudden loss of proprioception during performance; it can lead to catastrophic injury or death. In the clinic, our version of the “twisties” can lead to devastating harm to ourselves and/or patients.

Over the last 50 years, a largely silent epidemic of physician suicide and depression has been raging,¹ exacerbated by the explosion of social media and then worsened by the far-reaching effects of the COVID-19 pandemic. While rates of depression and burnout in dermatology are lower than those reported in other disciplines, the specialty is not immune. Rates of depression among physicians have been estimated at 19 percent and 28.8 percent among resident physicians, compared to 7.1 percent in the general population.¹ Physician assistants likely experience similar elevated rates of depression. Social media adds an entirely new layer of stressors as patients can exploit freely our every perceived flaw for the world to read. This form of cyberbullying, often done with complete anonymity, can continue to lead to mental scars.

Medical providers are trained to put the needs of patients first and provide optimal care to each of them. We find ourselves working through lunch for the urgent rash patient fit into an already packed schedule or working late due to an unexpected wound complication. We are trained to continually put others first, so that our own needs are all too often brushed aside. We sacrifice time with friends and family, vacations, and accrue significant debt to be healers in our craft, and it can be exhausting and overwhelming. Yet, we continually show up day after day for the needs of our patients. We find ways to bury or work around our own needs; however, if our mental health is in turmoil, it affects the way we think, feel, and handle stress, all of which can impact the care we give. It is time we put our health above “gold medals” and get rid of the stigma. It’s time for a real act of bravery.

Overcoming Stigma

While health care provider burnout is not considered an official mental illness, it is a mental health issue that directly affects our colleagues. Creating awareness and change requires us to come together to address main contributors to the problem. First, we need to stop awarding stoicism. Resiliency and grit, while admirable traits, should no longer be a coveted prize and primary fuel of pride. Physicians and medical professionals alike tend to hold each other to a high standard. Seeking care for mental health is often surrounded by stigma, perceived as personal weakness and a sign of vulnerability. Yet, we ask our patients to be open and vulnerable with us. We are not immune to the stressors and complexities of daily life. Decisions to seek care are often laden with fear of retaliation from medical boards. Perhaps the time has come that we create openness and shift focus from medical education lectures at conferences to mental healing strategy lectures. This culture of stigma leads many physicians to attempt to treat their own mental health issues with prescription medications or self-help style therapies; this idea of “physician, heal thyself ” has proven to be grossly inadequate.¹

Establishing Boundaries

Contrary to popular belief, white coats are not capes; physicians and other medical providers are not superheroes—well at least not all the time. We are humans who need to safeguard our mental wellness. One of the first steps we can all make in our clinics is setting boundaries with patients. According to a Medscape physician survey, 42 percent of women and 48 percent of men revealed that work-life balance in the workplace was the most concerning factor with burnout.² While this may be difficult at first, prioritizing your time may preserve your mental wellness. The pinnacle of mental toughness also comes with the courage to simply say “no.”

An Ounce of Prevention

As the saying goes, an ounce of prevention is worth a pound of cure, and we need to ensure we are the priority. It is essential to address your own mental health early to prevent burnout that can lead to poor patient outcomes.³ It is an act of bravery to reach out—not a sign of weakness. There are numerous resources available, many of which are free.

Perhaps the legacy of these Olympic Games will not be the gold medals, but rather the creation of a movement to confront a topic that is often brushed under the rug. We have much to learn from this act of bravery from Ms. Biles, but my hope is that we all realize the importance of and act to make our own mental health a top priority in our busy schedules. So, I ask you: What medal are you willing to sacrifice to ensure your own optimal mental health?

1. Kingston AM. Break the Silence: Physician Suicide in the Time of COVID-19. Mo Med. 2020;117(5):426-429.

2. Kane L. Death by a 1000 Cuts: Medscape National Physician Burnout & Suicide Report 2021. January 22, 2021.

3. Garcia CL, Abreu LC, Ramos JLS, et al. Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina (Kaunas). 2019;55(9):553. Published 2019 Aug 30.