Sengupta’s Mental Health Essay Gets National Response

In March, JAMA Network online published his essay, “Rebuilding More of Me.”

Sengupta wasn’t sure how it would be received, but in the few weeks since its publication, he has received personal email messages from dozens of physicians from across the U.S. who reached out to share perspectives and their experiences.

Since publication, Altmetric rated the essay in the top 5 percent of publications; in less than a month after publication it had been viewed more than 6,500 times and downloaded more than 500 times. Sengupta has received emails from physicians at every career stage, who tell him it was a relief to read it, to know that others have also gone through this and have succeeded.

It’s no secret that physicians have stressful jobs. Figuring out how to mitigate and deal with that stress can be a key part of a successful medical career. But while individual physicians seek and find help for their mental health issues privately, the prevailing public perception among physicians is that it just isn’t done.

Sengupta, who also treats patients, had reached a point a few years back where he knew that escalating professional and personal demands were impacting his effectiveness.

The essay describes the difficulty Sengupta felt in figuring out how to access the help he needed.

“I am an attending physician in the field from which I need support,” he writes. “Many of the best clinicians and treatment settings are not options. I know them too well.”

Once he found a psychotherapist he could work with confidentially — who wasn’t a colleague — he began to open up.

Sengupta writes: “His willingness to acknowledge that clinical work is stressful and can become toxic establishes a life raft upon which I can hoist myself, build new strategies, and shape a different perspective.”

That struggle is behind Sengupta now and he was ready to move on. Besides occasionally discussing his experience with others who might be going through something similar, he didn’t consider sharing it more widely.

He changed his mind this past December when he attended a screening of the provocative documentary “Do No Harm: Exposing the Hippocratic Hoax.”

The event was organized by Christian R. DeFazio, MD, clinical associate professor of emergency medicine and director of the emergency medicine residency program; Carolyn A. Wiech, MD, clinical assistant professor of emergency medicine and assistant director of the emergency medicine residency program; and Susan M. Orrange, PhD, assistant dean for education and resident services. Lauren Dube, DO, an emergency medicine resident, is credited with bringing the documentary to their attention.

The movie and a panel discussion that followed took on the issue of physician mental health and suicide. Among the alarming statistics discussed were:

• Suicide accounts for 26 percent of deaths among physicians ages 25 to 39 compared to 11 percent of deaths in the same age group in the general population
• 45.8 percent of physicians reported experiencing at least one symptom of burnout
• Doctors commit suicide at a rate more than twice the national average
• A study of more than 4,000 medical students at seven schools found that more than half of all students experience burnout while in medical school
• Approximately one of every nine students reported having suicidal thoughts while in medical school

The event struck a chord. Of the 300 people in attendance, the vast majority were trainees, including medical students, medical residents and fellows. As Sengupta listened to the discussion that followed the screening, he realized he needed to share his story.

“One of the most distressing themes in the discussion afterward was how scared or resistant or hesitant the trainees were about seeking any therapeutic support,” Sengupta  says. “I had the chance to share a little of my experience and a number of residents privately came up and wondered aloud if it might be helpful for more attendings and medical education leaders to open up a bit more about these kinds of things.”

“I wrote the essay for a very particular reason,” he says. “There were hundreds of trainees in the room, but the vibe around seeking support was quite negative. It wasn’t that people thought physicians shouldn’t get help, but that there were lots of factors that would probably keep them from seeking help, such as stigma, having enough time, and concern for how it might impact their careers.”

“I wrote the essay in the hope that I could convey to other physicians what actually happens when you work with a therapist, that it’s a collaborative process that can lead to really positive outcomes.”

Sengupta, who directs UB’s child and adolescent psychiatry fellowship program, also has a close-up view of the difficulties that students — and especially medical residents — undergo.

“I do see them struggling sometimes,” Sengupta says. “Medicine is such a challenging field to be in in this day and age. Trainees are such a critical part of the system and at the same time, they may need more support than they are getting. It can be a tough system to work in. You can lose track of what brought you into the field.”

Among the factors contributing to physicians’ reluctance to seek help are the traits that led them to medicine in the first place, Sengupta says.

“Who is the type of person that ends up wanting to be a physician and then succeeding?” Sengupta asks. “We are pretty intelligent and we’re hard-working, but we are probably not talking about the struggles we’re having. We’re internalizers.”

At the same time, the nature of medical training itself also contributes.

“The training values toughness and grit and perseverance. That shouldn’t be to the exclusion of getting help and support, but somehow it can be translated into that,” Sengupta says. “Taking care of oneself can seem to represent weakness or incompetence. Sometimes it’s the message that is given or sometimes it’s a message that trainees perceive.”

“Doctors are supposed to be larger-than-life figures, take in everything, be wise and be helpful,” he adds. “We do a really good job of stigmatizing ourselves, when really, getting support when needed could help us get back on track to finding meaning in helping others.”

Sengupta knows, however, that the challenges to changing the culture are significant. For one thing, he says, trying to find someone who can help is complicated and sensitive.

“How interesting would it be if we created some sort of way for physicians who are struggling to communicate with each other… a support group of sorts?” he ponders.

In the essay, he describes how he shared his experience with his trainees; it came up in the context of a broader conversation about self-care. Afterward, he noticed a change in the way they interacted with him.

“I sense a subtle shift in the way some of them approach me — they are a bit more willing to discuss challenges and vulnerabilities, and are more open to reflection and self-improvement,” Sengupta says. “A few clinicians even ask for help in finding therapists for themselves, allowing me to transform my process of seeking help into a way to help others.”