By Grant H Brenner

Medicine1 is a tough profession. Its both tremendously rewarding and terribly demanding.2 Along with a handful of other professions， doctors are privy to the most sacred and difficult aspects of human existence.3 We share in the joys and triumphs of illness. We witness the grief， horror， beauty， peace， and love that occur when people succumb to4 terrible diseases we have no way of effectively fighting or preventing. Physicians are at the front lines of humanity， along with other warriors like nurses， PAs， first responders， therapists， human rights workers， military personnel， clergy，5 and more.

But being at the front lines can take a toll6： In 2012， a study showed that physicians reported much higher work-life dissatisfaction compared to the general population. Within that study， 40.2% of physicians reported dissatisfaction versus 23.2% of non-physicians. The same study found that burnout rates were high across the board for physicians as well，7 with nearly 50% of doctors reporting that they were burned out. Emergency room doctors have it the worst， with nearly 70% reporting burnout， followed closely by physicians working in general internal medicine， neurology， family medicine， and a host of other demanding subspecialties.8

根據2018年美国精神病学会年会上公布的一项最新研究，医生的自杀率是所有职业中最高的。在美国，每天至少有一名医生自杀身亡，这一数字令人不寒而栗。权威医学杂志《柳叶刀》近期报告指出，极大的工作量、超长且不规律的工作时间、患者需求导致的压力、工作失误可能造成的严重后果，以及在行医过程中可能涉及的因违背自身价值观而带来的道德伤害等，都导致了医生自杀率持续飙升。此外，对于背负精神疾病这一污名的担忧，也使得很多医生不敢寻求帮助。然而，在惊人的数字之下，这一严重问题长期以来却并未得到应有的重视和有效的解决。为何以治病救人为使命的这一人群却无法获得自救？警钟是时候敲响了。

According to a 2015 Mayo Clinic9 survey， this situation is not improving any time soon. Of the nearly 36，000 physicians who were contacted， 6880 responded to an invitation to participate in a study of burnout. Results showed that these doctors became more burned out over time： 54.4 percent reported at least one symptom of burnout in 2014， up from 45.5 percent in 2011. Likewise， average work-life satisfaction ratings dropped from 48.5 percent to 40.9 percent in the same three-year time frame. Compared to the average U.S. citizen， physicians are much more likely to experience burnout and much less likely to enjoy work-life satisfaction.

Studies about physician burnout and stress are important but they typically dont reflect this groups high risk for even more dire10 mental health outcomes， like suicide. In a recent The Lancet Psychiatry review and meta-analysis，11 Katherine Petrie and her fellow authors reported that in addition to burnout，physicians also demonstrate a high risk for other depressive symptoms， like anxiety and suicidal thinking. Past research has also shown that physicians have a higher risk for suicide compared with other professions， ranking in the top ten of risky professions. And Petries study noted that while other occupational groups have high rates of difficult mental health symptoms， physicians are more likely to die by suicide. Chillingly， the study noted that one physician dies from suicide every day in the U.S.

The Lancet study authors also report that workplace factors contribute to physician suicide “including a large workload， long and irregular working hours， competitiveness of training programs， pressure of patient demands， the consequences of any errors， poor worklife balance， and the risk of moral injury if physicians are forced to work in ways that conflict with their ethics and values.”12 The authors note that the culture of medicine itself contributes to mental health problems， preventing physicians from seeking help because of factors like the stigma against mental health problems， burdensome regulatory practices， and concerns about being able to seek care for oneself due to confidentiality.13

From my personal experience both as a surgical resident and a psychiatrist， medical training is rough and at times， abusive.14 Despite positive changes in recent years， including some medical training programs that really do encourage openness and help-seeking， we are still haunted by stigmatizing labels. For this reason， revealing your need for help can be a risky business， as it can inspire comments about being weak， letting your team down， or not being able to“take it.”

According to The Lancet authors， despite growing research on burnout in medicine， there is little attention given to both the presence of diagnosable mental health issues or interventions that could prevent and treat mental health issues like suicidal ideation15. In my professional life， I have experienced this blockade16 first-hand： Early in my career， I was asked to participate in a physician wellness study. For the study， I was asked to stay on call， just in case they found any residents who needed psychiatric care immediately. I also recommended that they study depression and suicide risk as part of their survey. After I made that comment， I didnt get a call back and I was not invited to participate in the study； they just stopped responding to emails.

From my perspective， this new meta-analysis published in The Lancet is a major milestone for understanding and appropriately responding to the mental health crisis facing medicine today. Rather than dwelling on the past， the alarm has now been sounded17： Greater attention must be paid to physician well-being. We need better research that uses clear diagnostic measures and evidence-based interventions， on a large scale.

We need to look at interventions and preventive measures directed at individuals and groups， and we need to focus on systemic and organizational interventions that could change the very culture of medicine. We need to not only put new programs into place， but also take a deep dive into the culture of medicine itself to understand why a field devoted to caring for others is unable to properly care for itself. We want physicians to be safe and well， but we also need to help those we serve by modeling good health practices. When we fail to do this work， we let down not only ourselves， but also our patients and society.

1. medicine： 医学。

2. 它报酬颇丰，而又要求极苛。tremendously： 非常地，极其。

3. 同其他一些行业一样，医生了解人们生而在世最为神圣且艰难的方面。privy to： 私下知情的；sacred： 神圣不可侵犯的。

4. succumb to： 死于。

5. PA： 即Physicians Assistant，医生助理；first responder： 现场急救员；therapist： 治疗专家；clergy： 神职人员。

6. take a toll：（尤指逐步）损害，破坏。

7. burnout：（工作劳累造成的）精疲力竭，倦怠；across the board： 全面地，包括一切地。

8. internal medicine： 内科医学；neurology： 神经（病）学；family medicine： 家庭医学；subspecialty：分科。

9. Mayo Clinic： 梅奥医疗集团，世界著名的私立非营利性医疗机构，有医学诊断的“最高法院”和医务人员的“麦加圣地”之誉。

10. dire： 非常严重的。

11. The Lancet：《柳叶刀》，世界权威医学杂志，如今已衍生出一些附属性的专业期刊，刊名均以“柳叶刀”为开头，如这里提到的《柳叶刀精神病学》（The Lancet Psychiatry）；meta-analysis： 元分析，一种定量分析方法，它不是对原始数据的统计，而是对已有研究文献统计结果的再次统计。

12.《柳叶刀》这一研究的作者还指出，导致医生自杀的工作场所因素“包括极大的工作量、超长且不规律的工作时间、培训项目的竞争性、患者需求導致的压力、任何工作失误导致的后果、工作与生活的不平衡，以及医生如果在工作中被迫违背自身伦理和价值观而造成的道德伤害”。

13. stigma： 耻辱，见不得人的感觉；regulatory：监管的，管理的；confidentiality： 保密性。

14. surgical resident： 外科住院医生；psychiatrist：精神病医生；abusive： 虐待人的。

15. ideation： 思维过程。

16. blockade： 障碍，阻碍。

17. sound： 提出（警告），敲响（警钟）。