Reprinted from popularresistance.org
Physician burnout, depression, and suicide increasingly invade discussions within the medical field. Depression and suicide are more common among male and female physicians, with suicide rates 1.41 and 2.27 times greater than that of the general male and female populations, respectively. Though, the insults to the mental health of physicians begins much earlier in their career.
While the numbers may vary from study to study, some 28 percent of medical residents experience a major depressive episode during their training compared to 6 to 8 percent of the general population. These numbers are important, not only because suffering physicians are suffering humans in their own right, but also because this epidemic leads to poor patient care.
As a recent study out of the Stanford School of Medicine suggests, burnout and depression in physicians can lead to medical error and death. Many have tried to explain the causes of the epidemic, referencing everything from unmanageable workloads and work inefficiency, to lack of meaning in work and lack of work-life balance. Films are now being produced to shine light on the issue. In her TED talk "Why Doctors Kill Themselves," Pamela Wible points to a medical school culture of hazing and bullying that continues into residency, along with a professional culture that hinders physicians from obtaining mental health treatment.
These factors certainly contribute to the epidemic, but when discussing physician suicide, we ignore the elephant in the room: capitalism. We are unable to recognize how the exploitation and alienation of physicians is integrally connected to this dominant economic system, but nothing could be more poignant, given in the state of the world today.
Ironically, the same destructive system that is driving physicians to extremes is also the main driver of the deterioration of health of the patients and populations, requiring patients to see physicians in the first place. The sooner we realize and confront our own exploitation, the sooner we can join in the fight to address the real driver of disease that is plaguing physicians and patients.
The System Outlined
Busy physicians may not have time to study how the world's prevailing economic system functions, but doing so could benefit both our profession and the patients with whom we work. To briefly discuss, inside this system the working class that does not own the means of production is forced to sell its labor to an employer to survive.
A few corporations control most of the market for each of the commodities they produce. In these corporations, a very small sector of a board of directors and majority shareholders makes essentially all of the decisions on what to produce, where to produce and how to distribute profits. This puts the working class in a vulnerable position. With the ultimate goal of profit maximization, decisions are often made by the corporate class which are not in the best interest of workers and negatively affect the health of entire communities.
Outsourcing work, closing factories, creating poor working conditions to cut costs, polluting waterways and the environment--decision after decision may initially increase profits, but in the long term harms health. This harm to health can be more obvious, as when air and water are polluted, or more subtle, for example when families are put under chronic stress--which eventually leads to various forms of illness-- from poor workplace conditions or income insecurity secondary to factory closure and outsourcing.
In this system, certain "costs"--the health of families, and entire communities being destroyed--are "externalized." This means the business itself does not pay for these costs of poor societal health, which are created secondary to decisions made by business executives to increase profits. Such decisions are made by a small number of wealthy, powerful individuals pursuing their interests for greater wealth and power accumulation at expense of all else.
As economists such as Thomas Piketty have shown by combing through economic records from as far back as the 18th century, capitalism inherently generates inequality, concentrating wealth into the hands of the few at expense of everyone else. Study after study shows us that socioeconomic inequality itself is detrimental to patient health and actually increases morbidity and mortality.
Despite the negative effects , the working class today is more productive than ever , while wages remain flat (or are sometimes even lower ) and work hours continue to increase. Workers struggle to put food on the table and meet basic needs, while the ownership class continues to become richer. Workers are exploited and reduced to tools for industry, many times forced to do mundane tasks or assignments over and over. They are alienated , or separated from the control and the product of their labor, each day they go to work. Inside this system workers are ultimately reduced to mechanistic cogs producing profit for large corporations.
This combination of being overworked and lacking true meaning and fulfillment in the work being done, drives more and more throughout both the white and blue collar sectors into despair. As Johan Hari, shows in his recent work Lost Connections: Uncovering the Real Causes of Depression andUnexpected Solutions, workers become separated from loved ones and from things that bring them joy as they work multiple jobs for longer hours as they struggle to make ends meet.
This constant stress leads to anxiety, depression, and various other forms of disease. Meanwhile, all medicine has to offer for them are at best poor attempts--many times with questionable supporting data demonstrating efficacy-- to numb the pain that much larger systemic structures continue to create.