The Full Informed Consent: The Doctors Are Not Okay
When I started medical school nearly 20 years ago, I expected my colleagues and training and to be compassionate, nurturing, and enriching. Becoming a doctor was about helping people, and healthcare is supposed to be caring. So, I assumed the training and the people would be, too. But I could not have been more wrong.
The doctors are not okay, and the medical profession is not well.
Their emotional health and wellbeing are poor at all stages of professionalization. Almost 30% of medical students and residents suffer from depression and 10% report having suicidal thoughts. Physicians’ suicide rates are significantly higher than the general population, particularly among female physicians. Physician burnout, a work-related syndrome characterised by emotional exhaustion, reduced personal accomplishment and negative attitudes towards patients, affects over 50% of providers across specialties and training stages. It is also associated with depression and suicide.
There are a variety of explanations for these findings, including workplace stress and demands. However, fewer explanatory frameworks point to the abuse and mistreatment endemic to medical training and professionalization–perhaps because that’s something that the professions do not want to talk about. According to a 2018 report, female medical students were 220% more likely than non-STEM students to have faced sexual harassment from faculty or staff. It concluded, “many features of the medical profession, including its historical male dominance, strong hierarchies, and culture that [tolerates] mistreatment [increase] the risk of sexual harassment in the workplace.” Medicine’s toxic power dynamics and steep professional training create an environment rife with abuse and discrimination, especially for women, people of color, and lesbian, gay, and bisexual medical students. Not surprisingly, a number of outstanding women of color physicians have left organized healthcare settings to forge their own paths free of this toxicity. Some have had no choice but to leave: Black doctors are forced out of training programs at far higher rates than white residents, sabotaging their careers before they have a chance to start. This expulsion is devastating after years of grueling training and a burden of debt that averages the hundreds of thousands of dollars range.
If the doctors are not okay, what does this mean for you or your child’s healthcare?
It means that the care is often uncaring. The toxic work settings and unwell caregivers are a recipe for patient mistreatment and medical brutality. Hundreds of people have come to me for care because they have been traumatized by the healthcare system. They tell egregious stories of major medical conditions being ignored and nearly dying as a result. One client who suffered a botched surgery that maimed them came to the emergency room endorsing signs of sepsis (a life-threatening complication of an infection) only to be turned away multiple times. They were eventually admitted to the intensive care unit because they refused to go home–but not before a doctor shockingly said to them, “What did you do to yourself?”
Things are no different in the realm of child mental health. Countless parents have shared with me how recklessly diagnoses and treatment recommendations are made for their children with no regard for the related harm. One family was advised to either hospitalize or send their school-grade child to a residential program. During the first session with me, it was abundantly clear that this intervention–though a standard one for their level of distress–would only exacerbate their suffering. I also see adults who endured mistreatment at the hands of child psychiatrists related to being overmedicated, restrained, and forcefully hospitalized during their childhoods. Those wounds are still with them. Many people seeking healing through my private practice have lost complete faith and trust in the healthcare system and in doctors, in particular–all with good reason.
My 13 years of medical training were degrading, dehumanizing, and denigrating. Like many women of color, I was sexualized and fetishized repeatedly, my excellence was passed over while the mediocrity of my White male peers was exalted, and I repeatedly witnessed the mistreatment of people of color and other marginalized communities. I was consistently told that I cared too much for the people I was supposed to care for(?!); and on a number of occasions my refusal to settle for substandard or negligent care was framed as my being “difficult.” These patterns intensified when I worked in health equity settings and projects related to antiracism, community mental health, and global health. This went on for almost 15 years of my career before I realized that the only way I could retain my caring approach to care was to quit all hospital, clinic, and medical educational settings and go off on my own.
Since setting up my practice almost three years ago, it’s been a revelation to have the emotional fortitude to take excellent care of people. My days begin with a lot of joy because I am surrounded by my neighbors, instead of abusive supervisors. My care has more gusto because none of my energy is spent managing unwell colleagues or trying to prevent the mistreatment of children at their hands. While I am far from perfect and err as all humans do, most of the people I work with can sense that I love what I do and care deeply about their wellbeing. During moments when I begin to feel drained or fatigued by my heart and soul clinical work, I can easily scale back or restore. There’s no one at work to get in the way of that.
Unfortunately, for most healthcare workers, it looks like things are only getting worse post-pandemic, in terms of their emotional wellbeing and burnout. But don’t expect to find any informed consent paperwork explaining to you the risks of receiving care from people who are depressed, suicidal, or enduring mistreatment and abuse as part of their training. That informed consent process is one you’ll have to do on your own.
Parenting Tip: When commencing a child’s mental healthcare journey, ask your provider: “Can you tell me more about burnout and the emotional wellbeing of healthcare providers here? I’ve heard that doctors and medical students have high rates of depression and suicide. I want to ensure my child is receiving care in a setting that is not toxic. It also matters to me that my child’s providers are on their own healing journeys so I can ensure they are prepared to support my family’s.”
To learn more about Dr. Legha’s related scholarship, please read “White supremacy culture and the assimilation trauma of medical training: ungaslighting the physician burnout discourse” available here.
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