In medicine, where the expectation is to be the healers, the saviours, the ones who hold lives in their hands, a culture of silence surrounds physicians’ personal pain and mental health.
Surgeons often bear the weight of this silence due to their reputation for stoicism, determination and relentless drive.
However, beneath the facade of strength, many surgeons grapple with their mental health, and this can have dire consequences – one of which is the growing suicide crisis within the medical profession.
Professor Shafi Ahmed is an award-winning cancer surgeon at The Royal London Hospital and medical director of Surgery International.
He recently highlighted this sobering reality after the Guardian published an article online that recalled the mental health struggles of Carrie Cunningham, former president of the Association of Academic Surgery.
Carrie’s story is a poignant example of what surgeons around the globe face every day.
A former junior tennis prodigy and an accomplished associate professor of surgery at Harvard, her journey is a testament to the resilience often found in the medical profession.
But behind her remarkable achievements, she bore a lifelong burden of depression, anxiety and, eventually, a substance use disorder. A friend she met at medical school at the University of Michigan took her own life and proved an early catalyst for her moment of revelation.
Years later, the Guardian recounts the moment she stood before colleagues (including her friend’s sister) to share her devastating story: ‘Carrie Cunningham puffed out her cheeks and exhaled. She looked out at the audience filled with 2,000 of her peers. These surgeons were attending the annual meeting of the Association of Academic Surgery, a prestigious gathering of specialists from universities across the United States and Canada. Cunningham, president of the organisation, knew what she was about to reveal could cost her promotions, patients and professional standing.
She took a deep breath. “I was the top junior tennis player in the United States,” she began. “I am an associate professor of surgery at Harvard. But I am also human. I am a person with lifelong depression, anxiety, and now a substance use disorder.” The room fell silent. Her story underscores the immense pressure that surgeons face, which can lead to mental health crises.’
The competitive environment, demanding hours, and the weight of patient outcomes can take a toll on the wellbeing of many in the profession.
And as Shafi points out, surgeons can grapple with inner turmoil and question their sacrifices – even at the pinnacle of their careers.
When Carrie Cunningham broke the code of silence among physicians, she put the conversation at the top of the agenda.
Drawing on Carrie’s experience, Shafi recalls his moment of clarity.
Giving up his major cancer resections and all leadership roles, including Associate Dean, Cancer Lead, Clinical Lead and council member of the Royal College of Surgeons of England, as well as an extensive private practice, was, he says, a big decision and colleagues must have thought I was crazy.
‘I made this decision at the very top of my profession at the age of 50,’ he says. ‘And it may have seemed a little premature, but in hindsight, it was one of the best decisions I have made – and at the right time. It has allowed me to find new challenges, look after my physical and mental health and build an entirely different career.’
Last month, Surgery International heard from Beth Frates, President of the American College of Lifestyle Medicine, who made it her mission to instil healthy habits within the medical community when the pandemic shone a much-needed spotlight on physician overload and burnout.
She has since helped to craft an innovative wellness initiative to address the high burnout rate among surgeons.
Her efforts offer an antidote to the increasing number of physicians who end their careers early to find a suitable work-life balance. But suicide poses a much more profound and heart-breaking challenge to a profession where the reality of mental health often goes under the radar.
Shafi notes: ‘The profession needs to look at itself and look after its surgeons from burnout and stress and improve their wellbeing. We must address the toxic and competitive environment we and the health systems engineer. Otherwise, surgeons will continue to suffer in silence, and stories similar to Carrie Cunningham in the article will continue to surface.’
Tragically, surgeons, often seen as the embodiment of resilience, face one of the highest suicide rates among physicians.
Among doctors, these have consistently been higher than in any other profession. In the US alone, 300 to 400 doctors commit suicide annually, equivalent to one per medical school graduation.
Surgeons have some of the highest known rates of suicide among physicians. Of 697 physician suicides reported to the CDC’s National Violent Death Reporting System between 2003 and 2017, 71 were surgeons.
In a 2020 paper, Suicide among doctors: A narrative review, the authors concluded, ‘ Any changes have to be systemic as well as individualistic. Systemic changes need to tackle endemic as well as environmental factors. The culture of the workplace and social expectations need to change. Individual resilience must be encouraged, and support at all levels-clinical, educational, managerial and environmental must be readily available.’
The problem for surgeons is that the weight of responsibility for their patients’ lives can lead to profound emotional turmoil, anxiety, sadness, guilt and even shame when things go awry in the operating room.
The Guardian article recalls: ‘On Cunningham’s first night as an intern, three of her patients died. Their deaths were expected, but the losses still hurt. “I didn’t know how to call out a death certificate or even pronounce someone dead,” she recalls. “And I was like, ‘I’ll guess I’ll get used to it”.’
Post-pandemic and following a marriage breakup (her ex-husband is also a surgeon), alcohol became her support, and one night, she confided in some colleagues, eventually spending four weeks in rehab – ‘the first time in 20 years that she’d taken more than a week off,’ the article reports.
Deemed temporarily unfit for practice, she vowed to change her trajectory. And then, as her year as president of the Association of Academic Surgery ended, she chose the well-attended event of her outgoing speech to share her story – in front of hundreds of colleagues. It is a journey she hopes will serve as an inspiring beacon of hope.
She embraced rehabilitation and therapy, fighting her way back to sobriety and emotional wellbeing. Her message to her colleagues is clear: seeking help is not a sign of weakness but an act of strength.
In a profession where silence has reigned for too long, Carrie’s willingness to share her story has ignited a spark of change with fresh calls for the profession to address the toxic and competitive environment that can push its members to the brink.
Meanwhile, Shafi has welcomed the freedom his epiphany has gifted him.
‘Interestingly, I am now the healthiest I have been for over two decades as I simply have time to myself. Most surgeons run from one clinic to the next and from hospital to hospital, taking on additional leadership roles that are often never adequately recognised or remunerated. It is unsustainable.
‘I see my colleagues constantly under enormous pressure and stressed to the point of exhaustion and sheer frustration. I find my role is to listen and try to support them through their careers and offer mentorship.’
