Last year, during pre-clinicals, my preceptor harangued me for not asking the question, “In the last month have you ever felt guilty, hopeless or helpless?” At the time, I was shadowing a family medicine physician, and I was mostly concerned about patients with chronic conditions, such as hypertension, cardiac disease, or diabetes. In one encounter with a patient, I felt confident I had successfully helped manage a patient who had a poorly controlled illness. I felt valuable.
“Did you ask about depression?” the provider asked me. “No…I mean…she seemed okay…” “Always ask about depression. Always,” she quickly retorted.
Depression affects more than 3 million people each year. It’s something that most providers screen for briefly, but often we don’t address it as a true medical condition. We don’t appreciate it as a change in how the neurotransmitters are working in our brains. We are quick to refer someone to a mental health provider, or we are quick to tell someone to “suck it up” and be brave.
When I started my psych clerkship, that all changed. Most of the patients I saw had depression secondary to an illness. Yet we never treated depression as such. We worked with the patient to understand what were the factors contributing to the patient’s depression, and identified therapies that would be appropriate. Sometimes that meant medications. Most of the time, it meant time. It meant seeking therapy, it meant listening to the patient. It meant helping a patient adjust to a new normal, particularly if they are now bed bound after having once been an athlete.
And amongst health care providers, mental health is all to easily brushed off. We often say to “suck it up” or “it’s the culture, get over it.” We tell ourselves to work harder, to not worry about our own mental health, that our lives are about helping others. Yet depression, and unfortunately suicide, is higher, amongst healthcare providers than it is the general population. There’s a really good article about mental health amongst healthcare providers here.
So whether we go into psychiatry, or neurosurgery, or family practice, depression is an illness amongst our patients. It’s not something we should just ask psychiatrists about. We need to understand mental health in our patients and in ourselves to better understand. It’s an illness as predominant as diabetes, heart disease, and cancer. And treating it any less would be unfair for our patients and for ourselves.