and yet, they are less likely to seek mental health treatment than the general population.

然而，他們比一般人更不可能尋求心理健康治療。

Why is there such a stigma surrounding mental health among physicians?

為什麼在醫生中對心理健康有如此大的成見？

And what can we do to change it?

我們又能做什麼來改變它呢？

Let’s talk about it.

讓我們來談談。

Dr. Jubbal, MedSchoolInsiders.com

Jubbal醫生，MedSchoolInsiders.com

We are facing a mental health crisis among doctors.

我們正面臨著醫生的心理健康危機。

According to research, more than one in five physicians report feeling depressed.

根據研究，超過五分之一的醫生報告說感到抑鬱。

Even more concerning, male physicians are nearly one and a half times more likely to

更令人擔憂的是，男性醫生在以下方面的可能性要高出近一倍半： 1.

commit suicide than the general male population and female physicians are nearly two and a

自殺的人比一般的男性人口多，而女醫生的自殺率幾乎是男性人口的2/1。

half times more likely than the general female population.

比一般女性人口的可能性高半倍。

It’s not just attending physicians who are struggling either.

也不僅僅是主治醫生在掙扎。

It is estimated that nearly half of all medical students suffer from anxiety and nearly a

據估計，近一半的醫學生患有焦慮症，近1/3的醫學生患有焦慮症。

third from depression.

第三個來自抑鬱症。

Moreover, according to the American Foundation for Suicide Prevention, 28% of residents experience

此外，根據美國預防自殺基金會的數據，28%的居民經歷過

a major depressive episode during training compared to only 7-8% of similar-aged individuals

訓練期間出現嚴重的抑鬱症發作，而類似年齡的人中只有7-8%。

in the U.S. population.

在美國人口中。

As alarming as these statistics are, what is perhaps even more concerning is that the

儘管這些統計數字令人震驚，但也許更令人擔憂的是

true prevalence of mental health issues among medical students, residents, and attending

醫學生、住院醫師和主治醫師中心理健康問題的真實流行情況

physicians is likely much higher as underreporting has historically been a huge barrier to addressing

醫師的報告可能要高得多，因為報告不足在歷史上一直是解決這一問題的一個巨大障礙。

the mental health needs of doctors.

醫生的心理健康需求。

There are many reasons why a physician may not feel comfortable coming forward about

有許多原因導致醫生可能不願意站出來講述

their mental health issues, but let’s start with the culture of medicine.

他們的心理健康問題，但讓我們從醫學文化開始。

The stigma surrounding physician mental health starts early in medical training.

圍繞醫生心理健康的恥辱感在醫學培訓初期就開始了。

Despite having similar rates of depression to their nonmedical peers when they enter

儘管他們進入醫院時的抑鬱症發病率與非醫療機構的同齡人相似

medical school, research has shown that, on average, medical students’ mental health

研究表明，平均而言，醫學院學生的心理健康狀況

worsens over the course of their careers.

在他們的職業生涯中，情況會惡化。

Why is that?

這是為什麼呢？

To start, getting into medical school and becoming a doctor is highly competitive.

首先，進入醫學院併成為一名醫生的競爭非常激烈。

Everyone is trying to achieve the highest grades, the best test scores, and the most

每個人都在努力取得最高的成績，最好的考試分數，以及最

research to match into their desired specialty.

研究，以匹配到他們所期望的專業。

This immense pressure to perform can often lead to feelings of inadequacy and impostor

這種巨大的表現壓力往往會導致不充分和冒名頂替的感覺。

syndrome which can quickly turn into anxiety, depression, and more serious mental health

綜合症，這可能很快變成焦慮、抑鬱和更嚴重的精神健康問題。

issues.

問題。

Next, there’s the workload.

其次，是工作量。

Becoming a doctor requires countless hours of studying and hard work.

成為一名醫生需要無數個小時的學習和努力工作。

Aspiring physicians must endure sleep deprivation, long nights, weekends, and work after hours

有抱負的醫生必須忍受睡眠不足、長夜、週末和下班後的工作。

and on days off – and the workload doesn’t necessarily decrease when you become an attending

和休息日 - 當你成為主治醫生時，工作量不一定會減少。

physician either.

醫師也是如此。

The average attending physician works around 52 hours per week; however, there are many

主治醫生平均每週工作52小時左右；然而，有許多

specialties where working 60, 70, or even 80 hours per week is not uncommon.

在那些每週工作60、70、甚至80個小時的專業領域並不罕見。

When medicine is the primary focus of your life and you’re working these types of schedules,

當醫學是你生活中的主要焦點，而你又在從事這類工作的時候。

it’s common for self-care and hobbies to take a back seat to your career.

自我照顧和愛好被置於事業的次要位置是很常見的。

Despite the prevalence of mental health issues among doctors, few seek medical treatment

儘管醫生中普遍存在心理健康問題，但很少有人尋求醫療服務

due to the potential consequences of disclosing mental illness.

由於披露精神疾病的潛在後果。

One study from the University of Michigan found that medical students with moderate

密歇根大學的一項研究發現，有中度殘疾的醫學生

to severe depression frequently agreed that “if I were depressed, fellow medical students

到嚴重抑鬱症的人經常同意，"如果我是抑鬱症患者，醫學院的同學們

would respect my opinions less” and that “faculty members would view me as being

會減少對我意見的尊重"，"教員們會認為我是一個

unable to handle my responsibilities.”

無法處理我的責任。"

Mental illness is often perceived as a sign of weakness and, as a result, many students

精神疾病往往被認為是軟弱的表現，是以，許多學生

keep their feelings to themselves and suffer in silence.

把他們的感受留給自己，默默地承受。

By the time a medical student completes medical school, goes through residency, and becomes

當一個醫科學生完成醫學院的學習，經過住院醫師培訓，併成為

an attending physician, these beliefs are deeply ingrained.

作為一名主治醫生，這些信念已經根深蒂固。

Instead of not wanting to appear weak to their peers and instructors, now it’s their colleagues

與其說是不想在同行和導師面前顯得軟弱，不如說現在是他們的同事

and administrators.

和行政人員。

When you’re the one that’s supposed to be taking care of others, it can be difficult

當你是那個應該照顧別人的人時，可能會很困難

to admit that you’re struggling yourself.

承認你自己在掙扎。

The next reason physicians don’t seek help for mental illness is the fear that it will

醫生不為精神疾病尋求幫助的下一個原因是擔心它會

impact their ability to gain licensure.

影響他們獲得許可證的能力。

According to a 2016 study published in the Mayo Clinic Proceedings, approximately 40%

根據2016年發表在《梅奧診所論文集》的一項研究，大約40%的

of physicians reported that they would avoid getting mental health care for this exact

的醫生報告說，他們會因為這一點而避免接受心理健康護理。

reason.

原因。

Although it is actually against the law - specifically the Americans with Disability Act - to restrict

儘管事實上，限制殘障人士的權利是違反法律的，特別是《美國殘障人士法案》。

a physician’s right to practice on the basis of mental illness, there is still a gray area

醫師基於精神疾病的執業權利，仍然存在一個灰色地帶

that exists that can discourage physicians from seeking help.

存在的可能使醫生不願意尋求幫助。

To start, many state licensing boards ask questions regarding a doctor's history of

首先，許多州的許可委員會都會詢問有關醫生的歷史問題。

mental illness, addiction, or substance abuse on applications for medical licensure and

在申請醫療執照時，如果發現有精神疾病、成癮或藥物濫用的情況，應立即通知醫生。

renewal.

更新。

Those that disclose this information may be asked to provide medical records outlining

披露這些資訊的人可能會被要求提供醫療記錄，說明

their treatment and be granted only “conditional licensure.”

他們的治療，只被授予 "有條件的許可"。

The intended purpose of these questions is to help protect patients by ensuring doctors

這些問題的預期目的是通過確保醫生的以下幾點來幫助保護病人

are “fit” to practice; however, an unintended consequence is that they can also discourage

然而，一個意想不到的後果是，他們也可能會阻止 "適合 "執業的人。

physicians from seeking help.

醫師不尋求幫助。

The irony is that by deterring doctors from seeking mental health treatment, these questions

諷刺的是，通過阻止醫生尋求心理健康治療，這些問題

ultimately put patients at even greater risk as physicians who are struggling with mental

最終使病人面臨更大的風險，因為那些與精神疾病作鬥爭的醫生們

illness are more likely to make medical errors that they ordinarily wouldn’t make.

疾病更有可能造成他們通常不會犯的醫療錯誤。

Lack of energy, trouble concentrating, difficulty making decisions, anger, and irritability

缺乏活力，注意力難以集中，難以做出決定，憤怒和易怒

are all symptoms of depression that can negatively impact a physician’s ability to practice.

都是抑鬱症的症狀，會對醫生的執業能力產生負面影響。

According to Medscape’s 2022 Physician Burnout & Depression Report, 23% of depressed doctors

根據Medscape的2022年醫生職業倦怠和抑鬱症報告，23%的抑鬱症醫生

reported feeling less motivated to be careful when taking patient notes, 14% reported expressing

據報告，在做病人筆記時，感覺不到仔細的動力，14%的人報告說表示

their frustration in front of patients, and 11% reported making errors that they might

他們在病人面前的挫敗感，11%的人報告說，他們可能會犯錯誤。

not ordinarily make.

通常情況下不做。

Although you may hear this and think it is justification for including these mental health

儘管你可能聽到這些，並認為這是包括這些心理健康的理由。

screening questions, the reality is that they are causing more doctors to suffer in silence

篩查問題，現實是他們正在使更多的醫生在沉默中受苦。

and allow their mental health to reach the point where it is affecting their work.

並允許他們的心理健康達到影響其工作的程度。

With mental health, like most things in medicine, an ounce of prevention is worth a pound of

對於心理健康，就像醫學中的大多數事情一樣，一盎司的預防值得一磅的治療。

cure.

治癒。

It is much better to address mental health issues at the first signs of trouble instead

在出現問題的第一時間解決心理健康問題要好得多。

of letting them progress to much more severe issues.

讓它們發展成更嚴重的問題。

Doctors need to be able to get help before it impacts their ability to do their job.

醫生需要在影響到他們的工作能力之前能夠得到幫助。

To address this issue, the Federation of State Medical Boards came out with new recommendations

為了解決這個問題，各州醫療委員會聯合會提出了新的建議

in 2018 that urge state medical boards to omit these questions and instead rephrase

在2018年，敦促各州醫療委員會省略這些問題，而改用新的措辭

them to focus only on current impairment - which is more meaningful in the context of a physician’s

他們只關注當前的損傷--在醫生的背景下，這更有意義。

ability to provide safe care to patients in the immediate future.

在不久的將來，為病人提供安全護理的能力。

Many state licensing boards have since omitted some of these questions from their licensing

此後，許多州的許可委員會在其許可中略去了其中的一些問題。

applications; however, few have adopted them fully.

然而，很少有人完全採用它們。

As such, some medical license applications continue to deter physicians from seeking

是以，一些醫療執照的申請仍然使醫生不敢尋求

mental health treatment.

精神健康治療。

Even if we can get more states to adopt these recommendations, many hospital privileging

即使我們能夠讓更多的州採用這些建議，許多醫院的特權

applications continue to ask questions regarding mental health history as well, so there is

申請書也繼續詢問有關精神健康史的問題，是以有

a great deal of work that must be done before physicians can feel safe seeking mental health

在醫生們可以放心地尋求心理健康之前，必須做大量的工作。

care.

照顧。

If we are to make significant progress toward improving the mental health of our physicians,

如果我們要在改善醫生的心理健康方面取得重大進展。

we must start by normalizing mental illness.

我們必須從精神疾病的正常化開始。

According to the CDC, approximately one in five Americans will experience a mental illness

根據CDC的數據，大約五分之一的美國人將經歷精神疾病

in a given year and more than 50% of Americans will be diagnosed with a mental illness or

在某一年，超過50%的美國人將被診斷出患有精神疾病或

disorder at some point in their lifetime.

在他們一生中的某個時間點上有障礙。

This means that there is a good chance that you, me, and everyone else watching this video

這意味著，你、我和其他所有觀看這段視頻的人都有很大的機會

will experience struggles with mental illness at some point during our lifetime – and

在我們一生中的某個時刻，都會經歷與精神疾病的鬥爭--而且

yet, we often treat mental illness like it only affects a small percentage of us.

然而，我們常常對待精神疾病，好像它隻影響到我們中的一小部分人。

Furthermore, we don’t often have stigmas for other organ systems, so why is there such

此外，我們對其他器官系統並不經常有汙名，那麼為什麼會有這種

a strong stigma associated with mental health?

與心理健康有關的強烈恥辱感？

If you break your leg, nobody judges you for going to the hospital and getting it taken

如果你摔斷了腿，沒有人會因為你去醫院做了手術而對你進行批評。

care of.

照顧。

But if you’re struggling with your mental health it’s viewed as a reflection of your

但是，如果你正在與你的心理健康作鬥爭，它就會被視為你的一個反映。

character and you’re seen as weak.

角色，你就會被看作是弱者。

Does it make sense?

這有意義嗎？

I don’t think so.

我不這麼認為。

Part of the reason is that brain function and mental health are not nearly as well understood

部分原因是，人們對大腦功能和心理健康的瞭解還遠遠不夠充分

as many organ systems, and this opacity results in us attributing certain issues to character

和許多器官系統一樣，這種不透明性導致我們將某些問題歸結為性格問題。

flaws rather than biochemical or pathophysiologic origins.

缺陷，而不是生化或病理生理學的起源。

This stigma doesn’t just harm doctors either — it harms patients too.

這種汙名也不僅僅傷害了醫生--它也傷害了病人。

Despite being victims of mental health discrimination themselves, these deeply ingrained views towards

儘管他們自己也是心理健康歧視的受害者，但這些根深蒂固的觀點對

mental health can negatively affect the care that doctors deliver to patients with mental

心理健康會對醫生為精神疾病患者提供的護理產生負面影響。

illness.

疾病。

When it’s ingrained in you that mental health is synonymous with weakness, it doesn’t

當你根深蒂固地認為心理健康是軟弱的同義詞時，它並沒有

just affect how you perceive yourself but also how you perceive others.

影響你對自己的看法，也影響你對別人的看法。

These implicit biases towards patients with mental health issues have been shown to negatively

這些對有心理健康問題的病人的隱性偏見已被證明會對其產生負面影響。

impact the care that these patients receive.

影響這些病人得到的護理。

Studies have demonstrated that people living with mental illness commonly report feeling

研究表明，患有精神疾病的人通常報告說，他們感到

that their symptoms are not taken seriously when seeking care for non-mental health concerns.

在尋求非精神健康問題的治療時，他們的症狀沒有被認真對待。

They have also demonstrated that people treated for mental health often receive poorer care

他們還表明，因精神健康而接受治療的人往往得到較差的護理。

for physical health problems - likely due to physical symptoms being misattributed to

身體健康問題--可能是由於身體症狀被錯誤地歸因於

a patient’s mental illness.

病人的精神疾病。

This, in turn, creates delays in diagnosis and treatment which ultimately negatively

這反過來又造成了診斷和治療的延誤，最終對患者造成了負面影響。

impacts care.

影響關懷。

As you can see, the mental health stigma among physicians is an issue that impacts all of

正如你所看到的，醫生中的心理健康成見是一個影響所有

us.

我們。

This is not an issue that will be fixed overnight but one that we will have to consistently

這不是一個一夜之間就能解決的問題，而是一個我們必須堅持不懈的問題。

work at.

工作在。

We need to take a good hard look at the issue of mental health among physicians and start

我們需要認真審視醫生的心理健康問題，並開始

making strides to break down these barriers to seeking treatment.

在打破這些尋求治療的障礙方面取得了進展。

Only then will we be able to make meaningful progress towards happier and healthier physicians.

只有這樣，我們才能朝著更快樂和更健康的醫生方向取得有意義的進展。

Thank you all so much for watching.

非常感謝大家的觀看。

If you enjoyed this video, be sure to check out my videos on How to Manage Stress as a

如果你喜歡這段視頻，請務必查看我的視頻：如何管理壓力作為一個

Student or Why Are Doctors Miserable?

學生或為什麼醫生是悲慘的？

| The Burnout Epidemic.

| 倦怠的流行。

Much love and I’ll see you guys there.

非常感謝，我們會在那裡見到你們。