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Anales de la Facultad de Ciencias Médicas (Asunción)

Print version ISSN 1816-8949

An. Fac. Cienc. Méd. (Asunción) vol.51 no.2 Asunción Aug. 2018 


Farewell, Colleague

Julio Torales1  2 

Osvaldo Melgarejo2 

1Consejo Editorial de la Revista ANALES. Facultad de Ciencias Médicas, Universidad Nacional de Asunción. Asunción, Paraguay.

2Psiquiatría. Facultad de Ciencias Médicas, Universidad Nacional de Asunción. San Lorenzo, Paraguay.

Today he started his medical residency. Today he attended his first patient. Today, all of a sudden, he was not smiling like he used to. Today he was not seen having lunch. Today he seemed isolated from the rest. Today he missed work again. Today he is being mourned.

Nothing challenges and generates more impotence in all of us than the death of a colleague, and even more knowing that the cause of his death was the product of his actions towards his own self. This makes any department, service, institution, or place we are in, come to a sudden stop. Having shared a hand shake, a work space, shifts, and experiences, and knowing that today he is not here anymore, thinking "what would have happened if..."

Well known is a note left by a person who threw himself from the Golden Gate Bridge in San Francisco (United States of America), which more or less reads: "I'm going to jump off the bridge. If one person smiles at me along the way, only one, I will not jump". How many resident doctors may be having passive thoughts about death at this moment? When referring to the mental health of doctors, it is often done from an academic perspective, paying special attention to trends and statistics. Rarely is the voice of any specific individual emphasized.

Paradoxically, the way in which this topic is presented can make depression seem like a characteristic of medical education (1). For example, some authors reveal that 11% of medical students present suicidal thoughts during their career and that about 1 in 4, suffer depression or develop symptoms of this condition (2). In the case of medical students of the National University of Asuncion, it has been revealed that 18.7% present some positive case of depression or depressive symptomatology (3). The World Health Organization acknowledges that it is a public health problem and calculates that every 40 seconds a person commits suicide (4); and in the United States of America it is estimated that one doctor per day commits suicide (5). Untreated depression can result in suicide, and it is especially important in doctors, since during their entire training they “learn” to attend patients even while being sick. Many of them being "burned out" (6, 7), spending little time with their families or spouses, practically living in the hospital, sleeping only a few hours, eating when they can, with few personal resources to face the high levels of stress, living an asymmetric relationship with peers in terms of hierarchy and therefore with "less privileges".

The School of Medicine of the National University of Asunción, through its Department of Psychiatry (to which the new Department of Mental Health has been added) has carried out actions tending to promote a change in paradigm regarding the mental health of doctors, kinesiologists, surgical technologists, nurses, and other health professionals who provide services at the Hospital de Clínicas. Specific interventions have been carried out, accompanying cases, working with departments and services that face difficulties, providing continuous education, screening, promotion and prevention in the area of mental health. Unfortunately it hurts to say, that often, these actions have not found a decisive response in all the areas involved and they have been relegated to simple words. This may be due to many reasons, but in our opinion, one of the main ones is the stigma associated with mental health problems.

The stigma definitely kills (8). The stigma means that a doctor or any other health professional avoids seeking help from mental health professionals because they fear other colleagues might find out about their condition. The stigma causes health professionals to minimize their psychological discomfort and treatment by giving priority to work. This stigma is responsible for making a person believe that someone suffering from depression is “weak” and that people in their department or service might consider them as not qualified to practice the profession. The stigma, moreover, makes psychiatrists believe that their colleagues do not need help because they already “know" about the symptoms and how they are treated, and that quick consultations, through "preferential treatment", might generate a poor treatment, because of its superficiality or inadequacy. And finally, this stigma causes many colleagues to believe that psychiatrists are "psychologists who medicate", generating even more resistance towards consultations and reinforcing that same stigma, therefore making the vicious circle continuous and eternal.

All health professionals have the task of learning how to look after those who care for others, to pay attention, to make a stop, to listen, to carry out concrete actions to make mental health be envisioned as something more than just a privilege or a “gift”, but as a right for all of those who embrace the profession of healing. Delaying the interventions in mental health may result in the most feared outcome: saying goodbye to a colleague, a colleague who has made the commitment to save lives and who now decides to end his own. It is therefore in our hands to change that reality.


1. Gupta R. I Solemnly Share. JAMA. 2018;319(6):549. [ Links ]

2. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students A Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214-2236. [ Links ]

3. Torales Benítez J, Girala N, Moreno Giménez M, Arce Ramírez A, Trinidad S, Estigarribia E et al. Depresión y ansiedad en estudiantes de medicina de la Universidad Nacional de Asunción. Revista Paraguaya de Psiquiatría 2013;1(1): 12-28. [ Links ]

4. Organización Mundial de la Salud [Internet]. Nueva York: Organización Mundial de la Salud; c2018 [citado 19 de septiembre de 2018]. Suicidio [aprox. 1 pantalla]. Disponible en: Links ]

5. Anderson P [Internet]. Medscape; c2017 [acceso 19 de septiembre de 2018]. Physicians Experience Highest Suicide Rate of Any Profession [approx. 4 pantallas]. Disponible en: Links ]

6. Lee Y, Medford A, Halim A. Burnout in physicians. Journal of the Royal College of Physicians of Edinburgh. 2015;45(2):104-107. [ Links ]

7. Olson K. Physician Burnout-A Leading Indicator of Health System Performance?. Mayo Clinic Proceedings. 2017;92(11):1608-1611. [ Links ]

8. Myers M. Why Physicians Die by Suicide: Lessons Learned From Their Families and Others Who Cared. New York; 2017. [ Links ]

Received: September 19, 2018; Accepted: September 26, 2018

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