It’s 3:00 a.m. The fluorescent lights flicker and buzz above you. You haven’t eaten since yesterday. Your pager won’t stop. One patient is crashing, another is coding, and the ER just called — more are on the way.
You’re exhausted, running on caffeine and adrenaline, but there’s no time to stop. You tell yourself what you’ve always been told: Push through. Be strong. Don’t break.
In the high-stakes world of medicine, where precision and resilience are prized, vulnerability is often seen as a liability.
But what happens when the very culture that trains physicians to push through pain and suppress their emotions starts to affect your own health and well-being?
Daniel Saddawi-Konefka, MD, MBA, program director of the Anesthesia Residency Program at Massachusetts General Hospital, is confronting this question head-on.
Saddawi-Konefka has spent years guiding up-and-coming physicians through their residency training—one of the most demanding phases of their careers. Reflecting on his own training, he recalls the praised mindset of working through your own health issues, one that still shapes medical culture: “If you cough up a lung, you shove it back in and get back to work.”
It’s a phrase that captures the unspoken rules many physicians learn early on—rules that discourage showing their vulnerability and make it harder to seek help if they are struggling with mental or physical health issues, even when doing so could improve both their well-being and the care they provide to patients.
The Culture of Silence
Physicians are trained to connect patients to the care that they need, but when it comes to their own mental health, many still hesitate to seek help.
Saddawi-Konefka believes part of the challenge comes from the lack of visible role models who are honest about their own mental struggles. “We need more leaders who show that it’s OK to struggle and seek help,” he says.
His recent article in JAMA highlights that stigma and fear of professional consequences remain among the most powerful deterrents among residents and physicians for seeking help.
Nearly 60% of residents and two-thirds of practicing physicians cite confidentiality concerns as a primary barrier to accessing care. Many still fear that disclosing a mental health condition could jeopardize their licensure, credentialing, or career advancement and development.
Making a Difference
Saddawi-Konefka believes the culture of medicine, at least at MGH, is beginning to shift in a positive direction.
Over the last 10 years, residents in the anesthesia pogram have increasingly cited “support of the individual” as one of the program’s greatest strengths.
More residents are now reaching out for help when they need it, which Saddawi-Konefka sees as a sign that the stigma surrounding mental health is beginning to lift. He considers this a meaningful step forward and hopes the culture will continue to evolve in a supportive direction.
In recent years, recognizing the mounting pressures facing clinicians, Mass General Brigham has also launched initiatives aimed to improve clinician well-being and directly address some of the pain points known to contribute to increased stress and burnout.
There's still lots of work to be done, however. In the JAMA perspective, Saddawi-Konefka and team outline tangible steps that can be taken from the individual to the policy level that can help to normalize the seeking of mental health services among physicians:
- Education & Leadership Programs: Changing the culture by normalizing mental health needs and reducing stigma through role modeling, awareness campaigns, and leadership that demonstrates seeking help is compatible with professional success
- Systemic & Policy Reforms: Dismantling institutional barriers by replacing harmful policies with supportive ones, including legislative reforms like the Lorna Breen Healthcare Worker Protection Act and eliminating discriminatory licensing practices
- Support Programs: Providing a range of confidential, proactive, and peer-led resources to make support more accessible, including opt-out mental health programs, anonymous screening tools, and confidential therapy networks
Many of these innovative care models have already shown real promise, such as opt-out mental health programs—where trainee check-ins with mental health providers are scheduled by default and it is up to trainee to keep or opt out of the appointments. One example of this, the University of Southern California’s “Keck Checks,” has shown promise in normalizing mental health care among trainees and increasing the utilization of mental health services.
Saddawi-Konefka also points to the importance of anonymous screening tools, such as the AFSP’s Interactive Screening Program, and confidential therapy that offer safe, stigma-free entry points for physicians to access care.
The Emotional PPE Project, which he co-founded during the COVID-19 pandemic exemplifies this approach. To date, it has connected over 2,500 healthcare workers with free, confidential mental health services from volunteer mental health professionals, demonstrating the significant impact these resources can have when they address physicians' core concerns about privacy and accessibility.
Looking Ahead
The goal is not to glorify help-seeking, but to normalize it. “This isn’t about heroism,” Saddawi-Konefka says. “It’s about doing what you should to take care of yourself—just like eating lunch or filling your car with gas.”
And if encouraging more doctors to reach out when they are struggling leads to his phone ringing at all hours of the day and night, Saddawi-Konefka is OK with that.
“I don't actually lose sleep over the ones that call me for help,” he reflects. “I lose sleep over the ones that don’t."
Mental Health Resources
If you are a Mass General Brigham employee experiencing impacts from stress, burnout, mental health, addiction, grief, or more, the Employee Assistance Program is a free, voluntary, and confidential service which provides assistance for employees, professional staff and their immediate family household members with issues that affect quality of life inside and outside the workplace.
988 Suicide and Crisis Lifeline
Free and confidential emotional support available 24/7
Call or text 988 (Veterans: Press 1, Spanish Line: Press 2)
Chat available on 988lifeline.org/chat
Visit 988lifeline.org for additional information.
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