PHYSICIAN, DON’T HEAL THYSELF
Doctors not getting help they need
The suicide rate among doctors remains among the highest in the general population and statistics suggest that male physicians die due to suicide at a rate nearly twice that for other men. For female physicians the risk is three-fold higher.
This data may surprise some patients and even some doctors who are enjoying a career that is seen by many as a calling and an opportunity to be truly helpful. A former president of the Canadian Psychiatric Association, Dr. Michael Myers, author of Why Physicians Die by Suicide: Lessons learned from their families and Others Who Cared, is not at all surprised by the gloomy data.
One of the major obstacles in dealing with burnout is that poor mental health — despite many efforts by various organizations and celebrities — continues to be stigmatized. Myers admits that far too many doctors are too slow to acknowledge they need help.
What is clear from most cases of physician burnout is that it is a steady unravelling of mental resilience. Emotions of despair and sorrow simmer over time; many doctors suffer from compassion fatigue, denial and when they bring this up with colleagues they are told not to worry because it’s a stage and that all will be fine.
The stigmatization of mental health has a ripple effect. The impact can be far reaching and physician burnout has been correlated with an increase in reported errors and decreased patient satisfaction.
In the May 2017 edition of Pediatrics, Dr. Suzanne Crowe and her colleagues discuss a case of a Pediatric Intensive Care Unit (PICU) doctor who buckled under constant pressure of dealing with very sick children, their anxious parents, and in some cases the sudden and unexpected loss of a child.
The doctor was troubled by poor sleep and nightmares about children who died. She worried that she may have missed something when the child was deteriorating — second-guessing the quality of her care and seeing herself as a failure and a fraud.
One day, while trying to save the life of a very sick baby in the PICU, this doctor had to remove herself from the drama by asking a peer to take over. She recused herself and cried in her office, where another colleague heard her crying and offered some compassion. This doctor was later diagnosed with disenfranchised grief, a phenomenon where she failed to recognize the emotional toll grief and loss may have on the mental health of caregivers.
When doctors reapply annually to maintain their licence to practise, a standard question is that of mental health status. A recent survey revealed that only six per cent of doctors who received a formal diagnosis of depression reported it to their licensing board. Many doctors simply need permission to admit their struggles.
The Alberta Medical Association and other jurisdictions in Canada have established physician wellness programs, but once again the stigmatization of mental health remains one of the great obstacles in getting appropriate care.
Influential institutions such as the Mayo clinic are leading the way to deal with physician wellbeing. On the clinic’s website are nine strategies on how to prevent and resolve burnout. (See www. newsnetwork.mayoclinic.org/ discussion/mayo-clinic-reversing
The good news is that the overall job satisfaction rate among pediatricians remains relatively high. But even so, the American Academy of Pediatrics, at the time of this writing, is working on ways to support its members in the area of preventing burnout.
The academy feels that it has to be a priority, not just for the sake of the doctor, but also for the families who trust the physician for their medical care.
As a life coach and author, and being a pediatrician, I was asked to share some resources and ideas on the issue of physician burnout at two recent events for American Academy of Pediatric colleagues in Washington, D.C. and Seattle. What struck me the most is that many physicians, when given a safe environment, open up about their own struggles to stay in peace regardless of relentless stress and turmoil.
In Seattle I was introduced to a fellow presenter and poet, Elizabeth Austen. She is employed by the Seattle Children’s Hospital to use poetry and writing as a tool to reduce burnout and stress. Allowing participants to privately, by hand, write about their experiences and feelings may seem to be too simplistic, but more and more clinicians working in high-stressed areas find this a useful practice.
For the safety of patients, an increasing number of doctors are using resources to prevent burnout, set boundaries, adjust expectations and get help from psychologists or life coaches.
One doctor in particular commented that the best thing a psychologist did for her was to guide her.
“He did not tell me what to do, but instead asked good questions and helped me figure it out.”