White Coat, Black Art

Physician Heal Thyself

You might think that physicians are on the fast track to wealth and respect. But an increasing number of Canadian doctors are riding the express lane to burnout. It's a problem that affects established physicians and a disturbing number of ones just starting out. A new editorial just published in the Canadian Medical Association Journal is calling for action.
You might think that physicians are on the fast track to wealth and respect. But an increasing number of Canadian doctors are riding the express lane to burnout. It's a problem that affects established physicians and a disturbing number of ones just starting out. A  new editorial (unfortunately behind a paywall) just published in the Canadian Medical Association Journal is calling for action.

The CMAJ editorial says the rate of burnout among medical residents is an astonishing fifty percent.  One out of every two young MDs just starting out suffers from burnout.  Burnout is defined by three characteristics:  it means they're exhausted emotionally, they feel as if they have accomplished nothing, and tend to withdraw both from patients and from colleagues. The figure of fifty percent of residents is true for all specialties and for all years of residency - from the greenest rookie to the senior fellow who is about to embark on a career as an attending physician or surgeon.  

In my new book -  The Secret Language of Doctors - I talk about the many situations that residents face on a daily basis that make them prone to burnout.  For most of them, they are becoming acquainted with death - in its most sudden violent and cruel form - up close for the first time in their lives.  Not only do they see it; they must learn to shepherd patients unto death.  And they must learn to inform loved ones of the most terrible news a human being ever has to bear.

And, there's more. In my book, I talk about the growing sense of futility among doctors in attempting cardiac resuscitation on frail patients with little or no chance of success.  Situations like these lead physicians of all ages to feel what is known as moral distress - being forced to do something that runs counter to one's personal and even professional ethics.

But the risk of burnout isn't unique to residents. According to one study, two thirds of Canadian MDs out in practice felt their workload was too great.  And it's not just about physicians. Among nurses, I've seen studies that point to rates of burnout as high if not higher than doctors.  Paramedics have high rates of burnout.  Respiratory therapists - the people who manage the airways of patients in severe respiratory distress also suffer from burnout.  Depending on what type of place they work, so do pharmacists.  As is the case with residents, when it comes to nurses, some of the most serious examples of burnout occur not in middle age veterans but in young nurses and even nursing students.

You can't chalk it all up to stresses that come with the job.  As stated in the CMAJ editorial, the path to burnout is often set years before the first symptoms appear.  Personality traits like perfectionism and a martyr complex puts health professionals at risk.  Sleep deprivation reduces well being and makes health professionals prone to burnout.  The demands of being a doctor are quite high.

Most physicians I know tend to keep loading up on teaching and administrative duties.  And when you go home or go on vacation, there are no boundaries that can't be transgressed with pagers, text messages and email.  You can get an email that says: "Remember that patient you saw last week?" You could be in the midst of the one evening off you've taken in a month and get an email like that - one that makes you feel awful and that you can never get away.

In my opinion, one of the biggest problems that magnifies burnout is that doctors are notoriously bad at asking for help.  In medical culture, it's too humiliating to  ask for personal help for burnout and other mental health conditions.  These are seen by many of us as stigmatizing to our reputations and potentially a killer to our careers. 

You must read a  revealing article entitled 'Why doctors hide their own illnesses' published two weeks ago in the British newspaper The Guardian told the story of an anaesthetist who drank alcohol and who was terrified of killing patients in the OR would do a breathalyser test on himself rather than ask for help.  A doctor with bipolar affective disorder would buttonhole psychiatrist colleagues for hallway appointments.  She suffered from severe postpartum depression and set she and her newborn baby on fire.  A leading expert in the UK says more and more doctors in practice have mental health issues brought on by increased workloads and lower standing in society.  And when they do get ill, they downplay their symptoms to keep working.  They live in terror of being treated by a colleague. 

You may be tempted to chalk up burnout to "the doctor's problem."  Here's why you can't afford to do so.  Health professionals with burnout make more mistakes and their patients are at greater risk of being injured as a result of their errors.  There's also a good chance the patient who is going through a traumatic event like the loss of a loved won't get emotional support because the burned out doctor doesn't have any to provide.  

That's why the editorial in CMAJ says the system needs to focus on preventing burnout and early recognition of the symptoms.  It says doctors need to exercise, eat right, take regular medications, and learn to say no to extra duties.  

Who are they kidding?  The doctor who asks for help is often labelled one more interested in a good lifestyle than a meaningful career.

Doctors are used to giving advice to others.  In this case, medicine needs to take a page from industrial giants like BMO and US-based Goldman Sachs who insist that junior employees take weekends off.  Industry has realized that a martyr complex is bad for business because it leads to decreased productivity, absenteeism and high turnover. 

Time for doctors to do the same.

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