The Elephant In The Doctors' Lounge


 
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By Gary Price, MD, MBA

With roughly 156 million Americans fully vaccinated for COVID-19, physicians are seeing signs of relief on the horizon. That relief can't come soon enough. The initial energy and adrenaline that drove physicians to treat their acutely ill patients in the early months of the pandemic have been replaced by fatigue, burnout, and post-traumatic stress disorder (PTSD). It's time to talk -- and to act -- so these feelings of struggle don't drive more of our colleagues into a mental health emergency.

Physician suicide has been a public health crisis long before the COVID-19 pandemic. Nearly one in four physicians know a physician who has died by suicide. Now they've been in a non-stop crisis for more than a year, with COVID-19 inflicting serious psychological wounds upon them. Some physicians have dealt with more trauma and patient deaths in that time than they had previously seen over the course of their entire career.

Difficult working conditions -- such as a lack of personal protective equipment (PPE), caring for patients who may be seriously ill for weeks -- along with burdensome administrative tasks, long hours, and grief over losing patients have become the norm. Burnout can feel like death by a thousand cuts. In our 2020 survey of physicians, nearly 60% of physicians reported experiencing feelings of burnout, but only 13% reported seeking medical attention for a mental health problem caused by COVID-19's effects on their practice or employment.

A tired male healthcare worker in dark blue scrubs with closed eyes rests his head on his hand in the doctor’s lounge.

With roughly 156 million Americans fully vaccinated for COVID-19, physicians are seeing signs of relief on the horizon. That relief can't come soon enough. The initial energy and adrenaline that drove physicians to treat their acutely ill patients in the early months of the pandemic have been replaced by fatigue, burnout, and post-traumatic stress disorder (PTSD). It's time to talk -- and to act -- so these feelings of struggle don't drive more of our colleagues into a mental health emergency.

Physician suicide has been a public health crisis long before the COVID-19 pandemic. Nearly one in four physicians know a physician who has died by suicide. Now they've been in a non-stop crisis for more than a year, with COVID-19 inflicting serious psychological wounds upon them. Some physicians have dealt with more trauma and patient deaths in that time than they had previously seen over the course of their entire career.

Difficult working conditions -- such as a lack of personal protective equipment (PPE), caring for patients who may be seriously ill for weeks -- along with burdensome administrative tasks, long hours, and grief over losing patients have become the norm. Burnout can feel like death by a thousand cuts. In our 2020 survey of physicians, nearly 60% of physicians reported experiencing feelings of burnout, but only 13% reported seeking medical attention for a mental health problem caused by COVID-19's effects on their practice or employment.

Left untreated, burnout could cause more cases of depression, anxiety, PTSD, substance use, and suicidal thoughts in our profession. It's these people, our colleagues -- maybe even ourselves -- who are more likely to leave medicine, or worse, die by a preventable suicide death. Poor mental health among physicians can have devastating effects on the access, quality, and cost of our country's healthcare. It's estimated that approximately 1 million Americans lose their physician to suicide each year.

We must address the elephant in the room -- in our practices, clinics, and hospitals. We need to come together and break down the culture of silence around physician mental health.

It's important to give ourselves permission to talk about our own mental health. We need to shift the paradigm from a system where physicians think that burnout, depression, or suicidal thoughts are something we can, or must, overcome by ourselves, to one where we have a plan in place to access our own mental healthcare. Having a plan to get mental healthcare should not only be accepted, but also normalized. Accessing mental healthcare should become a fundamental and ongoing element of being a practicing physician.

A personal crisis management plan can help identify the coping strategies and resources that may work best for each of us individually to successfully navigate stress, feelings of burnout, or other challenges. In fact, at one health system, nearly a third of participating residents used a personal crisis plan within the first 3 months of being introduced to this resource.

That's a staggering number, particularly when you consider that it's among some of the newest physicians joining our profession. And while it may only be one data-point among many on physician burnout and stress, it demonstrates how many of us may be suffering right now -- or worse, suffering in silence or alone -- all because of the stigma associated with physicians seeking care for their mental health.

Encouraging the use of mental health resources and evidenced-based burnout improvement programs can provide that much needed open door for physicians to seek care and alleviate those feelings of stigma and shame.

For example, a practice in Washington state crafted several workflow redesign interventions to tackle physician burnout. One example they explored was a pre-visit laboratory order checklist to reduce administrative burdens for the physician and provide an opportunity to discuss results with patients at their visit. The intervention group ultimately saw a 3-hour decrease in the total number of self-reported hours per week spent on indirect patient care and administrative tasks, and reported an increase in both overall job satisfaction and value alignment with clinical leaders.

This is just one type of actionable solution to address physician burnout and help physicians manage the stressors that place their emotional and physical health at risk.

You may never know when the feather that breaks the proverbial camel's back will come. But in our profession, it's more likely than not that the day will come. It's simply the nature of the work we are privileged to do. Physicians, just like anyone else, should feel comfortable seeking help when it's needed most.

Gary Price, MD, MBA, is a an attending surgeon and clinical assistant professor of surgery at Yale-New Haven Hospital in Connecticut.

 
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