The elephant in the physicians’ lounge

Dr. Gary Price writes about burnout among physicians. He urges all colleagues to address the issue in the light of day, especially after what has happened over the past year due to the COVID-19 pandemic.

It's time to get healthcare professionals talking about their mental health

On MedPage Today, Dr. Gary Price writes about burnout among physicians. He urges all colleagues to address the issue in the light of day, especially after what has happened over the past year due to the COVID-19 pandemic.

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With over 150 million Americans fully vaccinated against COVID-19, physicians are seeing signs of relief on the horizon. This relief cannot come soon enough. The initial energy and adrenaline that drove physicians to treat their critically ill patients in the early months of the pandemic has been replaced by fatigue, burnout and post-traumatic stress disorder (PTSD). It is time to speak out - and to act - so that these feelings do not lead our colleagues into the midst of a psychological emergency.

Suicide among physicians has been a public health crisis long before the COVID-19 pandemic. Nearly one in four physicians knows a physician who has died by suicide. Now physicians have faced an ongoing crisis for more than a year, with the COVID-19 pandemic inflicting severe psychological wounds on them. Some physicians have had to deal with more trauma and patient deaths in this short period of time than they had seen before in their entire careers.

Difficult working conditions - such as lack of personal protective equipment (PPE), caring for critically ill patients for weeks on end - together with heavy administrative tasks, long hours and grief over the loss of patients have become the norm. Burnout can resemble a death with a thousand wounds. In a 2020 survey of physicians, nearly 60% reported experiencing elements of burnout, but only 13% reported contacting a physician about a mental health problem caused by the effects of COVID-19.

If left untreated, burnout could lead to more cases of depression, anxiety, PTSD, substance use and suicidal thoughts in our profession. It is these people, our colleagues - perhaps even ourselves - who are more likely to leave medicine, or worse, die an avoidable suicidal death. Poor mental health among physicians can have devastating effects on access, quality and cost of health care. It is estimated that about 1 million Americans lose their physicians to suicide each year.

We need to address the elephant in the room - in our daily lives, in our practices, in our hospitals. We need to come together and break the culture of silence about physicians’ mental health.

It is important to give ourselves permission to talk about our 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 should, overcome on our own, to one where we have a way of looking after our mental health. Having a system for psychological support should not only be accepted, but also normalised. Access to psychological health care should become a fundamental and ongoing element of being a practising physician.

A personal stress management plan can help to identify strategies and resources that may work best for each of us individually to successfully overcome stress, feelings of burnout or other challenges. In fact, in one health care system, nearly one-third of physicians in specialty training used a personal care plan within the first 3 months of introducing this resource. This is a staggering number, especially given that it affects younger physicians who have just joined our profession. While this may be just one more figure among many on physician burnout and stress, it shows how many of us may be suffering right now - or worse, suffering silently or alone - all because of the stigma associated with physicians seeking treatment for their mental health.
Encouraging the use of psychological health resources and evidence-based burnout improvement programmes can provide that much-needed open door for physicians to seek treatment and alleviate those feelings of stigma and shame.

You never know when the final straw will come. But in our profession, that day is likely to come. It is simply the nature of the work we are privileged to do. Physicians, just like anyone else, should feel comfortable seeking help when it is most needed.

Price G. The Elephant in the Doctors' Lounge. MedPage Today. 04/07/2021