Physicians need to focus on wellness to prevent burnout

I recently received a bulletin from one of the medical societies to which I belong: the topic was on promoting physician wellness.

My first reaction, “It’s about time “. Historically physicians have struggled with multiple health impacts from the demands of their work, with higher rates of depression, anxiety and suicide than in the general population. Physicians train under circumstances of extreme stress often resulting in unhealthy coping strategies; strategies frequently continued during years of practice. Job stress has been linked to poorer health among physicians.

An estimated fifteen percent of American physicians will be impaired at some time in their career, the result of mental illness, drug dependency or alcoholism.

As a resident physician I researched the issue of health habits among my colleagues in an urban hospital. The results of my survey were concerning. Only twenty five percent of respondents met exercise recommendations from the American Heart Association, thirty percent reported healthful eating habits; fast food was quite popular in the face of time constraints. Treatment for depression was reported by thirty percent, a finding common to other studies of physician health. Still others reported, although they were depressed they did not have time to seek assistance. My findings also revealed that nearly half had fallen asleep at the wheel; twenty two percent had been in a car accident. The majority of these accidents occurred after working more than twenty four hours.

The comments section of the survey was particularly revealing. Multiple comments centered around having no time to address personal health needs, such as medical appointments or time off for personal illness. One respondent reported having her first grand-mal seizure after a particularly long shift with no sleep. Another was in divorce proceedings, which he attributed to his work schedule.

One simply wrote “I’m too apathetic to fill out this section”, in itself a revealing comment. During my research I was stunned to learn that the railroads, recognizing that sleep deprivation impairs performance had restricted work hours for their conductors a full century before the medical profession did the same. Since my days as a student I have struggled with the irony of a profession that purports to be about health, but requires its caregivers to sacrifice their own health.

My research was conducted nearly a decade ago, but issues of physician health and burnout remain problematic. In a recent article from the Lancet, burnout is attributed to the dehumanization of modern medicine and the ways in which technology has altered the doctor-patient relationship. Burnout is defined by symptoms of emotional exhaustion, depersonalization and a decreased sense of self-efficacy. The authors attribute burnout to a crisis of meaning and identity, the result of working in a “techno centric, dehumanized and financially driven environment, often with a broken and unjust system of healthcare.”

It is time we confront the issue of physician burn out and incorporate the idea of self care into the medical training. In a time when our country faces rising medical expenses, an obesity crisis and multiple medical problems with lifestyle factors at their root, we in the medical field need to model healthy lifestyles to our patients and communities. We should be setting the example of what it means to make personal health a priority. Are we ready to set a good example?

Aldebra Schroll is a family physician who blogs An Apple a Day at NorCal Blogs.

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  • christophil, MD

    It’s all about making choices…
    -go get sushi for lunch or check vent patient in ICU
    -go home early and jog or finish chart notes in office
    -meditate at high noon or call patient with new cancer
    ummm….hard choice? Or one choice?

  • http://www.pacificpsych.com/ pacificpsych

    One huge problem is that administration in many (most?) settings could care less about physician well being. In fact, they often go out of their way to treat doctors in a demeaning manner. I think there’s a large element of “I’ll show you who’s boss” in there, coming perhaps from insecurity, envy, or business school teachings. The people in the suits run things. They sit in leather chairs in fancy offices. They look down on the workers who do the dirty work – and that includes doctors.

    The excellent Lancet article you refer to can be read here http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61851-1/fulltext?_eventId=login

  • Joshua Wald

    I’m a medical student at McMaster university in Canada. I’m not sure what it’s like in med school in the U.S. but here they’ve actually made physician health a part of the curriculum with several sessions in the first two years devoted to lectures and small group discussions on topics such as balancing work and family, substance abuse in the medical profession and other issues surrounding physician self care. Now that I’ve started clerkship and begun to experience for myself some of the difficulties in staying healthy and grounded during busy rotations and long call shifts I have really begun to appreciate having been exposed to these issues before hand. I think it’s an idea that more med schools should take a look at, if they haven’t already.