Saving a physician from burnout saves patients too

Burnout has taken center stage in health care. It impacts every aspect of care and our careers, as we realized we were not living out the ideals and values we thought we had signed up for. As we “merrily” worked along, it was the little grains of sand that grew into pebbles and now into boulders that we carry on our backs. Our gait has gone from brisk and resilient, to struggling at a crawl. Every study and survey in every specialty at every stage of a career documents the sometimes overwhelming signs of burnout. Whether you want to call it something more elegant like a “moral insult” or think you can transcend it, it is pervasive, insidious and affects all of us.

At first, we tried to adjust, adapt, and reassure ourselves we were valiant protectors of our patients and could take on anything. But then it became apparent. Outside forces were multiplying and imposing on the very quality that drove us to become physicians. We could not focus on caring for our patients as they have been usurped by regulatory, payment and technology-based requirements. And that has deflated and maybe even defeated the altruism that once nourished our souls.

Even worse, we have discovered this is a contagious disease, that not only affects us but the people we work with at every level of health care delivery and operations.

We have started to take a systematic approach to right this listed ship — addressing operational, institutional, regulatory and payer burdens — but it is a slow and intentional process. Even worse, it overlooks what may be the most horrendous outcome and fundamental issue to address: physician suicide.

Every day, one physician commits suicide. That roughly translates into two medical school classes a year and has been extrapolated as an estimate that one-million patients would lose their doctor yearly. It doesn’t matter how you look at it, it is a crucial and often preventable loss of life that has ramifications that go beyond the individual and their patients, forever impacting their families and colleagues in so many unfortunate ways. This rate is twice the rate of the age-adjusted general population, and the sub-rate for women physicians and those in training is even higher.

Who knows what feather finally breaks the back of a vulnerable physician who has been secretly struggling with the stress of their work and may have been suffering through depression or some other mental health issue in silence? Worse yet, it can be compounded by self-medication, whether it be prescription drugs or alcohol. The reluctance to admit, much less seek help when it is most needed, is way too prevalent in our profession. The potential for loss of professional respect, patient trust and licensure due to the disciplinary rules of regulatory and credentialing organizations is crippling and can precipitate even worse outcomes.

I am an independent practice pediatrician. I care tremendously for our profession and the service it provides to improving the lives of our patients and the health of our communities. It is an incredible privilege to be a physician, and we have all been forced to deal with distractions, diversions, intrusions and friction which undermine our care and divert our precious resources. There are so many ways we need to be strong and cultivate the leadership that is necessary to correct the course of health care and our professional identity in this great country.

Still, the most important thing we can do is save a life, especially one that is unnaturally plotting its own demise. We can help our colleagues who are in distress and just showing the signs through their behaviors and interactions.

There are signs and symptoms that we can identify and help them before there is a terrible outcome. The Physicians Foundation has taken on the cause of physician wellness, helping bring together thought leaders, supporting research and partnering with our professional medical organizations to devise and implement operational transformations that can reduce burnout and improve wellbeing and professional satisfaction.

Even more important, the foundation has developed a simple approach to starting the conversation with a struggling colleague. It is called Vital Signs. If it helps you recognize and intervene to save one life and sustain a professional career, you have helped thousands of patients. That effort you make to help someone in desperate need can also save their family and colleagues from indescribable pain.

If you are, or someone you love is a physician, learn the warning signs to look for in someone who might be burned out or suicidal. Hospital systems, medical societies and the health care industry, in general, lack the resources necessary to help physicians who might be experiencing suicidal thoughts.

As physicians become aware of the warning signs, the stigma around mental health will lessen, and we can start conversations about the stressors we face.

Russell Libby is a pediatrician and board member, Physicians Foundation.

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