December 7, 2017

by Dr. Philippe Erhard

The fifth Canadian Conference on Physician Health took place in Ottawa in September 2017. Here are some highlights that I would like to share with you.

Did you know that the suicide rate for physicians is six times greater than the general population?

We don’t have any statistics for Canada, but in the US, 400 physicians commit suicide yearly.

We often think that suicide is secondary to negative events occurring in our life, but in reality is more complex as suicide depends on biological, psychological, social and environment factors.

What make us at risk for suicide?

  • Presence of mental illness
  • Family history of suicide
  • Feeling of shame, hopelessness or despair
  • Inflexible thinking
  • Anxiety and insomnia

Those risks are aggravated by a very prevalent stigma in physicians: mental struggles/illnesses are a sign of weakness and shame. Because of this, we delay or avoid seeking help, a very dangerous attitude.

What protects us from suicide?

  • Good social support
  • Access to care and in Manitoba, we have great services easily available to us
    o The Physician and Family Support Program (available 24 hours at 844.436.2762) offering psychological support,
    o MD Care (204 480 1310) offering psychiatric care
    o PAR (Physician at Risk-204 237 8320) offering help for chemical dependency issues).
  • Positive attitude toward mental health
  • Good coping skills and good problem solving skills

What are the warning signs of suicide?

  • Increased substance (alcohol or drug) use
  • Feeling or expressing that there is no reason for living; no sense of purpose in life
  • Anxiety, agitation, difficulty sleeping, or sleeping all the time
  • Feeling trapped, like there’s no way out, hopelessness
  • Withdrawal from friends, family and society
  • Rage, uncontrolled anger, seeking revenge
  • Acting reckless or engaging in risky activities
  • Mood changes
  • Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself
  • Looking for ways to kill oneself by seeking access to firearms, pills or other means
  • Talking or writing about death, dying or suicide when these actions are unusual for the person

As physicians, pressed for time, we often neglect self-care and we push ourselves through the day without eating, drinking or resting. A sociologist hired to study medical doctors in BC was horrified by our lifestyle and this lead to a study where different biological and mental parameters were measured during a ‘typical’ physician day, compared with an ‘atypical’ day when physicians were fed on a regular basis during the day (breakfast, mid morning snack, lunch, mid afternoon snack). Without food or rest, physicians had a significant deterioration of their cognitive functions and were functioning like somebody ten year older. This was also associated with decreased mental focus, increased mistakes, increased fatigue, increased irritation and poor social interactions. We need to remember that it pays to stop, take a few deep breaths, rest and eat…

Burn out was also a prominent topic as it is alive and well among physicians for multiple reasons:

  • Strong need for control and achievement
  • Exaggerated sense of responsibility
  • Need to please everyone (how do I say no?)
  • Difficulties asking for help
  • Excessive guilt
  • Suppression of feelings
  • Difficulties taking time for one self
  • Perfectionism and workaholicism
  • Professional exposure to suffering and chronic illness
  • Decreased reward of work (due to less time with patient and increased workload)
  • Conspiracy of silence are we avoid discussing our difficulties
  • Stigma of mental illness (with the underlying idea that if we can’t take the stress of medicine, we should get out)
  • The health care system

Another study mentioned several drivers of burnout

  • Work overload
  • Insufficient autonomy, lack of control
  • Non supportive environment
  • Decreased respect and appreciation
  • Misaligned values, work life imbalance, loss of meaning in work

The Consequences of burnout are serious for our medical practice and our patients:

  • Increased errors,
  • Increased patient mortality,
  • Decreased productivity,
  • Decreased patient satisfaction,
  • Decreased retention of physicians

It is important to develop mechanisms to cope with burnout, but an alarming study shows that 37% of 40 year old physicians are only using one wellness promotion tool to deal with the stress of medicine: waiting for retirement!

This is very inefficient and by maintaining delayed gratification, physicians go through life, never really present, never really living and neglect their own needs as well as those around them.

We have seen that as physicians, we have a significant elevated risk for suicide and depression and this leads to the following question: are universities recruiting depressed people?

A study showed that medical students before internship has a 4% rate of depression (similar to the general population), however this rate rises to 27% after 3 months of internship and persists at 6 and 12 months.

CBT (Cognitive Behavior Therapy) seems to be the best treatment for depression and suicide and a short 4-hour CBT session before internship decreased the risk of suicide by half.

Enough of bad news…

An interesting randomized study from the Mayo Clinic demonstrates that a facilitated small-group meeting for physicians improves elements of physician well being, including meaning, empowerment, and engagement in work, and reduce distress, including depersonalization. This intervention represents an important addition to meaningfully promote physician well being and regular bi-monthly meetings (usually in a restaurant) are now part of the curriculum of all physicians working at the Mayo Clinic. (Colin P. West, MD, PhD, Division of General Internal Medicine, Department of Medicine, Mayo Clinic, 200 First St, Rochester, MN 55905)

Dr D. Puddester gave us an excellent presentation coaching and I will give you an outline of it in a subsequent article.

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