EDITOR’S NOTE: This is the second in a series of articles on the issue of burnout among physicians – a problem leading medical experts say is not only increasing in prevalence, but also intensity. During the coming month, several of these experts will be making appearances on Talk-Ten-Tuesdays, the weekly Internet radio broadcast focusing on all things ICD-10.
There’s a good reason adult airline passengers are instructed to put on their own oxygen masks first in the event of an emergency – they have to make sure they address the immediate danger to themselves before they can help those who can’t do the same.
The same principle could – and perhaps should – apply to the untold number of physicians suffering from burnout in the world of 21st-century healthcare delivery.
Physicians have higher-than-normal rates of clinical depression, post-traumatic stress disorder (PTSD), and addiction when compared to the general population noted nationally renowned psychiatrist H. Steven Moffic during a recent Talk Ten Tuesdays broadcast. Moffic was one of four healthcare professionals to speak on the topic.
“We now lose more physicians to early retirement due to burnout, but most frighteningly, physicians have the highest suicide rate of any profession in our country,” Moffic said. “Why is this happening to physicians at a time when there are actually more ways to help patients (than ever) – a paradox, no? Well, there’s a long list of causes, though most probably convene at a decrease in empowerment … in addition, burnout develops insidiously, making it harder to notice. Ironically, it is the most compassionate and experienced physicians that seem most at risk for burnout.”
Dr. Melissa Walton-Shirley, consulting cardiologist at Saint Thomas Heart in Gallatin, Tenn., a suburb of Memphis, said the issue hit home for her in a very personal way. She, too, shared her observations during the recent broadcast.
“I had a friend who was a physician that committed suicide about four years ago now; he just got into this helpless (downward spiral) and really couldn’t get out of it. It was extremely tragic, and it happens more often than people understand,” she said. “I actually had seen him two weeks before he (died); he came to my office, and I feel terribly that I did not recognize that this was getting ready to happen. I think one morning he just got up and decided ‘it’s really not worth it anymore,’ and ended it while his wife took his children to school.”
“Physician burnout is the first step toward suicide, in my opinion,” Walton-Shirley added. “I had an experience once where I felt like I was getting burned out, and I went to talk my minister because I knew I could not talk to anyone else – this was probably 15, 18 years ago. My minister looked at me and said ‘you know, Jesus Christ knew he had the entire world to save, but he (once) got in a boat and rowed away – he knew he had all these people counting on him, but he needed a break. And if Jesus Christ can take a break, so can you.’”
From that point forward, Walton-Shirley said, she started planning her calendar so that every two or three months, she took a three-day weekend to, in her words, “recharge and reenergize.”
She also noted that patients often can easily recognize signs of burnout in their own physicians.
“If your physician will not look you in the eye or they don’t spend enough time with you, they don’t answer your questions, and they just keep doing the same things for you and you don’t get better, then perhaps your physician has an issue,” she said. “If a physician feels like they are getting into a problem, they should take some time off. The patient can also do the same thing, they can take a break from that physician, but oftentimes patients don’t want to do that – they fear they’re going to hurt their physician’s feelings, especially if it’s someone they had a longstanding relationship with.”
Walton-Shirley added that it’s important for physicians to develop a degree of self-awareness regarding their own mental and emotional health, noting that while there may not be a clinical definition for “burnout,” you know it when you see it.
“I think (it’s) when you no longer look forward to greeting the day, when you dread having to go in to work, when you finish at the end of the day and you’re really not finished and you start to get this sinking, helpless feeling that no matter how much you work, you’re just a hamster on a treadmill,” she said. “We have to try to impress upon our healthcare providers that their health has to come first too, or else they can’t effectively take care of others.”
“Medicine is hard work under the best of circumstances,” Walton-Shirley concluded. “There’s long hours, heavy workloads, high levels of responsibility, (and) it deals with human suffering and complex ethical dilemmas. So we need to train folks better, and I think the healthcare system in general needs to keep an eye toward the way (this) impacts physicians.”