Physician burnout, suicide take a toll on everyone, and it’s getting worse. What’s the answer?

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The News:

Nearly two-thirds of US doctors feel burned out, depressed, or both–and those feelings affect how they relate to patients, according to a survey conducted by Medscape.

“One in three depressed doctors said they were more easily exasperated by patients; 32% said they were less engaged with their patients; and 29% acknowledged being less friendly,” said Leslie Kane, Senior Director, Medscape Business of Medicine, according to Reuters.

In addition, nearly 15% of depressed doctors said their depression might cause them to make errors they wouldn’t ordinarily make, while 5% said depression led them to make errors that might have harmed patients.

More than 15,000 doctors across 29 specialties responded to survey questions about depression and burnout, which was defined as feelings of physical, emotional or mental exhaustion; frustration or cynicism about work; and doubts about the value of their work.

Critical care doctors and neurologists had the highest rates of burnout (48%), followed by family doctors (47%) and ob/gyns and internists (46%).

The lowest rates were among plastic surgeons (23%), ophthalmologists (33%) and dermatologists and pathologists (32%), all specialists who are less likely to work under emergency conditions, according to the report. Fourteen percent of all doctors surveyed said they feel both burned out and depressed.

“Some specialties, by their nature, have shorter visits with patients and may have more pressure to see patients faster,” Kane said. “They don’t feel they can have the satisfaction of getting to know their patients, which was once the norm.”

“For doctors such as primary-care physicians who see many patients in relatively short time frames, it becomes increasingly difficult to stay on schedule and feel that there is any ‘decompression’ time during the day,” Kane noted.

Physician burnout and depression are driven largely by bureaucratic and practice demands, but “patients can make a difference,” she said.

“For example, if you have a problem with or complaint about something that happens in the office or an interaction with the office staff, try to find a way to let the physician know,” Kane suggested.

“Giving the doctor a chance to solve or address the problem averts having a disgruntled patient write a nasty online review for something the doctor wasn’t aware of,” she said.

Dr. Carol Bernstein, a past president of the American Psychiatric Association and professor of psychiatry and neurology at NYU Langone Health in New York City told Reuters Health, “Physician wellbeing is important because physicians who care for themselves will do a better job caring for others, and are less likely to make medical errors or leave the profession.”

Steve’s Take:

It’s been known for more than 150 years that physicians have an increased propensity to die by suicide, says Medscape. It was estimated in 1977 that on average the US loses the equivalent of at least one small medical school per year to suicide.

Exact numbers are not known. Although it is impossible to estimate with accuracy because of inaccurate cause-of-death reporting and coding, the number most often used is approximately 400 physicians per year, or perhaps a doctor a day.

If burnout has reached the point where we’re losing 400 physicians to suicide each year, that’s like a 747 going down. Something’s obviously very wrong with this, and the situation’s been getting worse, not better.

The Medscape survey referenced above gives the stats and doctors’ responses to whether they’re in the burnout cohort. And there’s the time-worn whys as well as the why-nots.

But given only token coverage is the depressed group. And they’ve learned what clinical depression is, versus mere burnout. I’d like to know what happens with this group, at least here in the US.

Of all occupations and professions, the medical profession consistently hovers near the top of occupations with the highest risk of death by suicide. Sadly, although physicians globally have a lower mortality risk from cancer and heart disease relative to the general population (presumably related to knowledge of self care and access to early diagnosis), they have a significantly higher risk of dying from suicide, the end stage of an eminently treatable disease process.

Perhaps even more alarming is that, after accidents, suicide is the most common cause of death among medical students.

So, what are the constructive recommendations that can address “change fatigue”—-one of the primary drivers of burnout among healthcare workers, particularly physicians who work with a traditional autonomy that carries some risk of becoming isolating and depressing?

The medical community widely recognizes the stresses physicians face. The overwhelming consensus is now is time to take measurable steps toward changing the profession.

Sadly, “Practicing medicine is bad for your health,” says Marschall S. Runge, MD, PhD, executive vice president for Medical Affairs at the University of Michigan and dean of the U-M Medical School.

Mounting evidence shows that stress-related burnout is a significant and growing threat for doctors–and their patients, according to Dr. Runge. But if there is a silver lining, it is that the medical community is finally beginning to acknowledge and address the complex factors at play, recognizing that good health care must include caring for caregivers.

The Medscape survey found that 51% of doctors surveyed in 2016 said they experienced burnout, an increase of more than 25% since 2013. This dovetails with a 2015 paper published in Mayo Clinic Proceedings that reported a burnout rate of 54.4% in 2014, up from 45.5% in 2011.

A 2015 Mayo Clinic study reported that roughly 40% of physicians suffer depression each year and almost 7% had considered suicide within the prior 12 months. Burnout is also connected to the decision to switch jobs or leave medicine altogether–an ominous trend as the US experiences a growing doctor shortage.

The challenges of balancing work-home obligations take a special toll on female doctors, whose burnout rates are twice as high as those of their colleagues, making them more likely to leave the profession.

Bottom Line:

“Medicine has long been hampered by the ancient myth of invincibility–the notion that physicians must never show weakness, always embodying grace under pressure”, Runge adds. “This is not only wrong, but also adds to the emotional toll on our physicians.”

Physician burnout is a national crisis. As I’ve written previously, it also costs the country $5 billion every year and puts patients at risk.

Steve's Take: We can all help relieve #physicianburnout by sending your #doctor a note thanking them for a particularly good visit or for refilling a prescription you forgot about. Click To Tweet

One solution – reduce the problem with paperwork:

It can take 32 clicks to order and record a flu shot, Runge notes sarcastically. Some studies show that doctors now spend about two hours on paperwork and desk work for every hour they devote to patient care. Personal contact is a major reason people choose careers in medicine, so it is hard to overstate how much this dispiriting lack of contact leads to the depersonalization and depression that are the hallmarks of burnout.

The use of “scribes” to handle some paperwork chores and drawing a sharper distinction between the care only doctors can deliver and that which physician’s assistants and other trained personnel can effectively provide would also help. Runge says Michigan will soon begin pilot programs aimed at creating such an environment.

Another solution – help physicians achieve a better work-life balance:

The next level is to make small, meaningful changes to help physicians achieve a better work-life balance, such as implementing more flexible scheduling that recognizes family commitments and better child-care assistance.

Dr. Runge points out that at the University of Michigan, two groups were added last year: one to look for meaningful changes among doctors and the second to focus on these same challenges among younger residents. Although some comfort results from providing yoga or meditation classes at work and the like, in the big picture, these approaches are not treating the root problem. It’s like putting a Band-Aid on an inflamed skin lesion–it may help temporarily, but it does not address the core issues.

Unfortunately, there is no quick solution. Medicine will always be a uniquely demanding profession, requiring years of training and long hours of service to be ready to make life-or-death decisions.

Still, a rock-solid start is the broad consensus these days that doctors cannot provide the best care if we don’t fathom how to take better care of them. As a patient, I can start by sending each of my doctors a note thanking them for a particularly good visit or refilling a prescription I’d forgotten about. It’s not much, but it’s a start.

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