Physician burnout, suicide: The postmodern doctor’s dilemma

Physicians experience burnout when the stresses of their work lead to emotional exhaustion and lack of a sense of accomplishment.  A recent survey of over 20,000 physicians found close to half, a record, self-report feelings of burnout.

Because data suggest that physicians who experience burnout are more likely to make medical errors, this phenomenon should concern all of us and not merely those who have friends and family who are physicians. Burnout is also a concern for nurses and other healthcare clinicians.

Risk factors for burnout include focusing on one's professional responsibilities obsessively, excessive workload, lack of sleep, and "frontline" exposure to patients such as experienced in primary care and emergency departments. Difficult interactions with patients with unrealistic expectations, demands of healthcare system administrators for productivity, added government regulatory requirements including use of an electronic health record, anguish over medical liability cases, and new requirements for maintenance of board certification could also be contributory factors.

When burnout becomes extreme, it can lead to depression and even suicide. It has been estimated that as many as 15-25 percent of medical students and resident physicians experience depression during the period of their training

The emotional toll of medical training appears to be increasing even as work hours and work conditions have generally improved under newer national regulatory guidelines.  A lessening of the public's perception of the superior nature of the medical profession may be a significant factor in the widespread burnout and even depression. The high level of respect that physicians previously enjoyed may have helped buffer burnout's effects.

Physicians don't like to admit to having an emotional problem because it could adversely affect their ability to practice. The attitude of "physician heal thyself" may also discourage them from seeking professional help. The result is that depression and related disorders often go untreated.

Physicians have a more than two-fold increased risk over the general population for dying by suicide, and this risk is even greater for female physicians. It is estimated that approximately 400 physicians commit suicide each year; that is equivalent to the number graduates from two medical schools. Physicians have ready access to lethal medications, but some physician suicides involve firearms.  An emergency physician who committed suicide in Texas left a suicide note citing dishonest expert testimony at his malpractice trial.  Outside forces, such as the shame of a malpractice judgment may be adding to the pressures that can lead physicians to take their own lives. The quality performance improvement movement, which intends to reduce medical errors, may also unintentionally add negative psychological consequences for clinicians.

I think it is fair to say that there a crisis in medical practice in the United States. We need to examine the cultural and social causes of this crisis if we are to maintain high professional standards for the medical profession.  No patient wants a clinician taking care of them who is burned out, depressed, or suicidal.  However, if we just focus on individuals and their psychological shortcomings, we will miss the big picture of factors afflicting postmodern healthcare.

As a start we need to teach physicians-in-training how to deal better with stress. Mindfulness training including meditation, case discussions of stressful practice situations, and other positive psychology practices need to be part of the curriculum of medical schools and should also be made available to practicing physicians. We also need to re-examine the current best practices in medicine to take into account their psychological impact on clinicians. Reevaluating the usual way of doing business in medicine is not just important for clinicians. It is also essential for the good of their patients and of society too.

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Arnold R. Eiser MD MACP is author of The Ethos of Medicine in Postmodern America: Philosophical, Cultural, and Social Considerations (Lexington Book, Rowman & Littlefield, 2014) and Professor of Medicine, Drexel University College of Medicine.

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