Written by Dave Verkh | International American University College of Medicine, Vieux Fort, St Lucia, West Indies
It’s a deadly secret that many of us keep inside. It’s a burden that only we can feel, while acting completely unaffected to the outside world. The thought of helping others before helping ourselves has been the mantra in the healthcare profession for generations. But one must ask, at what expense does the healthcare and wellbeing of the patient become more important than that of the physician treating them? Are patients receiving the best quality of care? Does mental illness increase medical errors?
Nearly one-third of doctors have some type of mental illness. Although the rate of depression is comparable to the general population, the rate of suicide for physicians is markedly higher. The relative risk varied from 1.1–3.4 in males, and 2.5–5.7 for women, when compared to the general population. The study also showed that the risk and rate of suicide tends to be higher when compared with other professions, measuring 1.5–3.8 in males, and 3.7–4.5 in females.1
Most interestingly, a study performed by the University of California, San Francisco, California, USA, showed that students entering medical school had rates of depression that were very comparable to the general population, while those in first and second year had rates of depression closer to 24%. Only 22% of the depressed students were reported to have perused any of the mental health services that were available to all students and faculty. Many of the students cited “lack of time”, and “no one will understand my problems” as the primary barriers to seeking help.2
So, we ask, what causes mental illness in the healthcare profession? What causes suicide rates to increase in such drastic way? There is no pinpointing one problem, or putting all the blame in one basket. Rather, it is a combination of stressors that overwhelm the physician and deadlines that are wholly unrealistic. The absurdity of codifying patient’s diagnoses and procedures, being audited by non-clinicians, staying hours after a shift has ended to finish charting in the Electronic Health Records (EHR), while not being provided any new tools to ease the pressure, are simply a few of the stressors our medical professionals face today. Doctors are not simply ‘just’ doctors anymore; they are managers. They are administrators. Not only do they heal, they must complete all the paperwork, follow every guideline, and record every consultation, electronically as well as via dictation.
An Australian otorhinolaryngologist by the name of Dr Eric Levi has become a speaker and an activist for doctors’ mental health and wellbeing. He is a social media spotlight that pinpoints some of the problems in the healthcare field that promote and facilitate mental illness. In his recent blogpost, entitled: ‘Changing the Culture of Health Care’, he outlines the need for considerable change in three areas: personal resilience, efficiency of practice, and culture of wellness, with emphasis that the increase in efficiency cannot come at the expense of the physician’s wellbeing. Dr Levi explains further how the languages spoken in a hospital contradict one another; those in administration rely on numerical figures and results, while the doctors would like positive patient outcomes. The healthcare practice, regardless of role, must find a solution for the wellbeing of all parties involved, allowing them to speak the same language.
Physician burnout is a topic that has been studied for nearly a decade, making efforts in order to combat its effects. The American Academy of Family Physicians (AAFP) defines burnout as:
- A syndrome characterised by a loss of enthusiasm for work, a feeling of cynicism, and a low sense of personal accomplishment
- An emotional condition marked by tiredness, loss of interest, or frustration that interferes with job performance
Although they are not synonymous diseases, the symptomology of burnout and depression are very similar. While the state of burnout is highly emphasised, the root of the problem rarely makes an appearance. The most reported causes of burnout include paperwork, feeling undervalued, and finding a work-life balance.3,4 We put emphasis on the importance of work-life balance, particularly, life. It is not solely the responsibility of the physician, but also the employer to facilitate an environment where the physician is able to create that balance.
Medical errors are a common cause of morbidity and mortality in a hospital. It is in the interest of both the physician and the administration to minimise all possible errors, particularly iatrogenic. According to the Institute of Medicine, between 44,000 and 98,000 patients die in the USA annually due to medical errors. Furthermore, >400,000 adverse effects of medication could have been prevented. A study published in 20085 revealed that residents, who are experiencing depression, make >6-times as many errors in prescribing medication as those who are not depressed. In addition, those who are depressed or burnt out reported poorer health and higher error rates than those who were not.
So, we ask again, why do we not do more to prevent mental illness in healthcare professionals? We cannot sustain a healthcare culture that does not promote mental and physical care for its employees. We, as healthcare providers, must do more to facilitate an environment that we can thrive in, and mental illness, regardless of who is affected, should never be stigmatised, but rather brought to light.
- Bright PR. Depression and suicide among physicians. Curr Psychiatr. 2011;10(4):16-30.
- Givens JL, Tjia J. Depressed medical students’ use of mental health services and barriers to use. Acad Med. 2002;77(9):918-21.
- Shanafelt TD et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-85.
- Lee FJ et al. Stress, burnout, and strategies for reducing them: what’s the situation among Canadian family physicians? Can Fam Physician. 2008;54(2):234-5.
- Fahrenkopf AM et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336(7642):488-91.