While one of the most respected professions, physicians also face incredible stress operating in today’s medical environment. Evidence of that is reflected in suicide rates.
Suicide is the top cause of premature death among physicians.
“The suicide rate among male physicians is three times that of the general population, and among female physicians the rate amounts to an astounding nine times higher than the general population,” says Dr. Dwalia S. South, president of the Mississippi State Medical Association (MSMA).
The pressures of the profession can be intense. South says one frustration is that it seems that physicians can never simply “get through” with a patient’s chart anymore.
“You can start out semi-fresh in the office on Monday morning with 35 or so patients on your schedule for the day,” South says. “After treating these patients, you will see a good half of those charts bounce back to your desk over the course of the week with Medicaid Prior Approval forms stuck to the top one day or a Medicare D plan mail order pharmacy fax requesting that you substitute your patient’s potassium prescription with their preferred brand of banana.”
She says physicians may get the bounce-back with a note from the patient himself requesting the doctor change a medication that the doctor agonized over prescribing the day before and fully discussed with the patient, counseling and reassuring for an interminable amount of time. The note says, “I’m not taking this medicine after I read that computer printout the pharmacist gave me. What are you trying to do, kill me, Doc?’”
A close race for her favorite bounce-backs are the Family Medical Leave Act forms and the dreaded 10-page Social Security Disability Determination forms.
Throw in the possibility of malpractice lawsuits, the inevitability of losing patients and the many other stressors physicians face, and it is no wonder that many physicians today face anxiety, depression and sometimes rage. Physician burnout is a commonplace but often ignored phenomenon within the ranks. It is estimated that 50% of physicians will face burnout at some point in their career.
“Virtually every physician I have spoken with lately readily acknowledges that the modern-day practice of medicine has become supersaturated with mounting stressors,” South says. “These range from unreasonable governmental regulatory controls, the loss of autonomy in our practices, third-party intrusions and unrelenting financial concerns. Too often these days, we find ourselves desperately succumbing to the cumulative effects of these frustrations.”
South says failure for physicians to care for their own minds and bodies can result in maladaptive behavior patterns, which in turn can morph into physician impairment, disability or even death.
“We refuse to believe that we are human and can suffer and die of all the same ailments as our patients,” she said. “My practice environment today is virtually unrecognizable compared to a mere 20 years ago. It seems that great hunks of my soul are nowhere to be found. I race to make production, to make each person’s needs fit nicely into a 10-minute slot. Numbers, numbers, numbers. I fear that the souls of my patients go hungry each day, as well.”
Rapidly changing, volatile situations
South believes it is critically important for physicians to care for their own emotional and physical health in today’s rapidly changing and volatile healthcare environment.
“Death and taxes are inevitable,” South says. “Physician burnout is not. If burnout simply killed us, well, that would be one thing. We’d be dead and done with it. But, far worse than that, it can make your life as a physician a hell on earth. There is so much more to be lost than just your life.
“I want doctors to stop thinking that we are somehow born with Teflon-hide that makes us immune to ailments that we perceive as character failings. Now during the course of a week in the office we can get boiling mad, burned up about something, totally steaming hot, seared, sizzling, scorched or even be half-baked, but I don’t want any of us to end up fried. I want us to wake up and have the resources to rekindle the fire of medicine every day.”
Unacknowledged and untreated burnout can cost dearly. In addition to being able to harm relationships with colleagues and partners in business, friends and family, it impairs the physician-patient relationship tremendously.
“You can lose the very thing that enables you to make a livelihood — your license to practice medicine,” South says. “The saddest note of all is that so many of us must get to that stage before we know there is a problem. Some of us physicians are as deeply in denial as our diabetic patients who don’t begin to get serious about their health until one day someone says, ‘I’m sorry. Your leg has got to come off’.”
South said most physicians who have complaints filed against them with the Mississippi State Board of Medical Licensure aren’t bad people. The licensure board gets a few physicians with senile dementia, and many of the physicians with complaints against them have a substance abuse disorder, sexual addictions, professional sexual misconduct and boundary issues.
“But sadly, so many of the problem doctors who face the board are people just like you and me who don’t fall into any neat category in that Diagnostic and Statistical Manual,” says South, who has served on the licensure board for the past four years. “These are doctors that are ‘dealing with a full deck’ but who aren’t ‘dealing very well with the hand that life’s circumstances has dealt them’ — doctors dealing with burnout.”
While not every physician dealing with burnout becomes impaired, it is important to recognize burnout. South says there are three stages of burnout:
• Stress arousal — you become irritable, anxious, forgetful, have mood swings, are unable to concentrate and blood pressure starts to rise.
• Energy conservation — morning fatigue, constantly late, procrastinating, resentful, socially withdrawn, lowered sex drive, apathetic, occasional headaches, and finding yourself using more caffeine products to pep up and alcohol to wind down.
• Exhaustion — deep sadness, profound physical fatigue, chronic headaches, relationships with family, friends and work deteriorate progressively.
“We all tend to put ourselves as a last priority,” South says. “We don’t like to ask for help. We become ‘people-pleasers.’ We feel that our own illnesses are a sign of weakness and refuse to acknowledge when we are sick. We don’t take enough real vacations or time off.”
It is important for physicians to acknowledge that burnout is not “simply having too much on your plate.” It is not incompetence, it is not a moral failing, it is not being a wimp, and it is not being a bad doctor.
“Quite the opposite is true in most cases,” South says. “But it can certainly be said that a burned out physician has not cared for himself enough. Another truth is that a lot of physicians are afraid of being labeled and treated for something that gets lumped in with all the other mental illnesses, afraid of patient and public opinion, or of sanctions or restrictions being placed on him by a medical licensure board. This happens in some states, thankfully not in Mississippi.”
South doesn’t pretend to have all the answers, but says physicians have to learn to rest. Coming to terms with human limitations in time space and energy is crucial to survive as physicians.
“Failure to acknowledge our limitations often leads to the denial of the immensity of our own personal needs,” South says. “We are so afraid of not being in control.
“The quick and dirty test of clinical depression and burnout is this: Take a full week’s vacation, and I’m not talking about a hybrid CME/family trip meeting. I’m talking a quiet agenda-free trip just you and your immediate family for a full week. If your symptoms disappear completely while you are away, it is highly unlikely that you have clinical depression.”
South has the following recommendations for physicians who find themselves in danger of burnout:
1: Pray and meditate.
2. Learn to say no.
3: Do something totally new.
4: Start exercising.
5: Start eating like you tell your patients to do and drink more water and less caffeine.
6: Make it a point to actively do things that you know lift your spirits.
7: Stop obsessing and worrying so much.
8: Get your own family doctor and get a reality check up.v
9: Renew relationships with those most important people in your life.
10: Make a house call and feel like a real doctor again.
11: Never let them call you a provider.
12: Don’t be afraid to seek help. Call the Mississippi Professionals Health Program (MPHP) if you need help.
“They are a fantastic and very confidential resource for physician health,” South says. “Physicians, please, help yourselves and help each other. Please call MPHP for assistance. MPHP will send help, or they will walk you through it, or they will do whatever it takes to help solve the problem and ultimately save someone’s career or life.”
MPHP contact information: Gary Carr, M.D., Medical Director (601) 261-9899; or, Kaye Gatewood, MPHP executive director 1-800- 844-1446.
Contact MBJ contributing writer Becky Gillette at email@example.com.