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Encouraging physicians to talk about their mental health and practice self-care are important tools to prevent burnout and suicide.
A year and a half ago, Kip Wenger, DO, systems medical director of Team Health in Knoxville, Tennessee, found himself tending to a colleague in the ER who died of her self-inflicted wounds.
Hit hard, the emergency room physician for 31 years describes the suicide as a “wake up call.” Sadly, it was not even the first time he’d lost a colleague to suicide.
“I can count on more than one hand colleagues of mine who have taken their own life,” he said. The physician’s death further girded his belief that medicine is overdue for a culture shift that encourages physicians to talk about their mental health and burnout. “Doctors are bad at being vulnerable,” he says.
Lauren Appio, Ph.D, a New York-based psychologist specializing in personal and professional caregivers, agrees that high achieving people, such as physicians, often avoid being open about mental health issues due to fear. Whether fear of job loss or simply that the job has become a core part of a physician’s identity, “there’s a lot of fear that leads people to avoid addressing these issues until it becomes glaring,” she says.
Wenger feels that “[Healthcare systems] need to make it OK to stand up and say ‘hey look, I’m having a problem,’ and not fear that you’re going to lose your job.” In addition, he feels that hospitals and medical systems need to make physicians and other providers aware of their vulnerability to depression.
In lieu of waiting for a medical system shift, Appio recommends some strategies physicians can employ at any time:
Appio urges her patients to focus on their self-care at the most basic level: eating well and getting enough sleep, and making sure their own wellness is a priority.
“We cannot pour from an empty cup,” she emphasizes.
In some cases this may mean that a physician should seek psychiatric care. “That’s really evidence of your commitment to caring for your community and your patients; it’s all connected,” she says.
Mental health issues “don’t just come out of nowhere,” she points out. It’s important that physicians figure out “what is the story they are telling about how they have come to be where they are?” If they believe their feelings to be random and invalid, they may be less likely to seek care, she says. It’s important they “connect the dots … about why they are stressed or depressed.”
In lieu of awareness, physicians might turn to less-than-helpful coping strategies, such as self-medicating with alcohol or food, which increase rather than help reduce stress. In her work, Appio tries to help clients “tip the balance more toward effective coping strategies like a support network, doing things that you enjoy, and making time for hobbies and other pleasurable experiences,” she says.
For physicians worried about how their particular culture or colleagues will support these efforts, especially when it could mean time off work, she suggests starting by finding allies within the working environment “who can be part of this network of support, and who will have your back.” This may be colleagues who are also friends, a mentor inside the system or even “creating support outside of the system, such as people in other hospitals or networks who are still saying ‘what you’re doing is right, and we’ll support you whatever the consequences.’”
Another way to approach this, she said, is to appeal to stakeholders in the system, from hospital administrators to patient advocacy groups, who can help make the case that a happier, healthier physician is better for the bottom line and patient care.
Appio and Wenger would both like to see more physicians encouraged to put down the tough-it-out attitude, and take up one of self-compassion.
“I would love to see a shift in the culture around allowing physicians to experience the full range of emotions,” Appio says. “Doctors are human, and that’s a good thing.”