TRIGGER WARNING: PHYSICIAN SUICIDE
By: Michelle Wenner Chestovich, MD, family physician, Entira Family Clinics, West Saint Paul; certified life coach
Exhaustion is sneaky. It grows slowly and we have been trained to keep working anyway. I think it is time to see exhaustion as a vital sign. When our body is crying out for rest, with headache and nausea, we must learn to listen. When dread fills our heart as we drive to work in the morning, we must take note. When the daily struggles seem to stretch on and on and there doesn’t appear to be a break in sight, and we drag ourselves to the weekend where we may finally get a small break, it is time to reach out for help. While life is challenging as a physician, it doesn’t need to be so hard. Please let someone help. Don’t just wait in hope that things will get better.
I have always been a passionate advocate for physician wellness. For years, I’ve asked others at our early morning meetings: “Who has gotten good sleep and exercised this week?” I’ve personally floated in and out of burnout many times, and I know that sticking to the fundamentals—sleep, hygiene, exercise, healthy eating, less caffeine—helps keep us from drowning. And yet, I’ve since realized that there is so much more that needs to be done than just these fundamentals. A recent tragedy in my family has made this flame to help “heal the healers” burn even brighter.
TOLL OF EMOTIONAL & PHYSICAL EXHAUSTION
Emotional exhaustion is a well-known, key component of physician burnout. Physical exhaustion, however, also greatly contributes. When we don’t meet the basic needs of our body, we have trouble functioning. We begin to dread the future and upcoming calls because we are already so darn tired. Occult depression, which can be born from burnout, is a disease as malignant as cancer.
We need to learn to screen for it in medicine as we do for breast cancer. My dear, younger sister, Gretchen Wenner Butler, MD, recently died unexpectedly from suicide. Everyone who knew her is absolutely shocked and heartbroken. She was the most amazing and adventurous woman who spread kindness everywhere she went. Even those who only spent a month with her during residency rotations had kind words to share. She had been named resident of the year and resident teacher of the year. She was recognized by both patients and staff as truly exceptional. She was the most loving mother of her three children and a wonderful wife, sister, daughter and friend. She worked as a radiologist at Minneapolis’ Hennepin County Medical Center and loved providing care for underserved populations.
INCREASED RISK OF PHYSICIAN SUICIDE
Statistically speaking, physicians (and especially physician women) face two to three times the suicide risk of the general population. In the United States alone, we unfortunately lose approximately 300-400 physicians each year to death by suicide. The pandemic trauma over the past 13 months (and counting) has served to dramatically increase the stress, isolation and depression—both observed/acknowledged and occult—that our medical providers face.
As a physician who has been dedicated to physician wellness for years, it is particularly troubling to me that my sister didn’t reach out for help. This makes me realize that, once a physician falls under the spell of depression, they may be unable to ask for help. As a result, if we, as a profession claiming to care for people, have any genuine desire to help our wonderful colleagues, we must do more to proactively recognize and take affirmative actions to help physicians before it becomes too late.
CULTURE OF MEDICINE MUST CHANGE
It is simply and manifestly insufficient for an organization to say “call this number if you need help” or “join the yoga class we provide once a month.” Real systemic changes must occur: regular support needs to be offered, protocols developed, investments committed. Perhaps as importantly as tangible changes, the very culture of medicine must change.
So how do we start making these needed changes in the culture of medicine and help the providers who are most at risk?
Adopt work-hour limitations. The week before my sister died, she was on call and worked 36/48 hours of the weekend. This, of course, was just a piece of the tragedy, but her exhaustion certainly contributed to her death. Other professionals, such as pilots and truck drivers, are limited to the hours they work. A few years back, work-hour restrictions were mandated for residency programs. Why not for the profession at large? Remember:People with medical degrees, or other degrees making them care providers, are people—human beings. We need adequate sleep and rest, hydration and interaction with others.
Change our mindset. As physicians, we need to “unlearn” the training that got us here; namely, always doing more and always saying “yes” is not the answer when inside we ache to say “no, I really can’t.” We need to learn to ditch the guilt and perfectionism that may have served us well in a short-term educational environment but literally grinds us down throughout the rest of our adult and professional lives.
Increase access for mental health support. We need regular, ongoing support for our mental health. We routinely deal with life-and-death situations. We deliver horrendous news to families, and we are firsthand witnesses to all of the trauma and heartbreak that visits our clinics and emergency departments daily. As an empathic radiologist, my sister felt the sadness and heartache of all the patients for whom she cared. She would often share with me some of her most difficult cases, and I could hear the heartache in her voice. Despite this, we have no real support other than “reach out if needed.” This approach is not working, and it is never going to. Even when someone is supported and loved, and capable of caring so much and reciprocating that love, it is too much to ask of a human being whose brain is already sick.
Offer professional coaching and other interventions. Besides changes in the culture of medicine, there are very effective, simple and proven(!) ways to help physicians reduce symptoms of burnout and improve their own self compassion. A study in JAMA Internal Medicine (1) showed that there was significant reduction in emotional exhaustion and overall symptoms of burnout, as well as improvements in overall quality of life and resilience, after only 3.5 hours of physician coaching.
Wouldn’t this be a simple solution to the overwhelm and burnout that physicians face? What if this was the norm and a part of the benefits package when we sign for our “dream job”? I think it needs to be—together with other organizationally supportive programs that strip away, or at least alleviate, the tedium of our jobs. These approaches can dramatically lower the great cost of provider burnout that is borne by organizations in the form of turnover, reduce medical mistakes and increase the satisfaction of the patients we profess to love and serve. Different approaches—namely preventive ones—to our epidemic of physician and provider burnout is what we, as providers and human beings, need.
To listen in on how I think exhaustion needs to be viewed as a vital sign to burnout and occult depression, I encourage you to listen to Episode 11 of my “Re-Mind Yourself ” podcast. Please take eight minutes to listen and share with a friend who also needs to hear this message.
REFERENCE
1. Dyrbye LN, Shanafelt TD, Gill PR, et al. Effect of a professional coaching intervention on the well being and distress of physicians. JAMA Internal Med. 2019;179(10):1406-1414.
This article originally appeared in the spring edition of Minnesota Family Physician magazine.