Check out this 4 minute video clip. What you will see is two female Cardiologists, discussants in my On Doctors’ MindsSM project, talking about the reasons that the pandemic is causing them both major stress. Covering for sick colleagues, concern about lack of PPE, worry about bringing the disease home to their families, being forced to treat hospitalized COVID-19 patients even though they are not trained as Intensivists, etc. are all contributory factors here.
Bottom Line. As I talk with these physicians every month, I wonder… I wonder what impact this stress is having on their current treatment of patients. I wonder whether this stress will cause them to burnout, retire, develop mental health problems, commit suicide.
Again, Wolf Blitzer and Lester Holt have done a wonderful job taking us inside the “nation’s busiest ICU’s” and showing us the living hell that the pandemic has made of the lives of Intensivists. BUT. Office-based Primary Care Physicians and other specialties will also likely be suffering the psychological sequelae of the pandemic for years to come!
I haven’t posted about Dr. Pamela Wible in 2021. I covered her several times in 2020. Her dedication is to the concept of “Ideal Medical Care,” which in her view must satisfy the needs of both patients and physicians to be sustainable.
But in fact, most of the posts I wrote about Pamela dealt with her dedication to understanding and preventing physician suicide. After my multiple posts centered around the theme that physicians have the highest suicide rate of any profession, I figured you had gotten the point and I moved on.
Then I found a new piece by Wible that offers a fascinating comparison. Check this out. What you will see is a comparison between a Duchess and a Doctor. As revealed by the recent interview with Oprah, things got sufficiently bad for Meghan during her time in the Royal Family that she considered suicide. When she asked for help from the “firm,” she was told to just maintain a stiff upper lip. As Pamela demonstrates in this piece, doctors are largely told to do the same thing. If that doesn’t suffice, we see here the laundry list of gyrations doctors have to go through to seek mental health care without being found out. Travel long distances! Use an assumed name! Pay cash for care! It should not be lost on any of us that a doctor being forced to go through these machinations to get assistance with mental health problems is quite likely to have these problems get worse. Much worse!
Bottom Line. Amazing! And very unfortunate!!! Pamela has been on this MD suicide prevention crusade for years now, and this is still the way things are. Even with the pandemic raging and physicians stressed now more than ever.Thought question. What will be required to change this dreadful set of circumstances???
A few days ago, a colleague asked me whatever happened to all of my blog posts on physician burnout and suicide. I had no immediate answer to the question. Strange. I must have written fifteen or twenty posts on those topics over time, but they had largely dried up over the course of 2020. Like so many newscasters, I had become so tied up with my observations about the pandemic that terms like “physician burnout” and “physician suicide” had largely, make that totally, disappeared from my posts.
I need to correct that here and now. Check this out. What you will see is a fascinating and in depth ABC story of the impact of the pandemic on front line physicians. There are several important things to note.
First, the causes of physician burnout and suicide have changed during the pandemic. In the “good old days,” they were caused by annoying, but relatively benign, things like having too much administrative paperwork to deal with. Not anymore. Now they are caused by:
Amazingly intense and long work weeks. I had a conversation with an Infectious Disease Specialist in December who told me that the day after we talked would be her first day off in 2020.
The unique horror of having to hold the iPad of patients who were saying goodbye to their relatives who weren’t allowed to be with them at the end. Or of holding their hands after the conversations.
The traumatizing experience, typically several times each day, of having to tell someone over the phone that their loved one has just succumbed to COVID-19.
The fear of carrying the infection home to their beloved families.
Yes, physician burnout, anxiety, depression and suicide are indeed on the rise, and changing in their causation and depth, resulting from a year long period of physicians experiencing threat induced hyperarousal without the fight or flight possibilities that are supposed to be available under such circumstances.
Bottom Line. Complicating all of this is physician “stoicism.” The training of physicians that they should not appear to be cracking under pressure. The result? They just crack internally.
The solution? There is none really. But palliation can be obtained through compassionate support. You can see this balm being applied in pictures like the one above. Hugs, yes risky hugs, are about all the compassion that front line physicians (and nurses, and respiratory therapists, and…) have time for during these days of the pandemic.
I am guessing that you all know this story by now. The story about the New York E.R. physician, Dr. Lorna Breen, pictured above. The story of how she was in charge of the E.R. in one of the most devastating epicenters of COVID-19 in N.Y.C. during the most devastating days in Gotham. How she contracted and survived the disease herself, only to succumb to a feeling of helplessness in the face of the pandemic. “I couldn’t do anything” was her summary statement of that feeling prior to her suicide.
But even though you know the tragic story, you still may want to check this out. What you will see is a detailed recounting of Lorna’s struggle and the attempts by her dear sister to help Dr. Breen to avoid disaster.
Bottom Line. As I read this NYT story over for the second time, a chill suddenly went up my spine. Why? Because I suddenly realized that it was because Dr. Breen was such a good/dedicated/perfectionist doctor that she couldn’t take the helplessness anymore and ended her own life.
And so? And so I am greatly concerned that it is going to be the great doctors like this one who are going to have the most permanent psychological damage from being “on the front lines.” It might not drive all of them to suicide, but 2020, this year of constant and multiple stresses for all of the HCP’s involved, will certainly leave its mark on our best and our brightest.
Check this out. What you will see is a light but important blog by a physician who feels that it is important to distribute uplifting messages to colleagues in the profession. In this post, the message is that while it is obviously important for an ER doctor not to suck in the line of duty, it is okay for a physician to be less than perfect in other aspects of life.
Bottom Line. While you are at the referenced URL, take a look around. You will see that the entire site is dedicated to the theme of “Physician Heal Thyself.” Many different upbeat posts and graphic elements. Up against the backdrop of physician unhappiness, depression and suicide, and especially with COVID-19 exacerbating an already bad situation, it seems especially important in 2020 to have a physician, especially an ER physician, sharing these upbeat messages with colleagues.
In the last couple of posts, we have talked about “little things” that can be done to reduce physician burnout. First, we covered practicing Physicians with Dr. Wible. Then we covered Residents with Dr. Orlovich. Now it is time to look at medical students with Dr. Choi.
Check this out. What you will see is the Dean of a medical school telling you that medical students are, at their tender age, already burning out. Many numbers being bandied about here. One study reports 56% of medical students are burned out. At the University of Pittsburg, 1 out of every 6 medical students has received mental health services. And it’s getting worse. At the institution where Dr. Choi is Dean, the number of medical school students reaching out for an appointment with a Psychiatrist has increased 60% in the last four years.
What to do? Clearly, providing accessible mental health services is important, but relying on that is dealing with the result, rather than the cause, of an environment that burns out medical students. Coming up with “resilience training” programs does the same.
SO. Is this like the last two posts, where manipulating some “little things” might make a big difference? Like, as is suggested here, grading courses on a pass/fail basis, thus reducing arguably meaningless academic competition?
Bottom Line. SO. If two points determine a line, how about three? We have now heard three knowledgeable authors opine that from medical school through residency and into practice, manipulating “little things” might help to reduce burnout.
Check this out. What you will learn is that he is the “Chief Resident of Wellness” at Stanford University. Interesting in and of itself. But the plot thickens. Continuing on the theme of my most recent blog, wherein I referred you to Dr. Pamela Wible’s presentation on practical things that can be done to reduce physician burnout, Dr. Orlovich recounts a study that found that simply granting Resident physicians a handful of “wellness days” every year can actually reduce their burnout rate.
Could it be that we could significantly reduce physician burnout by chipping away, one by one, at the laundry list of “little things” that cause it? Note the comment made to Dr. Orlovich by a physician coming to Stanford from another residency program. “Do you know how much they charged us to park there every month?” Overcharging in the cafeteria, no call room, other little things about her previous program just, well, made her nuts!
Bottom Line. There is no question that training to be a physician is inherently hard. BUT. What happens if we reduce the nonsense that has nothing to do with the training process?
Dr. Wible told us in the previous post that such improvements can reduce burnout rate for practicing physicians. Seems that the same thing might be true for Residents.
As I have mentioned previously, on February 5th of this year, I had the opportunity to give a presentation on physician burnout and suicide at the Pharmaceutical Marketing Research Conference in Newark, NJ. It was a very interesting experience. Amidst the Conference’s presentation after presentation on research methodologies, I spent my 35 minutes telling attendees that their physician customers/respondents were not as mentally healthy as everybody assumes they are. This was a new idea for most, and after the presentation I heard a number of comments indicating that the presentation had struck an important chord. Several participants asked if anybody is doing anything about the fact that 400 physicians in the U.S. commit suicide in an average year, and 50% of physicians report being burned out.
Answer? Yes! Check this out. What you will see and hear is a presentation made by Pamela Wible, M.D. Pamela has been studying physician suicide throughout her career. More importantly, she has been developing suicide prevention interventions that work, unlike the resiliency programs, meditation courses, and other nonsensical attempts that are currently being foisted on physicians by their “administrators.”
Bottom Line. Although Dr. Wible’s presentation lasts an hour, I think you will find it a very good use of your time. As pharmaceutical marketers and marketing researchers, I believe that we have a responsibility to make sure that we understand the mental health issues bedeviling our physician customers, to do what we can to help and, at the very least, to make sure that our presence in the physicians’ psychological space doesn’t make the problems of burnout and suicide any worse.
Check this out. What you will see is that a single hospital in Israel, pictured above, has had four physician suicides since 2018. Amazingly, two of the physicians weren’t just Residents, who kill themselves with an extremely unfortunate regularity due to the stresses of training, uncertainty and long work ours. Nope. One headed Plastic Surgery, the other Soroka hospital’s Cardiac ICU.
When I visited Israel years ago, I had the opportunity to visit with one of the world’s most renowned spine surgeons and his OR RN wife. We had sort of an amazing conversation. Routine in Israel is to work 6 days a week, taking only the sabbath off. Both the Doctor and his wife did that without complaint. Amusingly, his only concern, and it was a serious one for him, is that he got paid no more by the government for his expertise than did a Dermatologist who “just pops pimples.”
But scroll forward a couple decades. We see doctors in this Beersheba hospital working 430 hours a month to keep up with their surgical and training schedules. And yes, the hospital put in a program to try to prevent further suicides. And yes, the hospital says that the doctors are their “top priority.” But no, that doesn’t really cut the mustard when you still have physicians working well over 100 hours a week.
Bottom Line. Around the world, we seem to have the same problem. Administrators (Who I am guessing are notworking 430 hours a month!!!) are installing “Resiliency Programs,” when what they really need to be doing is to make physicians’ work lives more manageable.
In a couple of weeks, I am going to be making a presentation at PMRC on the three reasons why pharmaceutical marketers and marketing researchers need to start to include physician burnout in their understanding and segmentation of physicians. I am going to begin by expressing my frustration at the fact that although I have been writing about suicide and burnout for several years, nobody in our industry seems to care.
Check this out. You will see the answer. You will see that when a young, highly trained vascular surgeon admits that he has suicidal ideations, he is not likely to be going back into the operating room very soon. Or at all. You will learn about one such doctor who traded the OR lights for stage lights, and now speaks about mental illness as a way to get people to join the conversation and move toward openness about mental health.
Got a couple of minutes? Watch the video on the left. In 3 minutes, you will see Dr. Su start to realize that he was mentally ill when he seriously considered jumping off a bridge during a Cub Scout hike that he was leading. Take another couple of minutes with the video on the right side of the page, and you will hear him talk about “framing” discussions not around mental illness, but around mental health. Talking about goals and small step accomplishments as if they related to “leg day at the gym.”