Help Available For Doctors in Crisis |
By Barbara Kermode-Scott Medical Post October 12, 2004 Last year the
Canadian Medical Association (CMA) raised concerns about the issue of physician
health and launched a centre
for physician health and well-being. A CMA survey had revealed that,
out of 2,251 physicians surveyed, almost one in two (45.7%) were in an
advanced phase of burnout. These doctors were showing clear signs of depersonalization
in their relationships and were feeling that they were ineffective,
emotionally overrun and exhausted. "This
course should be a huge asset to train key medical decision-makers on this
issue," said Dr. Gautam, who also writes "Helping Hand," a
monthly column for the Medical
Post. At its annual meeting this summer, the CMA passed a resolution
to explore the feasibility of promoting an annual National Physicians' Week
to celebrate the contributions of Canadian physicians. "I am personally
excited by this," said Dr. Gautam. "I firmly believe that
appreciation of one's work leads to a healthier work environment, and
improved morale and job satisfaction.” At the
provincial level much is being done, too. In “It’s
no longer appropriate to just take a passive role,” he stressed. “A
lot of Over the
years, the program's founder and, until Sept. 1, when she stepped down, director
Robin Robertson has observed changes in how physicians are being affected by
stress in the workplace. These days, resource constraints are certainly an
issue, she explained. With fewer doctors dealing with more demands,
physicians are placed under higher stress than ever. Generational change “At the
same time, we have a generation of physicians coming up who are saying, 'I'm
not prepared to give my life to this' the way the generation before me did. I
believe that I can have both-I can have a life and a profession." Robertson feels
the next generation of physicians is going to be more willing to do what's
necessary to have a balanced lifestyle, whereas those who preceded them were
more willing to sacrifice their personal time for medicine. "There was a
different kind of work ethic... One's not better than the other. They're
just very different." The very
thing that makes medicine an exciting career also makes it a career with a
potential for burnout, she pointed out. The "It's
really about helping people make changes, positive changes in their
lifestyle prior to the 'cosmic two-by-fours,' " explained Robertson. "The 'cosmic two-by-fours' are things like marriage
break up, heart attacks and other serious things that happen in our lives...My
favourite saying is: 'Life is a journey, not a
guided tour.' We don't plan for the bad stuff that happens in our
lives." Although some
people are quite reluctant to make a cause-and-effect connection between
overwork and an unhappy lifestyle, a heart attack or a marriage breakdown,
intuitively we all know there is a connection, she
suggested. "We do
have studies that link those two things together in the workplace--workplaces
where there is high demand and little control. We end up with employees who
end up getting sick…Physicians have high demand and little control.
They really do fit into this category." It can be
tough for the younger audiences, the residents and medical students, to
understand they need to prepare for when things go badly in life, she added. They
need life practices in place that will enable them to be resilient when they
need to cope-not only with a demanding job but also with all the other
stresses that can come along in life. Talking about burnout Another thing
that's changed over the years is that there's a growing recognition that it's
acceptable to talk about burnout, suggested Robertson. "People are
saying it's not a sign of weakness that I'm feeling stressed or that I need
somebody else's opinion about how to handle these things." Another
change has been the loss of collegiality at the local level, with the loss of
doctors' lounges (now returning) and other opportunities for informal
networking. "We're trying to help physicians see the need for
collegiality," she explained. "We absolutely know that people who
have good support systems live longer and are more resilient to stress."
Dr. Gautam
also believes that how doctors handle stress now has changed in some ways,
but adds that in some ways nothing has changed. "Overall,
the culture of medicine is slowly changing and allowing that we are
vulnerable to stress, and that it is OK to take care of our selves,"
she explained. "We see young physicians lead healthier, balanced lives,
set better limits and more realistic work goals; and work to prevent stress
and burnout. It is more acceptable to acknowledge that we may need help.
There are more resources available and more resources are being utilized by
colleagues. Yet, we have a long way to go. The culture still has high
expectations of us, and our personalities are unchanged. As a result, we
remain highly conscientious and responsible, delay our own gratification and
continue to make ourselves vulnerable to stress." As for the
"cosmic two-by fours," she said doctors are people, too, and major
negative events will impact them just as they would others. "However,
it is how we express this impact that may be different. I am not sure if we
handle it better or worse. In part, it can be better, since we are used to
dealing with difficult news, and can use these skills here. We know there is
help available and where to go for it. However, we can also go into an
intellectualizing mode, as at work, which is not helpful in the long run as
it enables us to avoid dealing with and reacting to the problem. Although we
know there is help available, we do not always, or readily, access it." |