Burnout Plagues MDs, but They Won’t Get Help

by Sharon Kirkey

The Ottawa Citizen

September 6th, 2005

The stigma of mental problems or drug abuse keeps many doctors from getting assistance.

A cardiologist is paged to the emergency room one night. His partner has been struggling for an hour to get a pacemaker inserted into a patient with a dangerously slow heartbeat. He drives to the hospital, slips the pacer wires into a vein beneath the collarbone and expertly guides them into the heart. It takes him under three minutes. Graeme Cunningham wonders how fast he could have done it had he been sober.

An anesthetist hangs bottles from an intravenous pole at the head of an operating table. One contains fentanyl, a narcotic he will secretly administer into his rectum during surgery. Using a drug that way works as fast as if he were to inject it into a vein, says the addiction specialist who eventually treats him. "There are so many blood vessels to absorb it."

A family doctor pulls a plastic bag over his head and seals it around his neck with tape. Then he injects himself with an overdose of morphine.

Doctors know how to commit suicide. They know what works, and what doesn't, says Dr. Michael Kaufmann, medical director of the Ontario Medical Association's Physician Health Program. It is, he has said, the most "tragic irony": the very people trained to save lives have the hardest trouble saving their own. Nearly half of doctors who responded to a Canadian Medical Association survey reported being in an advanced stage of burnout. About 50 doctors in Ontario will call a 1-888 number this morning to see if they must provide a random urine sample. All are being monitored as part of a five-year recovery program for drug and alcohol abuse run by the province's Physician Health Program. They are doctors in remission who have been deemed medically fit to work.

Surveys suggest one in 10 doctors in Canada will use benzodiazepines this year without another doctor's supervision. Seventeen per cent will use mild tranquillizers. Twenty three per cent of medical residents will have an emotional or mental health problem during their training. And only two percent will seek help. Because nowhere is the stigma of mental illness stronger than within medicine.

"You would think that a group of educated people who have learned about psychiatry at some point in their training would be more open to the idea. That's not the case," says Ottawa psychiatrist Mamta Gautam, one of two doctors in Canada whose practice is devoted exclusively to physicians. "We somehow see this as a failure. It's something we can accept in our patients, not in ourselves."

The New England Journal of Medicine says the combined results of 25 studies show male doctors are 40 per cent more likely to commit suicide than men in general. Female physicians are 130 percent more likely to take their lives than other women, and the staggering suicide rate gap begins as early as the first year of medical school.

When Dr. Suzanne Killinger-Johnson leaped in front of a moving Toronto subway train five years ago, cradling her infant son in her arms, the world reacted in horror. "But that's just one case the public heard about," says Dr. Kaufmann. "There have been many cases, and the majority of them have succeeded." Harder for Dr. Kaufmann to accept is "the lingering resistance in the profession to respond to a colleague in need."

"It's denial. 'This can't be happening to one of us or if it could happen to them it could happen to me.' They might be afraid if they acted they were commit ting professional homicide,' which they aren't."

Every doctor in Canada has access to a physician health program, confidential assessment and referral services for those experiencing everything from burnout and marital problems to manic depression.

The Canadian Medical Association has launched a Physician Health and Well-being Program with outreach programs an lectures to medical students and doctors. But Dr. Cunningham worries the sickest doctors are falling off the radar. "The very sick, very shamed, very secretive doctors who do not turn up at wellness reviews, who do not go to alumni retreats ... because (drug and alcohol addiction) is a disease of secrets," says Dr. Cunningham, past president of the Ontario College of Physicians and Surgeons and director of addiction services at Homewood Health Group in Guelph, Ont., Canada's oldest and largest inpatient program for addicted doctors.

If they get help in time, prognosis is excellent. "In the case of the doctors we monitor, over 80 per cent experience stable remission of their substance use disorder over the long term - after five years monitoring -and go on to live very healthy, balanced, productive lives," Dr. Kaufmann says.

At his sickest, Dr. Cunningham, a recovering alcoholic, was collapsing in emergency rooms and having seizures on the ward. "Nobody said anything." Born in Scotland 62 years ago to an alcoholic doctor who died on skid row after losing his family and everything he had to alcohol, Dr. Cunningham was drinking a 26-ounce bottle of whisky every day by the time he became chief resident of medicine at St. Michael's Hospital in Toronto in 1975. His first wife left a note on the fridge one morning that said simply, "I can't stand you." She left him with two children, aged five and four. He moved to Timmins, be coming chief of cardiology and starting each day with five Tylenol3 and a cigarette. He hid whisky in his desk, in his truck and under his pillow at night, and he didn't stop until January 1986, when his heart stopped. By then, "I was senior, arrogant and disruptive. But people said, 'Don't confront him, he'll lose his temper and when he loses his temper, lookout.' I was a real pain in the ass."

Dr. Cunningham says the last thing to go in a sick doctor's life is his or her work. Dr. Michael Myers isn't so convinced. "I don't think physicians are functioning as well in the workplace as they say they are. I bet a number of their patients will say he seems a bit tuned out, or he snapped at me last week, or he looks different to me, he looks thin and stressed."