Unique Stressors in the Medical Context
This article originally appeared in the April 2019 issue of FOCUS.
Mental health difficulties and their prevalence are being acknowledged more in the public realm, but work remains to be done to address the mental health of health professionals. The 2017 Canadian Medical Association’s National Physician Health Survey revealed that it is not uncommon for physicians to be dealing with burnout, depression, and suicidal ideation.
BURNOUT AND PSYCHIATRIC DIFFICULTIES
Burnout is usually characterized by a sense of exhaustion, depersonalization, and decreased sense of personal accomplishment. Lack of control over work conditions, time pressures, fast pace of work, and lack of alignment between the values of physicians and administrators contribute to burnout. Specialties at high-risk include critical care, emergency medicine, family medicine, and surgical specialties. Other contributing factors include being of younger age or early in one’s career, working more nights on call, and lack of social supports.
Physicians can be exposed to unique stressors including regulatory college complaints, lawsuits, patient death, and medical error. Geographic moves for training or to fulfill return-of-service agreements contribute to a lack of sense of control, often leading to social isolation or even separation from family. Likewise, transitions in practice can take their toll, by challenging one’s professional identity and requiring adjustment to new roles and responsibilities. Furthermore, high debt loads and unpredictable government impositions affecting funding or practice models can cause substantial distress.
For Christ-following physicians, there can be questions and internal conflict in attempting to reconcile death and suffering with one’s faith, or navigating medical treatments such as abortion and medical assistance in dying. These are all layered on top of the usual seasons of faith, where there may be periods of darkness and sorrow in one’s non-professional life. At the same time, it is important to not conflate one’s spiritual life with one’s risk for mental health difficulties. Spirituality and involvement in a faith community can be protective against mental illness, but mental health is affected by a multitude of factors including hereditary or genetic risk, and the interaction between one’s biology and the environment; therefore, experiencing mental health difficulties should not be viewed as a reflection of a deficit in one’s spiritual life. With this in mind, the Christian physician may find relief and freedom from leaning on one’s faith and trusting God to lead, rather than trying to manage factors that are not within one’s control.
Besides burnout, physicians are not immune to psychiatric difficulties, including mood disorders such as depression and bipolar spectrum illnesses; anxiety disorders and obsessive-compulsive disorders; traumatic stress disorders (including vicarious trauma); disordered eating; psychotic spectrum illnesses; and substance use disorders (including the misuse of prescription medications). Physicians are also likely to have the ‘compulsive triad’ of personality characteristics – self-doubt, guilt, and exaggerated sense of responsibility, which further put them at risk. Because of internalized stigma, denial, and minimization of difficulties, physicians are less likely to seek assistance. Rather, they are more likely to attempt to self-diagnose and self-medicate, while also pre-maturely stopping medications or discharging themselves from hospital if admitted.
IMPACT OF BURNOUT AND PSYCHIATRIC ILLNESS
The impact of burnout and psychiatric illness plays out in various ways. On an individual level, there may be changes in mood, motivation, sleep, appetite, energy, lack of interest in usual involvements, or suicidal thoughts. Peers or colleagues may notice social withdrawal, unusual thoughts, and significant personality changes such as poor decision-making or impulsivity in spending, in relationships, or in substance use. Illness symptoms often have significant repercussions on romantic relationships, especially if one’s partner is unaware of the signs of mental illness or if s/he has psychiatric difficulties as well. Moreover, many medical couples need to navigate the constant tension between professional obligations and familial responsibilities in facing the realities of having a finite amount of time and energy to devote to the self and others. Often-times the workplace is the last place that symptoms reveal themselves — through reduced performance, absenteeism, impaired judgment, or aggression.
Though there has been much focus on ‘resilience’ as a trait of health professionals, there is dire need to address broader systemic factors and medical culture which have a larger impact on health status and wellness: learning and practice environments that value autonomy, collaboration, mentorship, safety, professional development opportunities, diversity and inclusion are needed. Intimidation and harassment have not been eradicated.
HOW TO HELP YOURSELF AND OTHERS
Many are likely already familiar with the typical recommendations of self-care through continued engagement in recreational and social activities and healthy lifestyle (sleep, diet, exercise, alcohol in moderation, and avoidance of substances with psycho-active effects). Activities which promote a sense of purpose are encouraged. Furthermore, involvement in professional associations are key to address systemic or political factors which affect the wellness of health care providers across the country.
Build relationships and community among peers – these personal relationships are avenues not only for allowing Christ’s love for us to overflow to them, but serve as invaluable resources for ensuring colleagues are their best selves for their health’s sake and for the protection of patients.
Become familiar with formal supports available. Supervisors can help navigate emotional responses to patient encounters and prevent boundary violations. Advice from program directors can be useful if academic accommodations are needed. Each province’s Physician Health Program can offer confidential supports and referrals for physicians and their immediate family members. They also assist those involved with their regulatory college due to mental health difficulties or disruptive behaviour.
- Spiritual mentors, church pastors
- Family physicians
- Peer support programs (where available)
- Student Life or Student Affairs Offices of Undergraduate Medical Education
- Residency Program Directors
- Postgraduate Medical Education Offices
- Provincial Residents’ Associations
- Provincial Physician Health Programs
- If in acute distress, call your local distress centre or go to the nearest hospital
Canadian Medical Association — Physician Health and Wellness
American Academy of Family Physicians — Physician Burnout & Work-Life Balance collection
“Mental Health and Mental Illness: A Christian Psychiatrist’s Perspective” — Dr. Jonathan Lee (Psychiatrist)
Johnson & Sanderfer. 2016. Created for Connection: the “Hold Me Tight” guide for Christian couples. Little, Brown Spark.
Sotile & Sotile. 2000. The Medical Marriage: sustaining healthy relationships for physicians and their families. American Medical Association.
Sotile & Sotile. 2001. The resilient physician: effective emotional management for doctors & their medical organizations. American Medical Association.