All the wellness in the world won’t help physician burnout
I will always identify as a vascular surgeon, but to be clear, I no longer practice in the field. Despite achieving a successful career, with satisfied patients, local accolades, and the admiration of my colleagues, I made the difficult decision to walk away from it all. I gave up years of education, rigorous training, and countless hours of hard work, as well as a significant salary.
The reason behind my decision is rooted in my experience as a patient struggling with constant suicidal ideation. I have stood on the edge of a bridge contemplating jumping, and even ascended to the top of my hospital's medical tower, only turning back due to the intervention of a nurse. I recognized that if I continued in medicine, I would ultimately put my own life at risk.
Despite having a balanced work-life dynamic, and avoiding the common pitfall of electronic health record (EHR) overload, I couldn't deny the overwhelming weight of my mental health struggles. I had a supportive relationship with my hospital administration and prioritized self-care, including maintaining a healthy diet and practicing yoga. Nonetheless, my decision to leave the medical field was a necessary step to prioritize my own well-being.
Rather than burnout, it was severe depression that led me to leave the medical field. I hope that sharing my story can help other doctors who may be struggling with mental health issues on a daily basis. It's important for our profession to acknowledge the possibility of mental illness and not view it as a taboo subject. By raising awareness and encouraging discussion, we can create a more supportive environment for physicians who are facing mental health challenges.
While burnout is a common experience for many physicians, the focus on physician wellness has led to an industry of conferences, curricula, and even chief wellness officers in healthcare organizations. However, mental illness in medicine is still not receiving the same level of attention. This is largely due to the fear of potential career repercussions for physicians who disclose their struggles with mental health.
It's crucial that we prioritize mental health in the medical field and work towards breaking down the stigma surrounding mental illness. By doing so, we can ensure that physicians receive the support they need to maintain their own well-being, as well as provide the best care for their patients.
Physicians often remain silent about their mental health conditions due to the fear of losing privileges, credentialing, and licensing. This silence allows mental illness to go unchecked and can lead to severe consequences, as was the case for me. By allowing the demon of my own mental illness to grow unchecked for years, I gave my worst self-hate a place to flourish.
While burnout is a topic that is widely discussed and accepted as a common experience for many physicians, it can lead to more severe sequelae such as depression, substance abuse, and suicidal ideation. Despite attending wellness drills, resilience workshops, and mindfulness exercises, physicians experiencing severe burnout may still keep their symptoms hidden. They may attribute their symptoms to the system, blaming factors such as administration, electronic health records, or long hours, rather than acknowledging their own mental health struggles.
It's crucial for the medical profession to address mental health with the same level of attention and acceptance as burnout. By creating a safe space for physicians to discuss their mental health challenges, we can work towards breaking down the stigma surrounding mental illness and provide support for those who need it.
Burnout is often treated differently than other mental health conditions, and one reason for this may be that it is considered an occupational condition rather than a medical one, despite the existence of a diagnosis code (Z73.0) for burnout. Additionally, the current version of the DSM does not classify burnout as a true mental illness, which allows authorities to remain unaware if a physician discloses their burnout. This provides a refuge for many burned-out physicians who may balk at the idea of being considered mentally ill.
As someone who no longer practices, I am not concerned with how burnout or depression is classified. However, I am passionate about ensuring that burnout is treated appropriately for those who suffer from it the most severely. Regardless of its classification, burnout should be approached with a mental health component as part of its treatment. In addition to personal resilience and organizational improvements, I propose the inclusion of a mental health component in burnout recovery to provide support and resources for those experiencing severe symptoms.
The distinction between burnout and mental health may seem like splitting hairs, but it does matter when it comes to treating those who are suffering from severe effects of burnout. While resilience and mindfulness exercises may be sufficient for the majority of burned-out doctors, there is a subset of individuals who require more comprehensive mental health treatment. Yoga and other wellness practices are not enough to address the severity of their symptoms.
It's important to approach all doctors with a focus on mental health, regardless of whether they are experiencing burnout or not. By creating a safe and open forum to discuss mental health, we can break down the stigma and encourage physicians to speak up about their struggles. This approach allows for a more comprehensive understanding of mental health, and encourages all doctors to prioritize their emotional and mental well-being.
Emphasizing mental health treatment for doctors can help avoid the stigma of mental illness disclosure, while still encouraging doctors to seek the support they need. However, untreated mental illness is a significant risk, and can be even more detrimental than burnout. Speaking from my own experience of two decades of untreated depression, I know how crucial it is for those who are struggling to seek treatment. By creating a safe and supportive environment that prioritizes mental health, we can encourage suffering physicians to speak out and seek help.
Ultimately, the goal is for all doctors to feel comfortable talking about their mental health, regardless of whether they are experiencing burnout or a diagnosed mental illness. The simple act of opening up a dialogue can provide a powerful sense of connection and community, reminding physicians that they are not alone in their struggles. While it may take time to fully address mental health in the medical profession, focusing on the mental health of those experiencing burnout is a critical step in the right direction.
