Canadian doctors’ mental health is suffering — and it’s hurting patients, too
“Burnout in healthcare providers reduces outcomes, it reduces patient satisfaction, and it increases healthcare costs,” Osler told Global News. “Promoting the health and well-being of healthcare providers will make our healthcare system more efficient.”
Doctors are an especially vulnerable population when it comes to anxiety, depression and suicide.
A recent survey by the CMA found that one in three physicians experience signs of depression, and according to a 2018 literature review in the U.S., roughly 40 physicians per 100,000 die by suicide each year — the highest rate of suicide of any profession, and double the rate of the general population.
Although there has been progress in the last five to 10 years, Osler said there’s still much more to be done to help doctors navigate work-associated trauma and mental illness. Only then can the healthcare system operate at its best.
“There’s a saying… the safety warning [when you’re on a plane] where you’re told to put an oxygen mask on first before helping others,” she said. “That means something.”
Osler defined burnout as feelings of “deep emotional and physical mental exhaustion, related to and caused by excessive and prolonged work stress.”
According to the World Health Organization, doctors can issue a diagnosis of burnout if a patient exhibits three symptoms: feeling depleted of energy or exhausted; feeling mentally distanced from or cynical about one’s job; and problems getting one’s job done successfully.
Burnout can be tougher to spot in doctors because “we can still maintain high levels of pay even though we may be burnt out,” said Osler.
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Most physicians feel their work is “important work that has meaning,” according to Osler, even if they’re experiencing the other symptoms of burnout simultaneously. This can lead doctors to ignore their own warning signs. When compounded with the negative stigma around mental illness within the medical community, physicians are doubly vulnerable.
Stigma in the medical community
Breaking down stigma is one of Dr. Ajmal Razmy‘s biggest concerns. He’s a psychiatrist at Trillium Health Partners and a lecturer at the University of Toronto.
Mental health is considered a taboo subject because of societal pressure, he said, everyone expects you to “always [be] able to perform at a high quality level.”
As a result, he says, “You’re never really able to switch out of doctor mode… it can take a toll.”
That concern over holding themselves to a very high standard creates a dangerous paradox in Razmy’s view.
“It can become hard to ask for help… physicians feel they need to be above all of that,” he said.
One way to change this is by training the patient to humanize their doctor. “If you hold [physicians] in an idealized state, it might be hard for them to come to terms with their own struggles,” he said.
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Razmy is also focused on addressing physician suicide — an epidemic he says has gone on for far too long.
“I think we need to have better surveillance in place, but also treatment measures in place to help our physicians that are saving lives but considering taking their own in the same day,” he said.
More resources and supports are needed at both the medical school and workplace levels. “It’s not just the attending physician… it’s also the residents,” said Razmy. “We still have a long way to go.”
Teaching the importance of mental health
For Dr. Keyna Bracken, one surefire way to improve physician mental health rates is to teach medical students how to be resilient. She’s a family physician and associate professor at McMaster University.
“Take medical students and compare them to their age-matched college peers… they are compassionate, they are resilient, their mental health is on the same level,” said Bracken. “Then they go through medical school, and something happens to them.”
One of the medical education system’s ongoing discussions is about the “erosion of empathy and compassion” which seems to happen to medical students over the years, according to Bracken.
“Why does that happen? That’s the million dollar question,” said Bracken. “Part of it is our lack of understanding of what is actually ‘normal’ in healthcare professions.”
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“Dealing with crisis after crisis, some people seem able to turn that into learning for themselves, and others don’t,” she said. What distinguishes the two groups is mostly unknown, but Bracken believes it has to do with compassion fatigue.
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Compassion fatigue is when “you no longer have the capacity to feel compassion,” and it’s a symptom she often witnesses in her own students as they advance in their medical degrees.
Part of Bracken’s job is to analyze that “student journey” to find the parts that contribute to compassion fatigue.
“Typically, in the third and fourth years of medical school is when [students] tend to be much more responsible for patient care,” she said. “It makes sense that as you feel more responsible for patients you may experience potential trauma which may or may not be dealt with in an appropriate way.”
She believes providing more mental health supports in the “clinical learning environment” will help students avoid compassion fatigue, build resiliency and ultimately, become better prepared for their working world.
“There’s a hidden curriculum. You’re supposed to work for 80 hours a week and not complain and not take time off for yourself,” said Bracken. “Much of the time, it was ‘suck it up, buttercup.'”
Thankfully, medical schools are beginning to attack this hidden curriculum head-on.
Removing exam marks or switching them from lettered grades to pass or fail, instituting a ‘no questions asked’ policy if they have to miss school or work for a medical appointment and student wellness weekends, when the student is completely off-call for a 48-hour period are all policies proven to make a difference.
‘Shared responsibility between individuals and the system’
To Osler, Razmy and Bracken, one thing is abundantly clear: the medical community can only move forward if change is a group effort.
“In the last 10 years, there’s been a whole shift,” said Osler. “10 years ago, [mental health] wasn’t something you saw people talk about out loud… When it was discussed, there was an emphasis on the individual.”
Now, as mental health becomes less taboo, the focus is shifting towards this issue being a “shared responsibility between individuals and the system,” Osler said. “By the system, I mean our hospitals, our workplaces, our health authorities… all those other factors external to the individual.”
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The CMA hopes to lead the way. The organization has created an entirely new department for physician health and wellness, responsible for promoting physician health in workplaces and medical schools across the country. It’s led by Dr. Caroline Gerin-Lajoie.
Currently, Gerin-Lajoie is leading a national analysis on the state of wellness supports and structures across the country, and in October, the department is leading the Canadian Conference on Physician Health in Newfoundland.
The goal is to determine “how we can promote wellness,” said Osler, and figure out “what changes in the system need to take place” to make that feasible.
“We have to move beyond teaching individual resilience, and that’s where we can play a role as the national medical association [in] promoting policy change. Promoting things like improving the health and well-being of healthcare providers will improve patient care and improve the efficiency of our healthcare system.”
— With files from Erica Alini
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