Lancet Review: Mental illness and suicide among physicians
COVID-19 is raising awareness of the fact that physicians are not immune to mental illness.
The pandemic has produced greater isolation. Hallway conversations that happened previously, group lunches, and all the socializing suddenly ended. That’s meant fewer ways for health care providers to process difficult experiences, leading to greater distress. The social support network that was once there suddenly vanished.
Ronald Epstein, M.D., professor in the department of Family Medicine at the University of Rochester School of Medicine and Dentistry, along with other researchers are unpacking how mental illness affects health care professions and the barriers to getting treatment. Their article, titled Mental illness and suicide among physicians, recently appeared in The Lancet.
Across all countries, physicians have a much higher suicide rate than the general population and those of similar socio-economic status. The article points out that according to estimates in the United States, one doctor dies by suicide per day.
“Part of the culture of medicine is a culture of invincibility,” says Epstein. “Physicians are resilient but reluctant to ask for help. When we’re suffering, we do it alone and in silence. We need to make more public that physicians too suffer from anxiety, depression and post-traumatic stress.”
According to Epstein, the way forward consists of intervention at three important levels: the regulatory level, the institutional level, and the individual level. It’s key to ask, for example, what can institutions do to recognize and identify people who might be suffering? How can they change the working conditions so they’re less likely to make matters worse?
“Think about working conditions that promote mental distress,” says Epstein. “A patient who dies unexpectedly, for example, what do we do after that? We need to think about the kind of debriefing that we need to do to help people process those traumatic events.”
At the individual level, it comes back to self-care, self-compassion and skills to address work-related distress. To that end, “Mindful Practice in Medicine” workshops developed by Epstein and Mick Krasner, professor of clinical medicine at University of Rochester, address the multiple sources of suffering that clinicians experience and demonstrated improvements in health professionals’ well-being, burnout, job engagement and stress-related symptoms.
Susan McDaniel, Ph.D, ABPP, a family psychologist and director of the University of Rochester Medical Center Physician Communication Coaching Program, helps physicians reconnect to the meaning of their work and remember the reasons they first went into medicine. Her program, which began in 2011, aims to provide the physician over time with the skills and self-awareness that will help them be as successful as possible. Her team works on mindfulness, coaching, psychotherapy, and other support that bolsters resilience in a group of talented people with enormous responsibility on top of the usual life stressors.
Both Epstein and McDaniel give URMC credit for recognizing the need for this kind of program. However, it’s uncommon.
“It’s unusual for medical centers to recognize the need for support for clinicians beyond the usual continuing medical education focused on new procedures, medications, and the evolving science about patient care,” she says. “As Dr. Epstein’s paper shows, we have to build an ongoing infrastructure for clinician wellbeing across the decades most spend in the workforce.”
Michael Privitera, M.S., M.D. serves as the medical director for URMC’s Medical Faculty and Clinician Wellness Program and has focused on reducing physician burnout for the last several years. During the pandemic, his program has advocated for normalizing self-care and creating boundaries between work and home.
He encourages faculty and staff to practice hanging on to ideas of better times ahead, gratefulness for the important people in their life, trying to focus on good things that happen during the day and reviewing them before going to sleep at night.
On the organizational side, Privitera says hospital leadership is key. Employees need to see that leaders care about their wellbeing. In reference to a September 2021 message to the URMC community from Mark Taubman, M.D., Ph.D., CEO of URMC and Dean of the School of Medicine and Dentistry, Privitera says the “message of appreciation of people’s dedication was a very important intervention at this time.”
In the video, Dr. Taubman thanks the URMC community for tapping into heroic resilience and supporting one another to fight through a third surge of the pandemic.
Epstein’s full review says organizational-level interventions like this are an urgent need. The role of training programs, leadership and the broader health-care system “must be given prominence, and evidence-based interventions focused on these areas must be given the greatest priority.”