The same people who offer help often need it the most. That's the takeaway from a study published last year that showed physicians make great sacrifices to save lives -- often at the expense of their own health.
That study, published by Stanford Medicine researchers in Mayo Clinic Proceedings, found that 1 in 15 U.S. physicians had reported having thoughts of suicide within the timespan of a year, a rate that exceeds that of other U.S. professions.
Physician burnout is a national epidemic that reached an all-time high during the pandemic. I recently turned to Tait Shanafelt, MD, the Jeanie and Stew Ritchie Professor of Hematology and expert in physician wellness, to discuss this crisis and understand how health systems and care professionals can change the landscape of wellness to support health care workers.
In a recent study you found that physicians with thoughts of suicide were less likely to reach out for help. How can colleagues and family members help physicians and other health professionals get the help they need?
When physicians are struggling, they will often invest all their energy into their work to provide the best care to their patients. As a result, family members and those in their personal life are the ones who most often see their struggles.
If the family members of physicians begin to see that their partner or loved one is not themselves, they should ask how they are doing and encourage them to consider talking to a confidential or anonymous support resource.
Even better -- systemize these types of check ins. For example, on the first Saturday of each month, a friend or family member can ask three questions: How are you feeling about your work burden? How are you handling all the demands on your time right now? And how are you feeling emotionally, at home and at work, right now?
As colleagues, we know that when physicians are experiencing work-related distress, they often want to talk to their peers most. And yet, physicians have professional norms that imply they're supposed to always have it all together. That can be a barrier to a physician who's struggling and wants to initiate an authentic conversation with their colleagues.
Hospitals and health care systems should support regular forums and physician connection groups where doctors check in with each other. Having such a pre-existing community eliminates the burden on distressed individuals to find or create such a forum when challenges arise.
All physicians and health professionals should also work to foster a professional culture that encourages vulnerability with colleagues, help seeking and mutual support.
How is Stanford Medicine providing better support for health care professionals experiencing distress?
We have a peer support program for physicians who are experiencing distress from a medical error, adverse patient outcome or other personal or professional challenges. We also have the Stanford Medicine WellConnect program led by my colleague Mickey Trockel, MD, a professor of psychiatry and behavioral sciences. WellConnect is a program that provides free 24-hour access to licensed professionals who specialize in providing assistance to physicians and others and can help them navigate emotional and mental health challenges related to the profession. They offer access by phone, by video or in person, 365 days each year. They provide confidential care that is not recorded in the person's medical record.
How else can we make progress on this issue? What are the questions that have still yet to be asked or answered?
Since occupational distress is so common for physicians, we need to consider what we can do upstream to address problems in the practice and prevent distress from occurring in the first place.
That begins with recalibrating the unrealistic workloads, addressing inefficient and sub-optimal approaches to work and improving aspects of organizational and professional culture that contribute to distress. For example, we know that the number of inbox messages a physician receives is strongly correlated with burnout.
National data also shows that, during the first month of the pandemic, the volume of those messages increased by 50% as patients transitioned to telehealth. It hasn't gone back down. We need to develop models of care delivery that allow us to continue to provide telehealth-based care without imposing on physicians' personal time.
Also, in many cases, the physician payment structure in the U.S. is a productivity-based payment system that incentivizes overwork. So, a newly trained physician who has large amounts of educational debt is incentivized to work 60, 70, 80 hours a week so they can pay off their loans. That's unsustainable and contributes to burnout. We have shown it ultimately leads to lower productivity, lower patient satisfaction and turnover rates that are untenable for organizations.
Lastly, health organizations sometimes create cultures that expect perfection, rather than a commitment to excellence, growth and learning. The solution isn't to teach physicians and health care professionals better personal resilience. It's to change the expectation around perfection and address the workload issues and inefficiencies making the workday overwhelming.
Getting help for yourself or others
Editors' note: As the landscape of wellness for health care workers and physicians continues to evolve, we've compiled a set of resources, videos and stories informed by Stanford Medicine experts. The videos, hosted by The Stanford Center for Health Education team and Shashank Joshi, MD, professor of psychiatry and behavioral sciences, explore how to help someone grieving, what to say to a friend who is thinking about suicide and coping strategies for educators and students. The stories below take an honest look at physician distress, grief and other topics surrounding mental health.
In this piece, Hui Qi Tong, PhD, a clinical associate professor of psychiatry and behavioral sciences who directs the Mindfulness Program at the Stanford Center for Integrative Medicine, speaks to how we can generate our own peace of mind. She calls it "mental health hygiene," and it includes daily mindfulness practices, which can decrease stress levels and improve mood.
Stanford Medicine psychiatrist David Spiegel, MD, weighs in on how the United States as a community suffers from widespread, prolonged grief, and what we can do. Spiegel speaks to community grief, the impact it has individually and in the community, how we can care for ourselves and others, and what we can do to get back to our normal activities -- particularly as we grapple with the realization that COVID-19 will not entirely disappear.
Stanford Medicine clinical psychologist and postdoctoral fellow Sarah Hagerty, PhD, discusses how the mental health of health care workers has been impacted by the pandemic. Hagerty discusses the mental state of health care workers and how the industry can help support them moving forward.
A survey conducted by psychiatrist Mickey Trockel, MD, PhD, shows there's nothing inherent about being a physician that leads to burnout. The problems are long hours and shame about errors. The study found that doctors who think of errors as an opportunity to learn and who don't work overly long hours are less likely to burn out than their non-doctor peers.
The next phase of the global pandemic will bring new mental health challenges. Stanford Medicine experts Debra Kaysen, PhD, professor of psychiatry and behavioral sciences and Victor Carrion, MD, director of the Stanford Medicine Early Life Stress and Resilience Program, offer tips for building resilience and handling chronic stress.
Stanford Medicine scientist Tait Shanafelt and others found that imposter syndrome is more commonly experienced by physicians, compared to other U.S. workers.
Resources for mental health support
For Stanford Medicine employees, extensive mental health and wellness resources are available through the programs listed below (employee logins may be required):
- Stanford Center for Continuing Medical Education: Program for Physician Distress
- Stanford Health Care: HealthySteps mental health and well-being resources
- Stanford Medicine Children's Health: HealthySteps mental health and well-being resources
- Stanford Health Care Tri-Valley: Stanford Health Care Tri-Valley resilience handbook 2022
- Stanford Medicine Partners: HealthySteps
- Stanford School of Medicine: Cardinal at Work well-being resources
- Stanford University students: Vaden Health Services
Additional resources for health care workers in need of mental health support can be found below:
- American Hospital Association
- American Foundation for Suicide Prevention
- American Psychiatric Nurses Association
- Centers for Disease Control and Prevention
- National Alliance on Mental Illness
- Substance Abuse and Mental Health Services Administration
Individuals in crisis can also receive help from the Santa Clara County Suicide & Crisis Hotline at 855-278-4204. Help is available from anywhere in the United States via Crisis Text Line (text HOME to 741741) or the National Suicide Prevention Lifeline at 800-273-8255. All three services are free, confidential and available 24 hours a day, seven days a week.