Physician burnout and physician suicide continue to plague the medical profession. Everyone knows the tragic statistic: one U.S. physician commits suicide each day. While some statistics report a decrease in the problem over time, the accuracy of these reports is questionable. The reality is that it is far too common.
The term burnout, while a necessary label, implies that a single factor causes it. In reality, each burned-out physician is different. In my opinion, the common thread is overwork. The culture of overwork is bred into those who wish to be physicians and is encouraged throughout their education and training. However, beyond this nearly constant factor, each burned-out physician has a different story to tell. For example, my risk factors included overwork, but in addition, mental illness and catastrophic medical illnesses. Other burned-out physicians are affected by substance abuse, financial crisis, family illnesses, as well as a host of other risk factors. Reducing the frequency and severity of this condition requires a multipronged approach.
I believe that the most important solution is to begin teaching a simple fact in medical school. To be an excellent clinical physician, you need to take care of your own mental health. The truth is, your ability to be an outstanding clinician will be adversely affected by an unfit mental health condition. Even if you are only partially affected by this prevalent condition, which we have labeled burnout, it will change how you approach patients. It is not enough to mention this problem on occasion. It is not enough to have a single class during medical school. I would have listened to those voices, written them down in my notes, and then returned to my usual routine, not appreciating the significance.
Our medical schools are excellent in teaching the mechanics of medical practice. They speak to the required surgical, medical, and pharmaceutical skills. We eventually assist in the operating room. We round on our patients and assist in making clinical decisions. My institution had an ongoing course in medical ethics. At UTMB, we practiced our interviewing skills on actors, using video recordings, and the results were critiqued to provide feedback. We were allowed to conduct physical exams on voluntary patient actors. The result is that physicians leave medical school with a solid foundation in basic medical science and clinical skills. Few appreciate the importance of taking care of their own mental health.
I propose that during the clinical years in medical school, continuous instruction with a common thread be provided to ensure that these future physicians understand the actual burden and risks associated with their future as clinicians. The goal is to introduce the idea of taking care of your own mental health, allowing the physician to practice excellent care. The course should be led by practicing physicians. They give real insight into what it is like to practice medicine. Other lecturers may include professors, health care providers, mental health experts, and others with unique perspectives. Related issues, such as financial planning, exercise, and social issues, among others, would augment the central theme.
It was late in my career when I learned this simple idea. I finally realized that to fulfill my goal, which I had begun pursuing at the age of seven, I would have to address my mental well-being. The realization of that idea, for me, only occurred near the end. At that point, I tried to access mental health treatment and tried to change my lifestyle. It was soon apparent that it was much too late. Had I realized this in medical school, perhaps my destiny could have been changed.
All physicians should come together to face this growing tragedy. Let’s begin by educating medical students about the concept that they must take care of their own mental health to be excellent clinicians. We need a multipronged approach to this tragically common condition, which we label as physician burnout. Access to mental health therapies, reduction of shame associated with this, anonymous help lines, buddy systems, and many more modalities all have their place. If physicians wait, however, for the symptoms of burnout, as with me, it may be too late for many in our scarce population of noble physicians.
I would appreciate your comments. It is not too late to address this critical issue.
William Lynes is a urologist and author of A Surgeon’s Knot.
