Lancet Review: Mental Illness and Suicide Among Physicians

Researchers highlight need for interventions to better protect doctors’ mental well-being

COVID-19 is raising awareness that doctors are not immune to mental illness.

The pandemic has produced greater isolation. The hallway conversations that had taken place before, the group lunches, and all the get-togethers all suddenly ended. This means fewer ways for health care providers to deal with difficult experiences, resulting in more distress. The social support network that was once there suddenly disappeared.

Ronald Epstein, MD, professor in the Department of Family Medicine, University of Rochester School of Medicine and Dentistry, along with other researchers, discuss how mental illness affects health professions and barriers to getting treatment. Their article, titled Mental Illness and Suicide in Physicians, appeared recently in The Lancet.

In all countries, physicians have a much higher suicide rate than the general population and those of similar socioeconomic 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. “Doctors are resilient but are reluctant to seek help. When we suffer, we do it alone and in silence. We need to make it more public that physicians too suffer from anxiety, depression and post-traumatic stress disorder.

The way forward, according to Epstein, is intervention at three important levels: the regulatory level, the institutional level and the individual level. It is essential to ask, for example, what can institutions do to recognize and identify people who might be suffering? How can they change working conditions so that they are less likely to make things worse?

“Think about working conditions that promote mental distress,” says Epstein. “A patient who dies unexpectedly, for example, what do you do next? We need to think about what kind of debriefing we need to do to help people deal with these traumatic events. “

At the individual level, it comes down to self-care, self-compassion, and the skills to cope with work-related distress. To this end, the “Mindful Practice in Medicine” workshops developed by Epstein and Mick Krasner, professor of clinical medicine at the University of Rochester, address the multiple sources of suffering that clinicians experience and have demonstrated improvements in well-being. , burnout, employment engagement and stress-related symptoms.

Susan McDaniel, Ph.D, ABPP, Family Psychologist and Director of the University of Rochester Medical Center Physician Communication Coaching Program, helps physicians reconnect with the meaning of their work and remember the reasons for which they first turned to medicine. His program, which began in 2011, aims to provide the doctor 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 supports that build the resilience of a group of talented people with enormous responsibilities in addition to the usual stressors of life.

Epstein and McDaniel give the URMC credit for recognizing the need for this type of program. However, it is rare.

“It is unusual for medical centers to recognize the need for support for clinicians beyond the usual continuing medical education focused on new procedures, medications and scientific developments in patient care,” she says. “As Dr Epstein’s article shows, we must build an ongoing infrastructure for the well-being of clinicians over the decades most spent in the workforce.”

Michael Privitera, MS, MD is the Medical Director of the Medical School and Clinician Wellness Program at URMC and has focused on reducing physician burnout for the past several years. During the pandemic, his program advocated for the standardization of personal care and the creation of boundaries between work and home.

It encourages faculty and staff to practice holding on to ideas of better times to come, being grateful to the important people in their lives, trying to focus on the good things that are happening during the day. and review them before going to sleep at night.

Organizationally, Privitera says hospital leadership is key. Employees need to see that leaders care about their well-being. Referring to a September 2021 message to the URMC community from Mark Taubman, MD, Ph.D., CEO of URMC and Dean of the Faculty of Medicine and Dentistry, Privitera stated that the “message of he appreciation of people’s dedication was a very important intervention. right now.”

In the video, Dr Taubman thanks the URMC community for tapping into heroic resilience and supporting each other in fighting a third wave of the pandemic.

Epstein’s comprehensive review indicates that organizational-level interventions like this are urgently needed. The role of training programs, leadership and the health system as a whole “must be highlighted, and evidence-based interventions focused on these areas must be given the highest priority”.

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