“The cobbler always wears the worst shoes” is a phrase that reminds us that physicians may not really take care of their own physical and emotional health. Such lack of physician self-care can have negatively affect patient care, the functioning of hospitals and clinics and the costs of healthcare. These topics are addressed by a recent Lancet article by Wallace and colleagues.
In this article the authors point out that physicians commonly suffer from physical and emotional health problems, but are not good about seeking help and getting care for such problems. As a result they often function in a sub-optimal state of health and burn-out that can lead to low job satisfaction, increased turnover and low morale in the healthcare organization. More importantly, such ‘professional malaise’ leads to poor patient care, increased healthcare costs and medical errors. The authors propose that therefore the ‘wellness’ of physicians is an important quality indicator that healthcare systems should routinely track.
Here are the main facts that I gleaned from the article:
Frequency and Types of Health Problems among Physicians
Studies on physician health have mostly focused on illness. Such studies have shown that they often suffer from burnout, stress, depression, substance abuse and relationship troubles. In some studies, up to 75% of physicians were burnt out. Suicide rates are six times higher among doctors than in the general population. Doctors have a higher than average cardiovascular mortality. Stress and burn out are common among medical students and residents as well.
However, health or wellness should not be considered just the absence of disease or sickness, but a positive state of well-being, including being challenged, thriving, and achieving success in various aspects of personal and professional life. Studies measuring this positive state among physicians are sparse, so we do not know exactly how often this ideal state is achieved.
Reasons for Physician ‘Unwellness’
The reasons for physician illness and stress include external and internal factors:
External Factors
- Heavy workloads that are increasing over time (increased patient-care demands)
- Fatigue and sleep deprivation
- Having to deal with emotionally charged situations (that are associated with suffering, fear, failures and death)
- Difficult interactions with patients, families and colleagues
- High cognitive demands (the need to quickly process an overwhelming amount of information over long periods)
- Growing bureaucracy
- Increased accountability
- Having to negotiate conflicts between the needs of the organization and patient needs, and
- Loss of autonomy from restrictions on practice placed by external regulators and payors.
Internal factors
- Physicians commonly have certain personality traits such as perfectionism, workaholism and ‘Type A’ attitudes. These traits are associated with burnout, depression, anxiety, eating disorders and cardiovascular disease.
- Female physicians often have to balance work and family responsibilities, which can increase work-family conflict and stress.
- Immigrant doctors can suffer from additional stressors and strains in addition to the stressors experienced by all trainees and physicians.
[to be continued.........]
Reference
Physician wellness: a missing quality indicator.Wallace et al. Lancet 2009; 374:1714
