How to preserve your own well-being in a challenging medical environment
Avoid burnout: Use these strategies to establish a healthy work–life balance
Depression and suicide. Gold et al12 analyzed a database that included information on approximately 31,600 adult suicide victims, and 203 of these victims were physicians. Compared with others, physicians were more likely to have a diagnosed mental illness or an occupation-related problem that contributed to suicide. Toxicology results also showed that physician suicide victims were significantly more likely than non-physician victims to test positive for benzodiazepines and barbiturates, but not antidepressants, which suggests that physicians with depression may not have been receiving adequate treatment.12
Although occupation-related stress and inadequate mental health treatment may be modifiable risk factors to reduce suicide deaths among physicians, stigma and fear of medical staff and licensure issues may deter physicians from seeking treatment.14
Steps to avoid burnout
Evidence-based interventions. There is limited evidence-based data regarding specific interventions for preventing burnout and reducing stress among physicians, particularly among psychiatrists.4
A randomized controlled trial of 74 practicing physicians at the Mayo Clinic in Rochester, Minnesota, evaluated the effectiveness of 19 biweekly physician-facilitated discussion groups.15 The groups covered topics such as elements of mindfulness, reflection, shared experience, and small-group learning. The institution provided 1 hour of paid time every other week for physicians to participate in this program. Physicians in the control group could schedule and use this time as they chose. Researchers also collected data on 350 non-trial participants.
The proportion of participants who strongly agreed that their work was meaningful increased 6.3% in the intervention group but decreased 6.3% in the control group and 13.4% among non-trial participants (P = .04).15 Rates of depersonalization, emotional exhaustion, and overall burnout decreased substantially in the intervention group, decreased slightly in the control group, and increased in the non-trial cohort. Results were sustained at 12 months after the study. There were no statistically significant differences in stress, symptoms of depression, overall quality of life, or job satisfaction.15
Preliminary evidence suggests that residents and fellows would find a wellness or suicide prevention program helpful. One study found that the use of one such program, which provided individual counseling, psychiatric evaluation, and wellness workshops for residents, fellows, and faculty in an academic health center, increased from 5% to 25% of eligible participants, and participants reported high levels of satisfaction with the program.16 Such programs would require institutional support for space and clinical staff.15
Empathy. As psychiatrists, we are taught to be empathetic. Yet, with the numerous challenges we face, it is not always easy. Stressors such as an increased workload or burnout can adversely affect a psychiatrist’s ability to provide empathetic care.17 However, empathetic treatment has clear benefits for both physicians and patients. Empathic skills can lead to more professional satisfaction and outcomes, which are important components of accountability, and can:
- promote patient satisfaction
- establish trust
- reduce anxiety
- increase adherence to treatment regimens
- improve health outcomes
- decrease the likelihood of malpractice suits.17
Mindfulness is a “flexible state of mind in which we are actively engaged in the present, noticing new things and sensitive to context.”18,19 It may sound mundane to cling to phrases such as “living in the present,” but mindfulness can be a valuable tool for psychiatrists who struggle to maintain well-being in medicine’s challenging milieu. The process of mindfulness—actively drawing distinctions and noticing new things, “seeing the familiar in the novel and the novel in the familiar”—can ensure that we have active minds, that we are involved, and that we are capturing the joy of living in the stimulating present.18
Focus on issues you can control
Many of the factors that negatively influence professional satisfaction and well-being, such as loss of autonomy, demand for increased patient care volume, and increasing scrutiny on the quality of care, are beyond a psychiatrist’s control. Medical administrators can help reduce some of these issues by increasing physician autonomy, offering physicians the opportunity to work part-time, offering medical staff workshops to enhance positive communication, or addressing leadership problems. However, psychiatrists may benefit most by identifying modifiable issues under their own control, such as prioritizing a work–life balance, applying the fundamentals of a health prevention strategy to their own lives (Box20,21), approaching medicine as a calling, embracing an empathetic approach to patient care, and bringing mindfulness to medical practice.
