From the
PRESIDENT
Robert A. Zaring, MD, MMM
GLMS President | [email protected]
THE BURNOUT Plague
W
e are entering the dog days of
summer and I needed a day in,
so I spent a whole day just Net-
flix binging. My show of choice
this day was a series entitled
“13 Reasons Why.” The show fascinated and ter-
rified me for all the reasons I believe the writer
intended. I do not want to ruin the show for
anyone interested in watching, but I will give
a brief synopsis: it’s about the tragic suicide of
a teenage girl. The twist in the story is the girl
makes 13 audio tapes regarding why she com-
mitted suicide. Following her death, she has the
tapes delivered to certain people. Each tape is
dedicated to a different person and what that
person did to lead to her suicide. Some of the
things that happened to her were clearly horrible,
but what I found terrifying were the things that
happened to her that were done by relatively
good people. These people’s missteps ranged
from poor decision making, to going along with
the group, to not stopping a misunderstanding,
or to not fighting for what they knew was right.
In short, their own human weaknesses that we
all have and have displayed led her to her death.
It made me think about wrongs I may have done
to someone and not even known. It also made
me think about a plague that medicine faces, and
that is physician suicide and physician burnout.
It is estimated that 300-400 physicians commit
suicide every year – that is about one every 24
hours. This epidemic affects males and females
at equal rates, which is far different than the
general public, where male suicide is four times
the rate of females. Medical students, residents
and practicing physicians are all afflicted. The
numbers for medical students are high enough to
make suicide the second most common cause of
death following only accidents. Different studies
have shown suicidal ideation to range from 6.6 to
9.4 percent in medical students and similarly 6.3
percent in American surgeons. These numbers
are up to 3-fold higher than that seen in the gen-
eral public. Although burnout (a term coined in
the ‘70s by psychologist Herbert Freudenberger)
can seem like depression, it is considered dif-
ferent. However, there are linkages across the
spectrum. Suicide is usually seen in untreated
depression. Burnout shares many similarities
with depression, and often leads to depression.
Burnout has classically been described as having
three main characteristics: emotional exhaustion,
depersonalization, and lack of personal accom-
plishment. It differs from depression in that it
can be seen without the symptoms of depression,
and burnout involves feelings of isolation from
work rather than all life activities. Burnout is
being felt by more physicians every day and polls
now put the number of those with burnout up
to 50 percent, but it is believed that number is
likely higher.
This scourge does not just affect physicians.
Those with burnout have been shown to be six
times more likely to make a medication error,
and it is felt that burnout will reduce the physi-
cian workforce by 1.2 percent, further inflating
the 45,000 to 90,000 physician shortage. The
causes are many and some of the most common
are these: physicians’ refusal to seek treatment,
litigation-related stress, too many regulations,
electronic health records, insufficient income,
harassment by co-workers, and inability to share
concerns with fellow physicians. Recently, there
has been a greater look at what programs or
treatments should be offered. Individual and
organizational programs have been shown to
be a benefit with focuses on mindfulness, stress
management and small group discussions. Fur-
thermore, work cultures encouraging teamwork
and appreciation have also seen success.
When I reviewed the causes and treatments,
what stuck out in my mind was what physicians
do to each other and how a little compassion and
kindness towards each other could go a long way.
Many of the causes of burnout, depression and
suicide will be difficult to address in our society-
but we can be better to each other. I have seen
firsthand one physician attack another physician,
and someone trying to pass on blame. Belittling
another health care provider over some action
adds little to improvement. Whether it is ego or
fear, those actions must be curtailed. In the end,
they only isolate and damage the attacker and
the one being attacked. Furthermore, we need
to look after our fellow providers and not try to
prove we are smarter or better. As in the Neflix
show, we can never really know what is going
on in someone’s life, and we never know if we
could be the one person to either add to their
destruction or be their salvation. After all, we are
professionals who dedicate ourselves to saving
lives by our skills. What if to save someone’s life
all we needed was a little courage and kindness?
In the Netflix show, after each of the 13 people
hears their tape, they are haunted in many ways
and must grapple with what they did. Sometimes
their actions were simply not fighting strong
enough for each other and what is right. I know I
would never want to get a tape like the characters
in the show received, and will be mindful of how
my words, actions or inactions can affect others.
We must fight and care for each other because
we are all in the health care profession together.
It is only together that we can make Louisville
healthier.
For anyone struggling with depression or
burnout, please consider utilizing the GLMS
Physician Wellness Program. This is a complete-
ly anonymous counseling service provided by
Raskin & Associates. You can reach them at
502-394-9990.
For those more interested in the topic of
physician burnout, I recommend a couple of
Youtube videos:
http://bit.ly/2tJupXK and http://bit.ly/2tEbYFA.
Dr. Zaring is an anatomic and clinical pathologist
with Louisville Pathology Associates and practices
at Jewish Hospital.
AUGUST 2017
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