As family physicians, we have a special ability to provide compassionate care to our patients and their families. Whether it’s the result of training or intuition, we’re well suited to treat and protect the vulnerabilities of those in need. Many of us appreciate the value of caring for ourselves as well, including eating healthy, exercising, and striving for personal and professional balance in our lives.
Of course, we’re human and we face many of the same struggles as our patients, whether it’s physical disease or emotional distress. In issues of mental health, however, we may be reluctant to talk about serious issues affecting our mental health or that of our colleagues, including depression and suicide. Unfortunately, physician depression goes largely untreated because of the stigma surrounding it, especially for health care professionals. Because doctors are reluctant to disclose the details of their depression, there is limited investigative work in this area. The result: Physician suicide has not been adequately addressed by the medical community to identify best practices for suicide prevention.
This is deeply concerning, and that is why our family physician community is making robust efforts to provide tools and resources to open the dialogue and combat the struggle.
Depression and suicide are a reality for family physicians, just as it is for any physician. First, we know depression can mirror the symptoms of burnout. Burnout is often characterized by the misalignment of work environment and your schedule, which includes a heavy workload, onerous tasks, long hours, and work-life imbalance, which can lead to emotional and physical exhaustion. Left untended, serious burnout can lead to withdrawal, disengagement, or even something worse.
Conversely, depression is a common, yet serious, mood disorder that affects how you think, feel and behave. Although burnout can resolve itself once work conditions become more favorable and you dedicate yourself to well-being strategies, depression is best addressed with the support of a mental health professional and your own physician. With depression, negative thoughts and feelings aren’t isolated to just professional dissatisfaction. Depression impacts all areas of your life. Typical symptoms of depression include:
It’s easy to see the potential link between physician burnout and depression, given the challenges of working within the health care system and its regulatory hurdles. Add the COVID-19 pandemic to the mix, and the threat to your emotional well-being has escalated exponentially.
You’re not alone. Statistics show there is a link connecting depression and physician suicide. First and foremost, if you are having thoughts about suicide or hurting yourself, reach out for help immediately. Contact the National Suicide Prevention Lifeline at 800-273-8255 (TALK).
Next, it’s important to access the resources that are available to you, starting with your primary care physician (PCP). Statistically, when considering all physician specialties, those who commit suicide are less likely to have a PCP than physicians who do not have suicidal ideation. In the general population, about 25% of people see their PCP one month before they attempt suicide. More than 75% of depression is treated by a PCP in this country.
Physicians who proactively address their mental health are better equipped to care for patients and sustain their own resilience in the face of distress. Family physicians, like all physicians, are encouraged to combine healthy self-care strategies with effective professional treatment for mental health conditions.
There are many organizations and associations, such as The National Academy of Medicine (NAM), doing their part to serve our health care professionals. NAM created the Clinician Well-Being Collaborative, an effort designed to raise the visibility of clinician anxiety, burnout, depression, stress, and suicide; improve baseline understanding of challenges to clinician well-being; and advance evidence-based, multidisciplinary solutions to improve patient care by caring for the caregiver. The Clinician Well-Being Collaborative convenes, publishes, and shapes the national conversation to target priority areas of leadership engagement, stop the culture of silence, and provide organizational practices and support on recommendations, and sustainability.
Such organizations are breaking down the barriers that connect physicians to mental health providers, including:
In another move to address these barriers, the American Medical Association (AMA) adopted policy in 2018 to improve physician access to mental health care. The new policy helps reduce stigma associated with mental health illness to ensure physicians can seek the care they need for burnout, anxiety, depression, and substance-related disorders without fear of punitive treatment or licensure and career restrictions.
Don’t understate the power of talking with a trusted friend or family member when you need emotional support. While burnout differs from depression, Medscape’s National Physician Burnout & Suicide Report 2021 reveals that 43% of doctors cope with burnout by talking with friends and family. To improve their well-being, most doctors engage in protective strategies when possible if the system in which they work is not changeable, including reducing their work hours or changing their work settings.
Treating our mental health as a whole and finding joy in health care is a shared goal among family physicians. The Institute for Healthcare Improvement calls it Psychological PPE (personal, protective, equipment). The concept was developed after the advent of COVID-19 but serves as a sound intervention with enduring tools when we return to more stable times in our society. The approach can be deployed before providing care and after a shift has ended.
In addition to the support provided at the organizational and association level, we family physicians can also individually create our own toolkits for improving our well-being. This can include taking a vacation, partnering with a mentor, serving as a mentee, and leading an effort within your own practice or organization for workplace changes.
Ultimately, when we prioritize our mental health and well-being and care for ourselves, we are better equipped to care for our colleagues, teams, and patients. Opening the door to discussions about physician well-being and taking action—either as an individual, organization, or practice—can incrementally restore our physical and mental health.
If you are having thoughts about suicide or hurting yourself, reach out for help immediately. Contact the National Suicide Prevention Lifeline at 800-273-8255 (TALK).