Doctors are not immune to mental health issues
5 October 2023
Doctors are not immune to mental health issues. In fact, research from Beyond Blue reveals that the prevalence of mental illness is higher amongst doctors and medical students than mainstream society. Despite this statistic, it is still not widely discussed in the medical community. A multitude of factors contribute to the burden of disease including stressful careers, unpaid work hours, workplace bullying, insufficient provision of training positions and jobs, ‘type A’ personalities and patient complaints.
“Physician Burnout” has been formally recognised as a condition by the World Health Organisation in 2019 and is a state of mental exhaustion caused by the doctor’s professional life, characterised by emotional exhaustion, depersonalisation and reduced sense of accomplishment of success. It is not a medical condition but is an occupational phenomenon. Clinical signs of burnout include low mood, irritability, lack of energy, poor motivation and the very real phenomenon of compassion fatigue. This can lead to clinician disempowerment and career dissatisfaction.
A survey in the United States during the COVID-19 pandemic revealed a burnout prevalence of 63% with a reported 70% dissatisfaction in work-life balance. Those who experienced burnout had a three to four-fold increase in job dissatisfaction with intention to leave their jobs. The cost of burnout is substantial with an estimated $4.6 billion dollar annual burden to the US healthcare system due to factors such as reduced hours, physician turnover and expenses associated with hiring replacement staff. Burnout has not surprisingly been associated with twice as many patient safety incidents, reduced productivity, increased absenteeism, and a rise in doctors wanting to reduce their work hours or leave the field entirely.
Unfortunately, there have been numerous doctors, nurses and medical students who have taken their lives in our profession. These suicides represent tragic statistics which are often not widely nor openly discussed. These are not just case numbers but represent the tragic loss of lives of our colleagues and friends. The COVID-19 pandemic resulted in daily announcements of mortality figures but the mental health endemic does not give rise to media attention. A death by suicide is no less worthy of substantiation than a death by coronavirus. The issue of mental health and its causative factors merits greater attention and research by the medical community, just like any other organic illness.
I have a lived experience of mental illness which I have openly disclosed in order to try and reduce the stigma that it plays amongst doctors. I am in the unique position of having experienced both sides of the fence as an inpatient and a medical practitioner. From the doctor’s perspective, I am disappointed by the discrepancy with which patients with mental illness are sometimes treated compared to those who are unaffected. The time taken to explore comorbid psychiatric problems is rarely comparable to physical issues. In addition, the training time in medical school dealing with mental health issues is limited leading to practitioners who are ill-equipped at managing affected patients, especially those with lower prevalence disorders such as schizophrenia, bipolar disorder and personality disorders.
From the patient’s perspective, I have unfortunately been on the receiving end of stigma from colleagues and hospital staff. I have not always been well-supported by my senior employers, peers and unfortunately some psychiatrists. My illness and episodes of hospitalisation during earlier years of training have been gossiped about in the medical community and I am certain that this would have been handled far more professionally had I suffered a physical illness. It has affected selection in specialty matching positions through employer bias. Having a mental illness has not affected my intelligence nor general competency as a doctor but I have had to advocate hard for myself in the face of stigma, and I continue to do so to this very day. On a positive note, my difficult experiences dealing with the mental health system and stigma from colleagues has allowed me to be a more empathic and holistic clinician when caring for my patients. More importantly, mental health challenges have not stopped me from reaching my career aspirations.
Accessing treatment through the mental health system was not always easy. When I was first hospitalised as a medical student, I found it interesting that amongst my peers of around 200 medical students and tutors, lectures and colleagues, no-one was able to successfully access services to help me. These inefficiencies with reporting, escalating and providing help to medical students and doctors in distress is ubiquitous across healthcare organisations even today. I believe that hospital organisations are well-intentioned but our staff simply do not have the training nor established systems in place to effectively deal with doctors in distress. This requires urgent attention in order to create safer work environments for medical students and doctors.
In 2015, I became a mental health advocate for SANE Australia and Beyond Blue. I shared a national video campaign of my story which received an overwhelming and supportive response. Open disclosure has allowed for widespread dialogue about these issues. Countless doctors, nurses and medical students have contacted me, often in anonymity, to share their personal struggles as they do not feel comfortable discussing this at work due to stigma. This demonstrates the power of vulnerability and sharing which fosters a culture of open communication and human connection. It also highlights that the medical profession is ready to have these important conversations about mental health – we just need catalysts.
Mental health can no longer be an additive. We need to move beyond simple initiatives such as annual mental health days and start initiating important conversations at a systemic level to foster real culture change. It is critical that we learn to speak openly about our own difficulties and struggles, which includes our clinical mistakes. Many people have commented that I am brave for openly disclosing my personal struggles. I want to see a medical profession where open disclosure is so commonplace that it is considered the norm. Mental health affects all of us, regardless of whether we receive a diagnostic label, and we need to give this issue the attention and credit it deserves so that we can influence a real culture change in medicine and how it is perceived for future generations.
Dr Dov Degan
MBBS (Hons), FRACP
Nephrologist & General Medicine Physician