By Benjamin C. Aaker, MD
“I don’t know if I can take it anymore.”
How many of you have said something like that to yourself when the third patient came in, who didn’t need to be there, or who refused to take your advice and came back to your office only to not listen to you again? Yet, you shrug it off, and move on with your work. Those thoughts aren’t a big deal, right? Meanwhile, other patients are sitting in the waiting room and you are getting more and more behind.
Or, how many of you have felt a dread with going in to work another day and try to ‘soldier on’ to make it through the next day in clinic? Or, felt the sadness that comes when a patient dies in your care? All of these thoughts happen to physicians from time to time. They are normal. The difficulty is in knowing when normal concerns become burnout, and when burnout is something more, like depression, and when depression is severe enough that it impacts the physician’s ability to care for patients.
Physician burnout is a huge problem, but it is thought to not come from hard work, but from psychological reasons. Even writing that sounds negative to me, but it shouldn’t be taken so. Burnout is the manifestation of symptoms, some of them the same as depression. Burnout has serious impacts. It decreases productivity (Dewa, VMC Health Services Research, 2014), causes emotional exhaustion, and impacts interpersonal relationships (Patel, Behav Sci, 2018).
Burnout is a problem, and so is depression. But, just as someone can live a productive life with diabetes mellitus, a physician can lead a productive practice with depression. With the proper help, that physician can continue to practice normally. If the practice is negatively impacted (what the South Dakota Board of Medical and Osteopathic Examiners [SDBMOE] calls impaired), then they need to not practice until they get help.
Clearly, we don’t want a physician to continue to practice until that impairment is resolved. But not every person with depression is impaired. Major depression is a common condition in the U.S., afflicting 7.1 percent of adults (National Institutes of Health, 2017). In resident physicians, it may be as high as 29 percent (Mata, JAMA, 2015). Suicide among physicians is double that of the general population (Anderson, APA, 2018). But suffering from depression doesn’t necessarily mean that the physician is not able to care for patients.
The SDBMOE expects physicians to self-report if they become ‘impaired.’ Statute defines impaired as, the inability of a licensee to practice his or her health-related profession with reasonable skill and safety as a result of mental health issues or substance use related disorders. Unfortunately, that leaves a lot up to the judgement of the individual, or later, the Board.
Physicians have a general fear in self-reporting such issues. They may perceive that as a physician, it wouldn’t help them to seek another physician with the same training. They might not know they have an illness. They might attempt to diagnose and treat themselves. They might get substandard ‘off the books’ care from a friend, who is also a physician. They might be worried about their license and their ability to make income.
The SDSMA Can Help
Our task in the SDSMA is to help our physicians who are at risk before they meet the level of impairment. We should be able to help them before they are impaired and are in need of the Board’s involvement. The best way to get people to self-report is to allow them to do it in an anonymous, nonjudgmental way, without risk to their license. We need a program that is well-known to physicians, that is easy to enroll, that respects privacy, and has no negative repercussions.
That’s why I have convened a group of SDSMA physicians to study and report on physician wellness. These volunteers will evaluate the problem we have right now and give us their guidance. They will look at successful programs in other states, such as LifeBridge in Nebraska.
The SDSMA is working closely with SDBMOE to achieve these goals. We believe that we are partners in healing our physicians and we are proud to report initial success. We won’t stop until we can help every physician who is hurting and in need. If you know of someone who is in need of help, the SDSMA has resources for you. Simply go to our website, SDSMA.org, click on Advocacy, then Physician Wellness. Or send me an email at firstname.lastname@example.org. Be well, your patients need you.