Tangible advice

Advice for physicians struggling with burnout or mental illness

Robert Piccininni, DO, says the best thing you can do to help a struggling physician is to talk to them about it.

In the medical community, it is no secret that U.S. physicians are more than twice as likely as the general population to commit suicide, a rate higher than any other profession. Preventing physician suicide starts with recognizing symptoms of burnout before they snowball into depression.

To help address increased rates of physician burnout, depression and suicide, the AOA formed the Physician Wellness Taskforce at the House of Delegates meeting last July. Systemic changes to the health care landscape must occur to better support physician well-being. Recognizing that enacting change can be slow, Robert Piccininni, DO, chair of the AOA’s Physician Wellness Task Force, says that the best thing physicians can do immediately to help a struggling colleague is to talk to them about it.

The Mayo Clinic and the American Foundation for Suicide Prevention explain how everyone can help prevent suicide in the medical profession.

When in conversation with a physician struggling with burnout or symptoms of mental illness, it may be useful to have some tangible advice on hand. The DO talked with members of the osteopathic community who offered advice to share with physicians who are struggling, whether they are in crisis or just beginning to experience burnout and depression.

Therapy is an option, despite confidentiality and privacy concerns

Physicians should be encouraged to seek professional help at all junctures of mental illness, especially those suffering from suicidal ideation and debilitating symptoms of depression. Some physicians avoid seeking help for mental health issues to circumvent running into patients or acquaintances, notes Vania Manipod, DO, a psychiatrist. But Dr. Manipod says attending therapy helped her work through feelings of failure over not maintaining her expected levels of productivity.

In a perspective piece from the National Academy of Medicine, AOA leadership recognized the need to talk with state licensing boards about physician concerns that they must report visits to a psychiatrist to boards, which could negatively impact their licensure and ability to practice.

Vania Manipod, DO

“People connect with me because most of us don’t talk about mental illness, and I decided to even publicize that I was in treatment and made some tangible changes as a result,” says Dr. Manipod, who drove an hour from home to see a therapist who wasn’t in her medical organization. “There are things we can do instead of waiting for larger bureaucratic changes, and I’m an example of that.”

Track your emotions daily

Dr. Manipod blogs about her experience recovering from burnout and depression in order to destigmatize mental illness and help other physicians and medical students recognize signs of burnout and depression.

Tracking her emotions in a tangible way helped her to better identify the progression of her healing, Dr. Manipod says.

“I started noticing I was writing more about self-care than my super busy life as a physician,” says Dr. Manipod. “I noticed that putting myself and my priorities first ultimately made me a better physician to my patients.”

Asking a loved one to pay special attention to your mood and outlook is also a great idea, Dr. Manipod says. This way, someone else is actively looking out for you and will raise their concerns if they notice symptoms of burnout or depression.

Practice self-observation through mindfulness meditation

In a recent webinar about mental illness among medical students and physicians, Ulrick Vieux, DO, MS, the psychiatry residency program director at Orange Regional Medical Center in Middletown, New York, discusses how meditation can help students and physicians create a more thoughtful and less automatic response to stress. However, mindfulness meditation takes practice, and it may take some time before physicians notice results, so this mental exercise may be more helpful to combat mild symptoms of burnout and depression.

Ulrick Vieux, DO, MS

“Insight is a key aspect in maintaining mental wellness and can be learned with effective practice,” says Dr. Vieux. “Insight can challenge hopelessness and negative automatic thoughts that are at the crux of physician burnout and dissatisfaction.”

A study from the Journal of the American Medical Association supports Dr. Vieux’s claim that individual and group mindfulness meditation can be beneficial. It found that physicians participating in a group mindfulness curriculum had improved engagement and morale at work.

Visit your local art museum

Physicians and medical students suffering from mild cases of burnout and depression could benefit from a trip to the art museum. At Kansas City (Missouri) University of Medicine and Biosciences College of Osteopathic Medicine (KCU-COM), educators find trips to the Nelson-Atkins Museum of Art improve reflection and empathy skills that can help alleviate burnout and encourage renewal.

Jim Dugan, PhD

Jim Dugan, PhD, KCU-COM’s director of counseling and support services, says with depression rates among medical students at 27%, KCU-COM’s Art, Observation, and Medicine program is a beacon of well-being for medical students.

“Critiquing and discussing art can foster emotional intelligence and critical thinking, and serve as a buffer against the all too common maladies of medical students—depression and anxiety,” says Dr. Dugan.

    7 comments

    1. Physians are burnt out because of excessive demands from all sides. We no longer are decision makers, but puppets for Ins Co and Govt to abuse. We have more and more regulation and oversight including targets on our backs for anything done wrong in their view. The rules constantly change, over head through the roof, income down. What money we make is taken by another upgrade???? Why can’t we charge like Ins Co? Oh, I’ll talk to a shrink…… he can talk to my accountant and attorney and everyone else and I will no longer be stressed! I was trained as a Physician and I love my job, not all the Unimportant things that are Most important quality markers. My markers are patients sending me Thank-you cards with a special note or a hug or a handshake. ALL this other stuff is Junk. Let Doctors be the Physians they are to be! I was not trained to be Bean counter.

      1. This article is nothing more than a puff piece. Seriously…..mindful meditation is really going to help me forget the crap I have to deal with on an everyday basis?? A visit to an art museum is going to unravel the stress I get from insurance companies and government over regulation?? I used to love my job, but now I wake up every morning dreading the day, and counting down the days until I can walk out of this. Although this profession has been destroyed, what keeps me up at night is the worry of how much worse it is going to get!

      2. I hear ya..and 100% agree with what you list as causes of burnout. But I ask that you not minimize the experience of people like myself where seeing a therapist helped overcome the burnout we are experiencing in order to make decisions to better advocate for ourselves in our careers.

    2. I think it’s a pretty good article, but I found the reply is negative, pretty demeaning and reflects the attitude that led to the whole issue. Although the points are understood, refusing to acknowledge that our colleagues suffer emotionally only hurts.

      I practiced for 25 years almost, same place, and had to get help myself. Now I still work a bit, same place and see that I did not practice self care well. Too self focused, etc. I maintain my health with a doc and even more importantly, get care from a therapist, not just take pills. For me, I want to emphasize the critical importance of my faith community and small group accountability.

      Our group is definitely trying to help our docs and that is great. In this article, and in my community, I have seen so much about mindfulness but how about age proven acknowledgment of the Creator and prayer to him and receiving intercessory prayer?

      The brave psych doctor (VM) who revealed her own struggles mirrors what I have done myself. I use my own difficulties to help people. Risky, sometimes, but worth it. My practice allowed me space and provided help. For privacy, I use my own professionals.

      1. Thank you so much for sharing your experience doc as it’s validating knowing I’m not alone and also want to stand up for fellow physicians who also seek support through community and mebtal health clinicians. I truly appreciate it ✊

    3. This goes across the spectrum of medical students, residents, and physicians alike. The American healthcare system is not conducive to our mental stability or health. Quite the irony. Yes, suicide rates are double compared to other professions, but has anyone actually done anything to lower this statistic? No. Instead residents and physicians are overworked to the point that many no longer take care of themselves like they should. You advise to go to the art museum? When? Between my shifts? Then when do I sleep? When do I eat? When do I exercise? You want me to meditate? Why? So I can “calm down” about how I’m being treated in this business. We advise all of this for our patients, but we can’t seem to follow those same recommendations for ourselves. I understand that we have devoted our lives to patients, to care for them, to advocate for their health. But who’s advocating for us? Definitely not the American healthcare system. Definitely not the hospitals. Don’t you think that a healthy, well-rested physician is a happy one who will provide better care for his or her patients? Of course! But the reality is a grand majority of us are running on 5-6 hours of sleep (some even less), eating whatever we can grab. But it seems that regulations are being changed where we continue to not be a priority. Allowing for a straight 24 hour shift, or better yet 36+ hour shift? That’s a joke. The American healthcare industry has a lot to learn from other countries when it comes to not only patient care, but also physician care. Unfortunately, I don’t see this changing any time soon, because here, money rules. And the more it can squeeze out from it’s workers across the board the better. So what if a few physicians jump out of buildings, overdose, or shoot themselves? There’s plenty more where they came from, right? Oh, wait…

    4. I hope that more physicians in congress can help lead the way. I am encouraged however to see growth of alternative medical systems in the US that allow physicians to get back to being physicians and put the focus on patients and not numbers, outrageous productivity demands that undermine good care, and egregious amounts of data collection and reporting that are NOT accurate or reflective of anything. When did it all get out of control? For me, I feel like it was when the productivity model became popular. See more people, less time, do more, report it, and do better than everyone else, …but don’t be fraudulent, don’t make mistakes, and just don’t care anymore. For me, it came to an abrupt head. I left the productivity model, went to an alternative model, and now I cant get the smile off my face. I feel like I am making a difference, I see positive changes in my patients, and I feel appreciated and respected by everyone. For me, bucking the system and standing up for what I think is right made me feel whole again.

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