Wellness in Physician Colleagues

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SPECIAL REPORT: CLINICIAN WELLNESS

Working in the health care profession is a privilege, yet it also carries some personal risks that we often don’t fully recognize. Medicine attracts high achievers with a strong work ethic and social and moral responsibility, devoted to the well-being of others and skilled in controlling complex situations. However, this may result in repeated exposure to stressful work conditions, affecting our well-being and leading to psychological distress that may manifest in various ways.¹ How one copes with their emotions can affect one’s sense of well-being and the care they provide to patients and family members.

Table. The 6 Dimensions for Well-Being

Psychological well-being is an ongoing multidimensional process geared toward a life that is balanced and whole, and it is engaged in the 6 dimensions from the Ryff Scales of Psychological Well-Being model (Table).² Ryff’s model is multidimensional and is not restricted to happiness or positive emotions. These are consistent with Substance Abuse and Mental Health Services Administration’s 8 dimensions of wellness (Figure 1).³

Figure 1. SAMHSA’s 8 Dimensions of Wellness

Current literature reports a challenge to well-being and mental health, as well as burnout in clinicians and medical staff. Before the COVID-19 pandemic, burnout, depression, and suicide rates were found to be more common in physicians than in the general population.^4-8 Since the pandemic, these numbers have increased dramatically^9-11 and are amplified in clinicians on the frontlines of the health care crisis.^12-17 Sadly, far too many health care professionals fear the ramifications of receiving mental health services. Untreated or inadequately treated mental illness poses a greater risk not only to the physician’s mental health but also to the welfare of their patients.¹⁸

I have previously described the inherent nature, demands, and culture of the medical profession that contribute to physician stress and burnout, and the barriers to disclosure.^19-21 An inverse relationship between demands or stress and performance has been described²²; in health care, this may affect patient care and outcomes. Prolonged stress can also lead to burnout, which is a state of emotional, physical, and mental exhaustion and the result of too many demands on one’s strength, resources, time, and energy, with the sense of having reached the limits of your endurance and ability to cope.

COVID-19 has introduced more complexity, bringing increased workload and demands, uncertainty, disruption of work and home environments, loss of autonomy with increasing oversight and regulation, having to choose between competing obligations and responsibilities, and increased moral distress, creating ethical trade-offs, conflict, and a gap where patient care delivery is inconsistent with clinical training and experience.

Stress, burnout, and mental illness in clinicians remain hidden secrets and often go untreated. Many physicians fail to recognize or acknowledge emotional distress or mood disorder symptoms in themselves and, when they do, they find it difficult to ask for help, perpetuating the myth of invulnerability and a tradition of self-sufficiency. Stigma is a major barrier to physicians seeking mental health care.²³ Nearly 40% of physicians report reluctance to seek mental health care due to fear of repercussions to their medical licensure, professional advancement, and fewer patient referrals, thus negatively affecting their career and livelihood.²⁴ Until recently, approximately two-thirds of states in the US have “character and fitness” or mental health questions on their licensing applications,²⁵ so clinicians need to be aware of their state licensing requirements and the wording of and response to questions. Fortunately, the Dr Lorna Breen Heroes’ Foundation helped to make strides in changing licensure queries about mental health as part of their Wellbeing First Champions Challenge (Figure 2).

Figure 2. States Making Positive Licensure Changes

All this strikes a familiar chord with me as a physician who has personal experience living with depression. As a medical student, trainee, and then later in practice, I sometimes found myself in deep despair, with both physical and emotional pain, unable to work or participate in and enjoy life. I was able to be focused and intent at work, fastidious about the care of my patients, and strived to make sound clinical decisions that would do no harm—and to my knowledge, I was able to succeed at that. It was later, at home, when I would crumble. Although the hallmark of my professional life has been compassion and understanding toward others, for many years I could not expect to receive the same in return. I felt private emotional pain and simultaneously found myself caring for and counseling those who had the very same illness as me.

I quickly learned that I should not speak of these issues to anyone for fear of being considered too weak and impaired to practice. Like too many physicians, I was hesitant to seek professional care because of the negative impact it would have on my career. My only choice was to be silent and hypervigilant. The reality of no support and no treatment was very isolating.

I eventually received treatment and survived, thanks to a team of extraordinary mental health professionals who worked overtime on my behalf. As a physician seeking help for depression, I needed to step aside and embrace the role of a patient and allow myself to receive care. I had to learn to trust and defer to others, and that receiving help is not a sign of weakness. Recovery is a lifelong process, and I had to accept that it’s OK to pause and hit the reset button.

We currently have clinician wellness programs in many major and academic hospitals and medical societies. This can only help to provide psychoeducation and support and decrease the stigma of mental health issues and clinicians’ reluctant to seek treatment. Moreover, in March 2022, President Joseph R. Biden signed into law the Lorna Breen Health Care Provider Protection Act,²⁶ which establishes grants for training health care professionals in evidence-based strategies to reduce and prevent suicide, burnout, and other mental health conditions.²⁷

Over time I have learned how best to manage stress, emotional distress, and mood disorders. The following are some suggestions I encourage you to consider.

Care for yourself physically, mentally, and emotionally. Aim for sufficient and regular sleep, exercise, relaxation, a balanced diet and nutrition, and social connection. Maintain relationships with friends and support individuals—those who sustain you.

Understand that self-care is not self-indulgent. It is a smart way to protect yourself using all the effective tools and resources available to not only function in the world but also contribute and thrive. Paying attention to your own needs does not mean you are ignoring your responsibilities, work, or your loved ones’ needs. Instead, it enables you to be a more available and effective health care professional, partner, parent, caregiver of senior parents, and/or coworker.

Prioritize and balance responsibilities, activities, and the demands placed on you. Set work and work-home boundaries, limits, and realistic expectations. Do your best to manage life’s little daily stressors, pace yourself, learn to say no on occasion, and delegate when necessary.

Adapt and implement effective coping strategies for stress, burnout, and emotional health.

Look to your own needs and wants and seek to do what increases your self-esteem, makes your life rewarding and rich, and sustains you. Nurture yourself and participate in and enjoy the moments of life. Include time and space for pleasurable experiences (eg, hobbies, interests, skills, music, sports, pets, or volunteer work).

Reach out to colleagues and clinician wellness programs as needed. Ask for help and support—this is not a sign of weakness or failure.

An article by Rothbard²⁸ has offered some additional suggestions regarding work and work-home balance, communication, identifying and managing goals, tasks and responsibilities, and self-advocacy. The World Health Organization has created a statement to “improve mental health and psychological well-being”²⁹ that is also in support of these goals.

Stigma continues to exist around mental health issues. Although the medical profession and society in general have become more open and accepting of those challenges, much more work remains. Improving the way mental illnesses are regarded includes education about these conditions as a biologic illness with effective treatment options. Our institutions need policy change and a cultural shift in the way mental health is perceived,³⁰ creating environments that encourage openness and wellness and offer time and support for treatment and to heal. Anything that deters health care professionals from seeking help poses a greater risk to themselves and to their patients as a result of untreated or inadequately treated mental illness. Thus, it’s imperative that physicians, nurses, and other health care professionals feel that they can get the help they need—free of shame, guilt, stigma, or negative professional repercussions.

Psychoeducation and policy change are not enough to accomplish change. Exposure to and social contact with those who have lived experience and continue to function and thrive is essential. Only when our medical colleagues who have sought and successfully received help for depression, suicidality, and other mental illness come forward to share their experience will more of us in need of psychiatric treatment feel comfortable seeking and receiving that care.

Dr Noonan is a physician, mental health and wellness coach; author of 5 books on managing mental health and mood disorders with a print and video blog; consultant; group facilitator; and certified peer specialist. Dr Noonan is the inaugural recipient of the National Depression and Bipolar Support Alliance Peer Support Specialist of the Year 2022. Her most recent book, published by Johns Hopkins University Press, is Reconnecting After Isolation: Coping With Anxiety, Depression, Grief, PTSD, and More.

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