Doctors often appear to be the epitome of health, resilience, and boundless energy. However, beneath the white coat, they grapple with their own trials – physical exhaustion from long hours, emotional strain from demanding situations, and the weight of responsibility in making life-altering decisions. Despite their expertise, doctors aren’t immune to illness, stress, or the toll of their profession. According to studies, the rate of psychiatric disorders, especially suicide, is considerably higher in doctors than in the general population. Researchers undertook a study discussing the challenges doctors face regarding mental health, stress, and the high rates of suicide within the profession. The text covers various dimensions, including personal, structural, and systemic factors contributing to doctors’ struggles.
A proactive approach to well-being, through training, and support will not only benefit doctors but also the patients who utilize their services each day.
“Using defined terms (suicide, self-harm, doctors, physicians, residents) in PubMed, we identified pertinent articles for review. We found that suicide in doctors is influenced by exposure to the physical and emotional distress endemic to the profession. These experiences may be compounded by emotional giving to the brink of exhaustion; a lack of positive feedback; alongside workplace isolation and poor support networks,” said the authors.
“Moreover, risks may be magnified by impacts outside of work; long hours, strained family relationships, poor work–life balance, as well as system and organizational politics. Despite this, doctors persistently avoid seeking help because of stigma against mental illnesses, stigma against themselves, and growing concerns that disclosure may impact their medical license,” they added.
Doctors frequently decide to use prescription drugs, alcohol, and a variety of other substances as forms of self-medication. It’s critical that medical services attend to doctors’ needs in an appropriate, timely, and sensible manner. It is morally required of organisations, including regulators, to look out for the welfare of its employees.
Patients who use doctors’ services daily can also benefit from a proactive approach to well-being through training and assistance. Journal of Psychiatry in India published the findings.
The physician well-being concept
Physicians in a variety of professions frequently operate under extreme stress. Patients, supervisors, their own professionalism, and structural elements are the sources of these pressures. It has been stated that the suicide rate among doctors is significantly greater than that of the general population. The notion of physician well-being is multifaceted and encompasses aspects pertaining to both the workplace and the individual physicians.
“In this brief overview, we aim to provide an overview of some of the issues affecting doctors’ and medical students’ mental health and well-being in this and accompanying paper. We will attempt to draw some common factors together in our understanding of factors affecting doctors and suggest some ways forward,” said the authors.
Reasons for suicide among doctors
Suicide has a wide range of causes, which fall into three major categories. First, there are private motives. These may include underlying mental health conditions, but they can also include growing responsibilities at work, a lack of support, and other factors that raise stress and anxiety. This group also includes peer interactions, stress, and trauma exposure, with a deficiency of support frequently leading to a changed mental state. One factor that may contribute to these feelings is a loss of control.
The second explanation has to do with structural factors, meaning that the fact that doctors practise in multiple counties could be a factor. These include the rise in “paperwork,” hurried patient interactions, access to and control of electronic health records, and greater managerialism in many healthcare institutions. Anecdotal data suggests that doctors are feeling more and more oppressed by the system in many different countries. Sociocultural issues could be present in addition to management pressures and rising patient demands. These could include external elements that impact the environments in which clinical medicine is practised, such as work-related stress, the inability to take breaks, unwind, or rest, and a dearth of secure areas where medical professionals can rest or recharge while on call.
The third group of factors, which includes experiencing trauma and fatalities as well as not having access to safe places where one can reenergize themselves, is best characterised as endemic issues. In addition, physicians are frequently urged to maintain a “professional” distance from their patients while also being empathic—a dichotomy that can make conflict between the two difficult to reconcile at times.
Rates of various psychiatric disorders
Undoubtedly, due to their sensitive age, medical students and doctors-in-training are more likely to suffer psychiatric illnesses (see the accompanying study). It is commonly known that around half of adult psychiatric illnesses begin before the age of 15, while three-quarters begin before the age of 24.
The syndrome known as burnout is characterised by signs of depersonalization, emotional tiredness, and a diminished sense of personal achievement. Its incidence has recently increased significantly, showing up more clearly in certain medical specialisations than in others. Without a doubt, burnout can have serious, wide-ranging effects on the system as well as the patient and the physician. It may result in subpar treatment, a rise in medical mistakes, and discontent among patients and healthcare professionals. It can result in melancholy, feelings of worthlessness, loneliness, and attrition from the medical field for the physician, which puts further strain on others.
Compounding the problem, burnt-out doctors are reluctant to get help from a professional and instead may try to cope with substance addiction, despair, and suicidal thoughts on their own.
Due to their perfectionist tendencies, high standards for themselves, and the conflict between rising and falling patient expectations—they are instructed to maintain a safe distance yet are nevertheless expected to be compassionate—doctors are frequently more vulnerable than other professions. Feelings of estrangement are further exacerbated by loneliness and a lack of support. Doctors very never receive appreciation; instead, they frequently receive letters of complaint and criticism.
Doctors who are under stress may engage in a “disappearing act” that involves not returning calls, taking frequent sick leaves, arriving late, or leaving without explanation. They may exhibit “Clinic Rage,” which manifests as outbursts of fury, shouting battles, and reacting negatively to perceived or actual slights. They may also be tardy in doing procedures, clerking patients, writing documents, and making judgements. They may also arrive early, leave late, and yet not complete an acceptable task. Presenteeism is the term used to describe the situation where an individual is physically present yet unable to function.
There is a five to seven times greater risk of suicide among doctors than in the overall population. Psychiatrists, general practitioners, and anaesthesiologists are common specialties with high rates.
Role of regulator in ensuring Doctor’s well-being
Regulatory agencies have a significant responsibility to care for people who may have turned suicidal because of reports and investigations by the agency. Global regulators must ensure that doctors are continuously supported throughout the investigation process and that they have sensitive support mechanisms in place.
Steps that can be taken to prevent depression, burnout, and suicide among doctors
There are essential steps that must be taken to prevent depression, burnout, and suicide. System adjustments are also required, in addition to early detection, early intervention, peer support, and suitable, easily accessible supportive services on an individual basis.
To support doctors who might need assistance, a significant change in institutional policies and professional attitudes is required. Determine the obstacles to untreated mood illnesses and the elevated suicide rate, such as prejudice in hospital privileges, professional growth, and medical licencing.
Approaches in attempting to support doctors and help remove barriers:
- Prevention of suicide in doctors requires a range of strategies, including improved management of psychiatric disorders, measures to reduce occupational stress, and restriction of access to means of suicide when doctors are depressed.
- System-based approaches are likely to be more successful in combating suicidal behaviour and ideation. These include limitations of the electronic health record, long work hours, and substantial financial debts within a no-blame but highly litigious culture.
- Using several approaches such as individual counselling, psychiatric evaluation, and wellness workshops for doctors in training and for trainers they were able to demonstrate that participants reported a high level of satisfaction with this wellness program.
- Education and training with a multi-faceted approach involving all the stakeholders including regulatory bodies.
- Limited data are available regarding how best to address trainee burnout, but multi-pronged efforts, with attention to the culture of the workplace, the learning and work environment, and individual behaviours, are needed to promote trainees’ wellness and to help those in distress.
- Appointment of wellbeing guardians in each hospital, better occupational health access, and spiritual and healthcare of medical staff.
- Assisting junior doctors to manage workload demands and patient contact will have beneficial effects on their work enthusiasm and mental health.
Systemic and individualistic changes
Understanding doctor vulnerability is crucial. It’s critical that doctors receive more individualised help in their first training phases. This could show up as the onset of suicidal thoughts, sadness, burnout, or other problems. The loss of life can place a significant strain on healthcare systems, which is why early diagnosis and management are crucial.
Any modifications must be both individualised and systemic. Changes at the systemic level must address both environmental and endemic variables. It is necessary to alter social norms and workplace culture.
Support at all levels—clinical, educational, managerial, and environmental—must be provided in order to foster individual resilience. It is necessary to have mechanisms for managing stress and stressors in order for physicians to provide the best care possible. Peer support and self-care are beneficial. Employing techniques to increase resilience is a crucial first step.
Help is here:
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Name of the Organisation: Vandrevala Foundation
Vandrevala Foundation is a non-profit that partners with organizations to help communities thrive by providing education and healthcare. Vandrevala Foundation launched a mental health helpline in India in 2009 to offer free psychological counselling and crisis mediation to anyone who is experiencing distress due to depression, trauma, mood disorders, chronic illness, and relationship conflict.
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Name of the Organisation: Aasra
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