Physician burnout - Part 3 - Suicide
By the time the COVID-19 surge in our community did arrive last fall, I was ready. In the months prior I had recognized that I was feeling burned out and therefore made changes in my life to restore some balance, which was no easy task. I first determined what my “non-negotiables” were: those activities I made sure I did every day in order to prevent feeling burned out. For me this meant at least eight hours of sleep, daily exercise, spending quality time with my husband, writing, and not listening to negative news. Because there are only so many hours in a day, that meant having to let go of many activities that didn’t make the cut.
It also meant I needed to be more thoughtful and efficient at work so that I could take the best care of my patients and still have the energy to improve the stroke rehabilitation program. In order to avoid physician burnout I learned how to say no. I found that by cutting back on my responsibilities where I could, I was much more relaxed with my patients, which meant clearer thinking and less chance of making mistakes. I also experienced much less irritation with the usual bumps in the road, such as insurance company pre-authorizations, documentation requirements, or demanding (in other words, scared) family members. My reserves had been replenished and continue to be so even today.
Not everyone in healthcare, however, has had the fortune of seeing the signs on the wall and making changes before it’s too late.
Dr. Lorna Breen was an emergency room physician and medical director of her department, an outstanding doctor who went far above and beyond on the front lines of the COVID-19 pandemic in New York City. Prior to the SARS-CoV2 outbreak here in the United States, Dr. Breen was already aware of the effect of physician burnout in her field of medicine, having authored an article in the American Journal of Emergency Medicine back in November 2019 entitled “Clinician Burnout and Its Association with Team-Based Care in the Emergency Department.”
Many months later, Dr. Breen’s emergency department and hospital were quickly overwhelmed with very ill COVID-19 patients, at three-to-four times the normal capacity of the facility and its healthcare workers. She herself also got infected with the virus; when she returned to work, she continued to experience all of the hallmarks of physician burnout, including extreme fatigue and a sense that nothing she did made a difference in this pandemic. She worked well beyond her twelve-hour shifts during this crisis to try and meet the needs of her hospital and community. She was afraid to get help for her symptoms of burnout due in part to the stigma associated with mental-health issues within the medical community.
Tragically, Dr. Lorna Breen committed suicide on April 26, 2020.
Physicians have the highest rate of suicide of any other profession in the United States, and per a meta-analysis in 2004 , this rate is 1.4 (men) to 2.2 (women) times higher than the general population. A more recent meta-analysis in 2020 shows similar results, with female physicians having a higher suicide mortality ratio as compared with women in general.
It’s true that many physicians experience high degrees of stress and physician burnout and do not struggle with mental-health issues or commit suicide. Physicians generally have a high amount of resilience, which was required to get through the arduous training process and to continue to successfully work in the current healthcare system that often takes away our autonomy. Resilience aside, physicians are humans, too. They need to take breaks; they need time off work for restoration; they need mental health support; and they need less stigmatization by those who believe having a mental health issue makes one unable to take care of patients. This stigma may be keeping physicians from speaking up and getting the help they need in the earlier stages of their burnout. I can only imagine that the mental healthcare needs of all healthcare workers are going to rapidly increase due to the unprecedented trauma and loss brought on by this pandemic.
You can learn more about Dr. Lorna Breen and the Foundation that has been started in her memory, as well as the healthcare legislation act in her name by clicking on this link: The Dr. Lorna Breen Healthcare Provider Protection Act