epocrates

epocrates Panel Q&A Webinar: Clinicians & mental overload

April 10, 2024

Clinicians are leaving their profession at an alarming rate: in 2022 alone, 145,000 health care professionals exited the field. And the number of health care workers (HCWs) experiencing harassment has doubled, with those who experience harassment five times more likely to report anxiety and three times more likely to report depression.

What factors are contributing to these sobering statistics, and most importantly, what can be done to mitigate them? Host Anne Meneghetti, MD, Executive Director of Medical Information at epocrates, was joined by panelists Philip Muskin, MD, professor of psychiatry and senior consultant in consultation-liaison psychiatry at Columbia University Medical Center, and Douglas S. Paauw, MD, MACP, professor of medicine and Rathmann Family Foundation Endowed Chair for Patient-Centered Clinical Education at the University of Washington School of Medicine, to discuss these and other topics in the epocrates’ webinar, Clinicians & Mental Overload.

Time constraints, attention to detail are challenges physicians face when attending to their own mental health

The excessive conscientiousness or normal compulsiveness of physicians is partly to blame for the incredible stress that physicians bear and can take a toll on mental health. This tendency towards attention to detail and perfectionism, which Dr. Muskin attributes to world-renowned psychiatrist Glen Gabbard, requires a great deal of time, a luxury that is all too often lacking in a physician’s busy schedule. “How much time do we really have to be able to pay attention to our own care in between the electronic health record (EHR), patients, and our own lives?” asked Muskin.

Stigma towards mental health is pervasive, but that is slowly changing

For individuals in the medical field, the stigma attached to mental health issues is systemic and can reduce the likelihood of a physician seeking help. “We’re supposed to be perfect, and somehow having any kind of mental health issue means that we’re not perfect,” explained Muskin. Paauw sees newer generations of clinicians as more comfortable acknowledging and challenging the stigma associated to physicians’ mental health, but at the same time, he voiced concern about the increasingly high bar for entering the medical field. Future medical students are required to not only have excellent academic qualifications, but to also demonstrate that they are “Mother Theresa” through their countless hours of volunteering and service work. “They have done so many special things in their lives coming in [to this profession] that I think for many of these folks, they are already pretty exhausted and have not had enough time to focus on their own mental health,” said Paauw.

Workplace factors amplify the symptoms of mental overload

In health care, the integration of technology – specifically EHRs and smartphones – is a double-edged sword that has offered solutions but also presented challenges. Doctors are reachable 24 hours a day through phones, computers, and sometimes pagers, and the constant interruptions disrupt the intense work involved in patient care. And, when the interruptions continue long beyond the end of the workday, clinicians are unable to decompress. Muskin relayed a story from morning rounds when a resident said that he was pinged with questions late at night. “The technology, which is fabulous, is not supposed to be 24/7. But it really does engage us potentially all the time,” said Muskin. Paauw and Muskin also cited patient frustration with the health care system and the time spent interfacing with insurance companies as sources of physician mental overload.

Strategies and tools to manage stress and overload

Paauw cited the three “B’s” – boundaries, bundling, and breaks – as strategies that younger generations in particular appear to have developed to safeguard their well-being. Boundary-setting is challenging for physicians, Paauw explained, because of the tendency to want to do everything and to do it well. “Setting boundaries with your patients, the system, and even yourself is such an important thing…we have to be able to bite off what we can chew,” said Paauw. The second “B” refers to bundling, or the concept of working on one specific task in a pre-defined period to avoid distractions from other tasks. Finally, the third “B,” breaks, is vital for well-being. Both Paauw and Muskin focused on what they call “the little things” like taking a walk, focusing on breathing exercises, and eating lunch away from work. They also cite the importance of talking to trusted people – significant others, colleagues, family members – to vent and find support. And both panelists encouraged physicians to identify therapists through employee assistance programs. The most important thing, said Paauw and Muskin, is to understand that taking time for self-care is not selfish; it’s necessary. “Do not feel guilty – because you’re not doing it for yourself, you’re doing it for the greater good,” said Muskin.

Source:

Meneghetti, A. (2024, April 5). epocrates. Clinicians & Mental Overload. [Webinar]. https://zoom.us/webinar/register/9017123433701/WN_M8_vyRFtQs2DcFU6XWnqQw#/registration