Battling Burnout



By Louise Gagnon

Medical Post

November 20, 2001


Dr. Eric Grief made a conscious decision to put his personal life before his care" in medicine because he saw he was likely to be a victim of burnout if he maintained the status quo. A graduate of the University of Toronto, Dr. Grief, 36, found his fulfillment in practicing medi­cine was declining and he felt he was delivering revolving door medicine.


"We were encouraged to handle our concerns on our own," says Dr. Grief. "I was experiencing warning symptoms of burnout. I felt I was working too hard. I felt I was asking myself questions like: 'How much do I have to give of myself?' "


A husband and father to one child, Dr. Grief gave up his hospital privileges and now works independently at walk-in clinics in the Toronto area, making his own hours, and taking part in activities like yoga to relax. In short, being a "family man" is his top priority in life. Dr. Grief is indeed not alone in his sentiments about his profession. Many of his colleagues are suffering from stress and a heavy workload, says Ot­tawa psychiatrist Dr. Mamta Gautam, director of the faculty of wellness program at the University of Ottawa. She exclusively treats physicians who are suffering from burnout and other co-morbidities such as depression or anxiety.


"The first thing they suffer from is emotional exhaus­tion," she says. "They find that at the end of the day they have no energy left." Patients tell Dr. Gautam that if they come home and find the roof has leaked or the kids are asking to play street hockey, they can't do it. They just have nothing else to give. Dr. Gautam describes the phenomenon that physicians are facing as depersonalization and withdrawal, which is characterized by individuals pulling away, isolating them­ selves, feeling a diminished sense of accomplishment and considering a departure from medicine altogether.


Dr. Gautam says she wants to ensure that medical stu­dents learn that it's alright to ask for help in their studies, and that as physicians, reaching out is not a sign of weakness, but a sign of strength. "The culture has to change from one of being tough to one where it's OK to take care of yourself," said Dr. Gautam. "There is more education taking place now at an earlier stage. We are talking at grand rounds and at continuing medical education events about this problem. The key is prevention."


She says she observes that medical students are striving to maintain a balance of work and life as students, which she foresees will continue when they enter their professional careers.


Her sentiments are echoed by Canadian Medical Association Pres­ident Dr. Henry Haddad, who says there has been a sea change in the attitudes of medical students to­ ward coping with difficulties. "I applaud today's students for wanting a more balanced life between their professional re­sponsibilities, family and leisure," says Dr. Haddad. "It's very healthy and they will probably cope better with the everyday stresses of physicians. I think they are be­ing instilled with the notion that there is no shame in admitting they are having a hard time."


Indeed, the outlook of younger physi­cians is in contrast to physicians of his own generation, notes Dr. Haddad. "There has been a certain stigmatization to the fact that we are sick," he explains. "We have believed ourselves to be supermen or superwomen who cannot get sick. There have been concerns we may lose our licence, we would suffer a loss of income and a loss of prestige if we seek help. Some physicians then and now medicate them­selves."


While the code of ethics of the CMA explicitly calls for its members to seek help from their colleagues and appropri­ate qualified professionals if they sense their work is ad­versely affected because of physical or emotional strain, the CMA is actively encouraging members to get help. It recently published a pamphlet on the subject which it is distributing to physicians throughout Canada. Its long-term plan is to have a hotline for physicians to call if they are in need of external support. According to a CMA survey in 1999 of 3,100 respondents, 57% of physicians who work on-call report that the lifestyle restrictions imposed by on-call work are stressful. The sentiment was more pronounced among younger physicians: 65% of physicians 35 and younger as well as 62% ages 35 to 44 stated that call-related lifestyle problems are stressful or highly stressful.


Another survey of rural physicians in British Columbia indicated 55% suffered from burnout (self-reported). Nearly half (44 %) said they had moderate-to-low feelings of personal accomplishment. A whopping 80% said they suffer from moderate-to-severe emotional exhaustion.


Dr. Haddad points to several probable causes for the soaring numbers of physicians who feel overwhelmed by their jobs. For one, with the proliferation of health infor­mation on the Internet, patients are asking more questions of their physicians, requiring doctors to ensure effective patient-physician communication. Not only is the population increasing, but also it is aging, making medical man­ power a critical issue that has to be addressed.


“Some of our physicians are more vulnerable to stresses," says Dr. Haddad. "If they are based in remote regions, they are indeed at risk of experiencing depersonalization or are unable to feel accomplishment at work."


At present, the CMA now directs any calls from physi­cians who are needing help to the provincial chapters. Some provincial organizations, such as the Ontario Medical Association, have a program for providing resources to physicians needing assistance.


Dr. Michael Kaufman, who directs the physician health program at the OMA, says an increasing proportion of calls are non-drug and non-alcohol related and that the number of calls coming in is on the rise. He attributes this to greater awareness of the existence of the service.


“Doctors may call and say they are burnt out, and we inquire as to what that means," says Dr. Kaufman. "We ask for details of the presenting problem, looking for things like anxiety, depression and stress. It's a preliminary assessment."


The service receives about 150 calls per year, which Dr. Kaufman believes is an under-representation of the extent of burnout among physicians. "It is likely nowhere near what the problem actually is," he says.


When physicians do seek professional help they typi­cally are involved in psychotherapy for about 12 to 18 months, says Dr. Gautam, who sees about 150 patients per month. They may be taking antidepressants in addition to receiving psychotherapy.


Dr. David Rainham, a Kitchener-Waterloo, Ont., physi­cian and author of stress management guides for various audiences, says the medical profession may attract individ­uals who are perfectionistic and have high expectations, which may contribute to their stress. That being said, the profession needs to be more proactive in providing re­ sources.


“A more intense person has a harder time with ups and downs," says Dr. Rainham, who teaches at the University of Western Ontario. "It would be good to offer physicians sup­ port groups they can be part of."