Why do People Commit Suicide?

March 25, 2015

#doctorstress #doctorsuicide #workplacestress #suicideprevention #SAVE

I have to admit that this one was hard to write. The statistics are overwhelming. The stories I’ve been reading are very compelling – and sad.

Even someone as powerful (scary?) as Tony Soprano knew that there would be repercussions if it came out that he was seeking help from a mental-health professional to help him deal with the conflicts and stresses of his private and “professional” lives.

In the last post (read it here), I said I’d research and then write about the reasons people commit suicide. It’s a hard, emotional topic for all of us. It seems as though many of us are touched by the act in some way – we know someone that has tried to commit suicide, has committed suicide, or we are friends with someone that knows someone that tried it, or was successful.

Normally I try to keep everything about the blog surrounding workplace stress in general, and doctor’s s stress in particular. But this topic made me look at it in a more generic sense, as I began the research process, so we’ll stray just a tad from our normal focus today.

The SAVE organization

One of today’s main background articles is “Suicide Facts” authored by the SAVE organization (Suicide Awareness Voices of Education). It can be found on-line here: <http://www.save.org/index.cfm?fuseaction=home.viewPage&page_id=705D5DF4-055B-F1EC-3F66462866FCB4E6>

According to the CDC, suicide is the 10th leading cause of death in the US.

There were 41,149 suicides in the US in 2013, as you can see from this CDC chart, below, from the study referred to above:

2013_Leading_causes_of_death

I grew up in a town that had a population of about 9,000 people in it. That means that 4.57 times the population of my hometown kills themselves every year.

Another way to look at it – every day, about 105 Americans take their own lives.

That’s about 1 every 13 minutes.

Think about that for a minute.

According to this SAVE study (and quoting the CDC), the US Suicide rate over the last decade is 12.1 out of every 100,000 people, which is up from 10.4 per 100,000 during the previous decade. I’m sure that the Great Recession had a significant impact, with it’s high unemployment rate, the financial collapse of the stock market, the significant reduction in housing prices/values, and other reasons.

So, why …?

The short answer to the question “why do people commit suicide?” is obvious, and the basic fact remains the same. Simply put, we may never know the truth of the matter for that person. We’ll never really know for sure why someone did it – even when a note is left behind, we cannot be completely sure as to the reason. In fact, the victim may not even know for sure why they are doing it themselves.

And each individual case is different as well. Many times, we can surmise at causes, but overall, all we’re doing is guessing.

Depression is generally accepted to be a significant cause. Substance abuse. Bullying. Chemical imbalances in the brain. Frustration. PTSD. Unemployment. Chronic pain.

An extraordinary amount of stress (as a possible contributing factor to major depression) is considered a prime causation, and is the main focus of this blog, and so this post. The SAVE report shares that 90% of all successful suicides have an existing mental health issue, or substance abuse problem within the month of their taking their own lives.

Primarily in the medical arena, amongst doctors and other medical professionals, to reiterate from research I’ve found and quoted in a previous post (read it here), doctors kill themselves at a rate twice that of the general population. Around 400 per year take their own lives. That’s roughly equivalent to one graduating class from a single medical school.

Each year.

It goes without saying that the cost to their families and circle of friends is emotionally overwhelming. There can be no monetary value – no price can possibly be – put on the life of another human being.

And the cost to society overall is stunning as well. It is thought that a single general practitioner has about 2,200 – 2,500 patients in their panels. That means that about one million people a year are impacted by the loss of their doctors.

And again – in no way do I wish to minimize or reduce the emotional pain felt by the physician’s family and circle of friends – in no way. Doctors are human, just like the rest of us. They have families and friends. They are people with stresses we lay professionals simply don’t face on a daily basis. And they have very few outlets for stress relief available to them, for many reasons.

Because the societal stigma is still attached

According to a Tragedy Assistance Program for Survivors (TAPS) study, 80-90% of all people that seek help via therapy and medication are successfully treated, but only about half of those impacted by major depression will seek help.

The personal and professional stigma that doctors might face seems greater to me than if one of us were to seek help from a mental-health professional. Because of that, many doctors do not seek the help that may save their very lives. Anecdotes that I’ve read say that, for those that do choose to seek help, they drive several miles away to another town, and make appointments under false names. They then pay in cash, so to avoid paper trails.

Isn’t that a sad statement on our society overall? A friend, when he found out I was writing this particular blog post, sent me this “cartoon” about how ridiculous it would sound if we were to question a person with a physical malady.

Helpful advice cartoon

My personal favorite is the middle one on the left column – “Have you tried … you know… not having the flu?”

See how ludicrous that sounds? And yet we do it every day, either intentionally or unintentionally to people that have mental-health issues and are “brave enough” to ask for help.

Why is that? It probably goes back to this famous quote that has been attributed to many people. Here is Dan Brown’s version of it:

“What we don’t understand, we fear.  What we fear, we judge as evil.
What we judge as evil, we attempt to control. And what we cannot control…we attack.”

― Dan Brown,
author of The DaVinci Code,
Angels and Demons, others

The human brain is an organ, plainly put. It does not actually contain our “selves” – our makeup; our personality. And yet, if we see someone that is suffering from a mental illness, we inadvertently tend to think less of them, don’t we?

Let’s take the correlation to a farther conclusion. Would you think twice about someone that is seeking treatment for their liver? A kidney? Their heart? Probably not – you’d wish them well, and possibly send a get-well card, depending on how well you know them. But when there’s “trouble with the brain,” we tend to think less of them, don’t we? We may even think they are weak. We want to avoid speaking with them about it. Or we may go so far as to think they might be “crazy…” If they were our doctor, we certainly wouldn’t want them operating on us now, would we?

And so it is human to fear that which we don’t understand. And we laymen do not understand brain functionality well at all, if we admit the truth to ourselves. We’re just not sure where that line is from “being angry” to “going postal” in the minds, hearts, and the actions of another.

The CDC says that 20-25% of all Americans over the age of 18 experience depression every year. That’s one out of four or five. I’m not saying that to be overly obvious, but merely because it is so prevalent – emphasis by repetition – if you will.

There are about 350 million people in the US. That means then that 87.5 million of us experience depression at some level, each year. And that’s a big number.

Get help if you need it

To anyone that may be considering suicide at this very moment – please reconsider. We need you here on this earth. You are unique and valuable, and someone loves you and values you.

And no one else can play your role here.

Please – I’m not a psychologist or a psychoanalyst – so I simply cannot provide the type of help that someone in need, needs. Not because I don’t want to – I simply don’t know how. Please, if you (or someone you know) are feeling depressed, get help. Start with your doctor. Get a physical. Find out if something over which you have no control – such as a chemical imbalance – is at work.

And doctor? Call your doctor for help if you need it, OK?

Please get help – it is proven to work over 90% of the time. Those are great odds.

Start on-line here: <http://www.sprc.org/>

Find the suicide-prevention line in your area, and call it. Talk to them.

And the problem is international in scope

According to the World Health Organization (WHO), depression is the leading cause of disability worldwide. There is one death by suicide every 40 seconds, somewhere in the world.

Over 800,000 people commit suicide each year. Is it because other societies stigmatize depressed/stressed individuals as much as we do, here in the US? More?

Now let’s remove the stigma – begin the conversation. Understand.

Ignorance is fixed with information. Let us all make it a point to open our minds and learn something about mental health, so we can better understand it, and more effectively treat it, and possibly save a life.

Alan Kay, one of the members of the original Macintosh team at Apple, once said “Perspective is worth 80 IQ points.” Something like that, anyway…

In conclusion of today’s post, I’ll quote Dan Brown again:

“The power of human thought grows exponentially
with the number of minds that share that thought.”

― Dan Brown,
author of The DaVinci Code,
Angels and Demons, others

Next post: Causes of doctor/workplace stress and research on coping strategies

Keep_Calm

When Nurses Need Nursing

stressed-out-nurse-cartoon

Friday, March 13, 2015

In the last post, (read it here) I mentioned that this post would cover the topic of “When Nurses Need Nursing.”

Nurses in general are the people that patients deal with most often in a health-care-delivery situation, especially when in the hospital. They are expected to be calm, collected, and stoically professional at all times. Smile in the face of all situations. Don’t cry. Don’t show negative emotions at all – hey – it’s unprofessional.

2_nurses_smiling

Anecdotally, I’ve heard that many a nurse has been “written up” for unprofessional behavior – for crying in a location where a patient may see them.

Our expectations are incredibly high on this profession as a whole, overall. Should they be? Yes of course, but we also need to understand that the nurse is someone’s sister or brother, daughter or son; wife or husband. In other words, they are human, and therefore bound by the same limitations as the rest of us.

Let’s walk in their shoes before judging.

“Emotional Labor”

One of the studies we’re looking at today claims that the nurse’s identity is the “outward persona of competent and composed professionalism.”

This study explores the concept of “emotional labor.” Other related terms for this include burnout, compassion fatigue, job stress, or that one nasty word – stress.

images

Let’s look at “compassion fatigue” and “emotional labor” as the two base phrases today.

I found an article to cite about the topic, called “When Nurses Need Nursing: The Toll of Emotional Labor.” It was written by Laura A. Stokowski, RM, MS., and published by Medscape on May 13, 2014 (http://www.medscape.com/viewarticle/824689).

Ms. Stokowski is an experienced nurse, and focused her article on nursing in a Neonatal Intensive Care Unit (NICU) at a Level 4 NICU in a children’s hospital. She cites extensively from a research study performed by Roberta Cricco-Lizza, a University of Pennsylvania researcher. Cricco-Lizza performed what’s called “ethnographic research” at this NICU. This type of study means that she became embedded into the daily lives and routines of these nurses (114 of them) over a period of 14 months.

Ethnographic research – continuous observation for long periods of time

This type of research uses many tools for a project of this type, including observation sessions, informal interviews, and formal interviews with 18 “key informants.” The behaviors and approach of the nursing staff with patients, parents, and other staff members, and were studied and documented over a significant period of time, as you can see.

In other words, this was a long-term project in an attempt to get to the root of the subject area rather than just be a one-time (or repeated) “snapshot-in-time” survey. Quite a contrast in approach. This type of study is designed to provide deeper insights as well as somewhat more objective observations of the researcher. What may not be thought of, or come up during the time a nurse fills out a survey, may appear in the long-term observational study.

In a nutshell, the ethnographic approach allows the researcher to study the deeper nuances of a situation. It also helps to divine the sheer level of impact that topic has on the subject(s) being observed. These deeper data points are discovered due to the fact that trust naturally builds over the significant amount of time researchers and the subjects spend together.

Cricco-Lizza wanted to gain a better understanding of the challenges of working in a busy NICU, as well as how that work environment affects the nurses’ private lives.

“Stressful work environment”

One of the early statements both authors make is, simply put, “the NICU is a stressful work environment.” On the face of that, it seems both obvious and at the same time, counter-intuitive. Obviously it is stressful because the babies in the NICU are in distress. Bluntly, some will not make it home – and that is very hard to accept for some nurses.

They are human after all.

But it’s counter-intuitive too. This is because for those children that thrive and go home in the face of all that adversity – well – let’s say that the positive impact those nurses had on the lives of that child and it’s parents is profound indeed. It has to be incredibly rewarding to see a struggling small one gain strength and thrive over time.

And therein lies the issue.

Nurses in general cannot show their emotions when challenging things happen, and yet  they need to be able to celebrate with the parents when they get to take their child home, finally.

Think about that for a moment – in your daily life – if you see “bad things” at work, you are expected to either fix them, or at least speak with others in your organization (or your customer’s /supplier’s organization) to the point whereby the issue is resolved. You are respected for your professionalism as well, of course – you identified a problem, and you fixed it. But if you make a mistake, more than likely, and depending entirely on your profession, a defenseless little one doesn’t die. So yes, we all have stress, but for most of us, it’s not “life or death” type stress.

Yes, the nurses have chosen this life, but that doesn’t mean that stress is now non-existent for them. Let’s admit that, and find a way to reduce it.

Three disparate causes for stress

Cricco-Lizza found that there are three main sources of stress in the lives of a NICU nurse:

Caring for the babies – many nurses (quite naturally) become very attached to the babies and their families. And when they do well (or not), at some point, that relationship comes to an end. As we know, there is little room for any type of error when dealing with challenged patients, and much need for constant vigilance, regardless of how tired or stressed the nurse is feeling on that particular shift.

what-can-a-nurse-manager-do-to-decrease-staff-stress-infographic-1-638

Employer demands – there are many and varied sources of stress from the employer perspective. Constant change in rules and regulations, new technology – both medical and computer system-wise, training new staff members (due to a fairly high turnover rate), short staffing, rotating shifts; even something as simple as answering the phone “promptly.” That last one seems minor to most people in most professions, but many times a phone call interrupts the care procedure they may be giving at that particular moment. Now add that to the demand that no mistakes are made when delivering care, and you can see the conflicting issue here, which in turn causes stress.

Personal life – many NICU nurses are also mothers, and therefore can project the issues their patients are suffering onto their own children. Expectant mothers can suffer anxiety about their unborn child as a result of what they see on a daily basis. Also, today’s reality is, many “experienced” nurses are at an age whereby they are also caring for an elderly parent at home, perhaps. This can be stressful also, and does not then provide for an escape from the work pressures, even at home. Many nurses also report that because of the privacy expectations we have of them, their profession does not allow them to speak with friends and family members about their cases, and so the burden is carried alone.

So where do they learn how to handle it?

The study by Cricco-Lizza points out the fact that there is no class on handling stress during the nurses’ educational experience and formal training periods.

Most hospitals and doctor’s offices do not have workshops for the nurses in any of the departments on how to deal with job stress. In fact, most health-care organizations will not even admit that high levels of stress (or emotional labor) even exists, much less have methods for handling it well.

Again, it boils down to the powerful stigma that our nation holds towards people that suffer emotional or mental challenges. If a legal professional were to find out that a nurse has been “acting out” due to high stress, and one of the babies under her care were to pass, there would be justification for legal action against the nurse and the health-care organization that employs him or her. Whether or not it’s deserved –  or even related to the care that NICU nurse provided – a diligent attorney will find a way to make it a cornerstone of his or her case against the hospital – and probably win that case when presented to a jury of his/her peers.

If, societally, we’d be OK with heading off stress prior to it’s building up that far, perhaps the issue may not have happened in the first place. Perhaps that baby would have gotten a different level of care. Perhaps that nurse (or doctor) would not have subsequently committed suicide.

Let’s be honest with ourselves here. We all have our mental issues (at some level or another) simply because we are all human. We all have some sort of mental challenge we’re working on, or a stressful situation we are dealing with. An addiction we’re trying to overcome – be it substance abuse or even just a guilty pleasure of too much reality tv. Some people handle stress better (longer?) than others, but at some point, we all have our breaking point. It’s called the “end of our rope” in some circles.

So, even though I’m not a “bible-banging” person as a rule, I do have two “Christian” rules from my upbringing that keep coming to mind as I study this topic:
1) Judge not lest ye be judge
2) Let he who is without sin stand in the circle and cast the first stone

If you’d like the exact biblical reference for either of these, please leave me a message in the comments section, below.

Maybe we’d all be better served if we were to allow medical professionals unfettered access to the counseling, seminars, stress-reduction workshops that they need, to avoid more stress buildup.

Healthier doctors and nurses mean healthier patients. Healthier patients means lower health-care costs overall.

Win/win/win.

Next post: Thoughts and research on why people commit suicide

Keep_Calm

Studies, numbers, facts (and several opinions) about Physician Burnout

Monday, March 2, 2015

In the last Blog Post (you can read it here), we talked about a year’s worth of personal experience, with the promise of facts coming next. Below are a few facts, and a few thoughts/ideas/opinions sprinkled in.

Recently, when a friend of mine discovered I was developing an interest (dare I say “passion?”) in the phenomenon of physician burnout and it’s related side effects, she sent me a study performed in Norway a few years back. I’ll get to that after we look through some basic facts about the health care arena.

Some cold, hard facts to set the stage:

– There are about 820,000 registered, licensed physicians in the United States (according to the AMA’s Physician Master File)stethoscope

– There are 5,686 Registered hospitals in the US (according to the American Hospital Association)

– Most GPs carry a patient load of about 2,200 – 2,500 patients (based on a computer program that models optimal practice size, written by Dr. Sergei V. Savin, PhD, Columbia School of Business). This is at 83% average appointment utilization rate. That equates to 70 patient visits per 5-day week, and 20 appointments per day. Doctors normally take 155 working days away from the office annually (including weekends)

– The US now spends about $3 trillion per year on healthcare – 17% of the GDP

– American physicians conduct about 1.2 billion patient visits in aggregate (according to a survey of 13,575 physicians by The Physicians Foundation in September of 2012)

– Physicians are working 5.9 fewer hours per week this year; less than they did in 2008 – roughly equal to 44,250 Full-Time Equivalents (FTEs) being removed from the physician workforce (at the same time that the ACA is showing more and more patients are signing up for coverage)

– The average debt load of a graduating doctor is $156,456 (according to this Physicians Foundation study, and according to the Association of American Medical Colleges)

– There are over 130,000 pages of regulations that doctors must abide by (by comparison, the US Tax code is about 75,000 pages long).

Now some opinions:

– 77.4% of doctors surveyed in this report are “pessimistic” or “very pessimistic” about the future of the medical profession

– 84% of the docs surveyed agree that the medical profession is in decline

– 57.9% would NOT recommend medicine as a career to their children or other young people

– Over 33% would NOT choose medicine if they had the opportunity to “do over” their career choice

So what does all this mean? I have my thoughts, a few of which I’ll share here, but I am much more interested in hearing yours. Please comment in the box provided, below.

Question mark

My one big question about all this is also tied to an observation – in today’s world, why is it that anyone, much less a doctor – why are those that seek help from a mental-health professional still seen as having a personality defect?

What many doctors do (as anecdotally reported) is see a mental-health professional from another town, several miles away.

They make the appointment under an assumed name.

And they pay in cash in avoid the paper trail.

The Norwegian Study

Meanwhile, “A Three-Year Cohort Study of the Relationships between Coping, Job Stress and Burnout after a Counselling Intervention for Help-seeking Physicians” by Karin E. Isakssson Ro, Reidar Tyssen, Asle Hoffart, Harold Sexton, Olaf G. Assland, Tore Gude | BMC Public Health 2010; 10(213)” is available on-line here: (http://www.medscape.com/viewarticle/723595).

This study was recently performed in Norway, following a counseling intervention for those docs seeking help. It found that they were doing better after learning strategies, tools, and techniques to fight the job/stress issue. The gains realized at the first follow up (one year later) were also maintained three-years later.

Those gains were significant, as you’ll see if you read the study. I’ll also include some of the ideas here.

Perhaps that tells us that Europe is ahead of the U.S. in the realization that those who need mental health assistance and guidance… well… that type of help is just as “real” as is the help we would look for when we need physical-body help (treatment for a broken arm, a major cut, etc.).

And it doesn’t (it shouldn’t, anyway) mean those people who seek mental health assistance have any sort of personality defect because they seek that help.

The study provides data from self-reported assessments at baseline, one-year, and three-year follow-ups. Reading through the study, I learned that there were significant improvements at year-one, and those that answered the survey again at the three-year follow-up (81% did continue to participate) point, reported that these gains were still holding true.

The main gains were in reduction of emotional exhaustion, job stress, and emotion-focused coping strategies. And neuroticism. (It appears that neuroticism is the personality trait most associated with emotional exhaustion; therefore, neuroticism is the personality trait on which many of these workshops are based.)

A few studies that are US-focused seem to show an association between the number of hours worked and physician burnout. That makes sense on the face of it, but many European-based studies have failed to support that. Is that because they work fewer hours than US-based docs do?

In 2003, US work-hour limitations for residents seems to have helped, but when coupled with stress-management workshops during their educational careers, several gains were seen. When surveyed 6 weeks and one year after the workshops, these gains seem to have been maintained. But after 2 years, however, without further interventions and coping workshops, these gains slipped backwards. Again – this is for the US-based resident, not the Norwegian study we’re about to review here.

More on the Norwegian Study

The Resource Centre for Health Personnel, Villa Sana in Norway, is funded by the Norwegian Medical Association, and is located at a psychiatric facility, Modum Bad.

The counseling intervention program was focused on two major areas:

1) Mapping and discussing the physician’s current life situation – the work-home interface (as the study authors call it)
2) Identifying and challenging them on their coping strategies

Baseline data showed that those that need help (and sought it) were helped, and at the one-year follow-up, the improvements they made were still intact. At a three-year follow up survey point, those gains were still seen.

According to the authors of this study, there were no previous data on coping strategies for this cohort, prior to this study.

A 5-point scale (1= does not fit; 5= fits very well) was used to generate Maslach’s Burnout Inventory (MBI) for this study, rather than the standard 7-point scale, due to criticism that has shown that the 7-point scale could provide a couple of categories that would not show mutual exclusivity.

227 physicians took part in the initial survey, and 81% (184 – 83 males, 101 females) took part in the three-year follow-up studies. Average age was 46.9 years old. Several physicians that took the study were preparing to become specialists at baseline, and had completed those studies by the three-year follow up.

The following is Figure 3 from the research study. As you can see, on a 5-point scale, at baseline, the average level of emotional exhaustion reported was 3.0. At the three-year follow up, the average was 2.4. Reported level of job stress at baseline was 2.4, and at 3 years, it was 1.9.

Norwegian Study, fig3

– The results for emotion-focused coping was 2.9 at baseline, and 2.5 at year 3

– The level of neuroticism reported at baseline was 2.6, and at year 3, it was 2.0.

– Tangibly, the number of weeks taken for full-time sick leave/rehab benefits dropped from 4.4 to 3.2.

– The average work hours per week at baseline was 43.2, and at year three, it was 39.6.

All of these results are significant in their impact on the quality of the doctor’s life!

This all leads me to believe that those that seek help and take it seriously seem to gain much from that help. May we next assume that those doctors that actually seek and receive help, and then implement the coping strategies in their lives create better outcomes for patients?

Healthier doctors should also equate to healthier patients, it appears. Very nice side-effect.

Please leave your comments in the box below – I look forward to reading your thoughts. They may also spark another blog post…

Next Blog Post: When nurses need nursing

Keep_Calm

An outsider’s thoughts on “Physician Burnout”

Microsoft Word - Document18Tuesday, February 24, 2015

Full disclosure: this is my first foray into this arena. The arena of physician burnout and its related effects, that is.

And let me start this by saying I’m not a physician – I am an everyday businessman, father, husband, brother, uncle, cousin, an all-around “normal” person, watching his adult children grow up and “launch.”

I’m also in the relative “later stages of life” – in my mid-to-late-middle-age you might say – and I’ve just spent a bit more than a year helping a close family member navigate some challenging health situations.

The journey all started with a major diverticulitis attack a couple of days before New Year’s Eve (2014), two major (related) surgeries in June and September, two systemic infections, multiple pulmonary emboli, a slight case of pneumonia, afibrillation (and all the side effects of heart issues), a cardioversion procedure , and, for added good measure, a couple of bouts with the flu. His energy level is still quite low, but for the most part, he’s healing up quite well, and returning to normalcy (whatever that represents).

During this timeframe (about 14 months) we’ve interacted with many medical professionals (all manner of physicians and surgeons, nurses, PAs, imaging technicians, blood-lab personnel, etc.) – closely – that helped keep this person literally alive, and actually helped him thrive.

Every day, we all drive by doctor’s offices, hospitals and rehabilitation centers, chock full of patients in all stages of life, and in all states of health. There are doctors with great empathy and those that, let’s say, lack bedside manner.

One overriding point to all this is, most physicians are very self-confident. Simply put, they have to be – they hold the lives and well-being of (on average) 2,200-2,500 people in their hands. Research shows that most GPs have about 2,200-2,500 patients in their “panels.” (based on a computer model designed by Dr. Sergei V. Savin, PhD, Columbia School of Business).

Some thoughts and opinions:

– Some have been led to believe they are even at god-like levels in terms of their chosen profession. And you know what? That’s OK by me – I want someone looking after my loved one (and me!) that is confident in his/her ability to help, and to make the right call under some very tough circumstances, and not always with all the facts at hand.

But there are always two sides to every coin, or two edges to every blade. Choose your analogy.

The incredibly sad thing is, physicians kill themselves literally at double the rate of the general population – about 400 a year commit suicide. That’s equivalent to one graduating class of medical students from one medical school.

Each year. And some would say that’s underreported.

According to several research studies (http://www.medscape.com//features/slideshow/lifestyle/2014/family-medicine) reaching back to the 1980’s, about 1 out of every 2 physicians is suffering at least one effect of professional burnout, as judged by the Maslach Burnout Inventory (MBI) test and results.

This figure was confirmed by a study recently released by VITAL Worklife Solutions in St. Cloud, Minnesota. The study I’m referring to was co-authored and co-sponsored by VITAL Worklife Solutions (http://vitalworklife.com/) and Cejka Search (http://www.cejkasearch.com/).

These two organizations repeated a survey they took in 2011, and found some startling results.

One out of two (it’s actually 46%) doctors is feeling some level of workplace stress.

Compare that to…

I know that in today’s society, professional burnout is rampant across the board, for many reasons – the requirements of working people have doubled or even tripled over the last 10-15 years due to the Great Recession, the housing bubble burst, the .com economy experiencing a huge fallout, extended high unemployment/underemployment rates, and so on, and so on.

High Stress

Some research estimates that up to 84% of all working people are looking to leave their current jobs for another (as reported by CBS News, based on a study taken in 2012 by Right Management: http://www.cbsnews.com/news/84-percent-of-workers-looking-to-leave-their-jobs/), because they felt that they have fewer career opportunities with their current employer, and feel that they are still doing the work levels of 2, 3 and even 4 people than their work levels prior to the Great Recession.

 

But also in today’s world, employed people are somewhat glad to have their jobs – any job – rather than be unemployed. But as you will see in a moment, that is changing.

Again – that’s 84% of all (surveyed) employed people that are looking to move…

In fact in an article in Forbes Magazine in March of 2014, 2.457 million people quit their jobs (http://www.forbes.com/sites/ericjackson/2014/05/11/the-top-8-reasons-your-best-people-are-about-to-quit-and-how-you-can-keep-them/). That’s about 30 million people a year that are quitting their jobs.

The pre-recession-era figure was about 3 million a month.

The low, during the Great Recession, was 1.67 million “Quits” per month (according to the Bureau of Labor Statistics).

And you know what? This pressure is real. But when we look very closely, most of the professionals that are burned out do not have positions that literally impact the saving of lives every day.

We non-physicians have golf outings (not as many as we used to have, admittedly), lunch dates with friends, dinner with their significant others, movie nights, and so on. We have opportunities to share our work frustrations and concerns with people that care about us. We can “get it off our chests,” so to say.

What is the physician to do?

Doctors cannot share case contents freely, due to professional privacy commitments, contractual commitments like HIPAA – and hey – they aren’t supposed to feel that way, anyway.

And the cases they see daily – cancer patients, broken bones, torn ligaments and muscles, depression – these people in general are in pain. Things are not going well for them. All of these are very negative interactions. Even depressing in their makeup you might say. Negative interactions – by nature. On most days, the doctor hears only the bad things going on in the lives of others. It has to impact them somehow, because they are, after all, human beings.

Simply put, their emotional bank accounts are overdrawn on a daily basis. When was the last time you visited your doctor to tell him or her that everything was fine? You would both consider this a waste of time and money, frankly. But emotionally, how and when does your doctor get a chance to hear from you that things are OK with you? That life is treating you well? That you’re feeling good? To hear you tell a joke or two? Share a smile? A thought or two about your local hockey team? What’s his/her favorite car? What are his/her hobbies?

“There’s no time for this folly,” you say. And maybe your doctor agrees…stethoscope

Now add to all that, the pressure they are being put under to see more patients every day, and to document more closely those patient interactions. And then know that they will see reduced payments resulting from governmental, insurance company, ACA mandates, and the ever-rising expectation level of patients and medical-practice leadership teams.

When we walk in their shoes, it’s akin to us being asked to do more with less. We all have our limits as human beings. But again, our professions probably do not include the saving of lives on a daily basis.

On top of all this, they see increasing costs of remaining in business – tort/medical malpractice costs and lawsuits, increased taxes on their office space, new equipment to purchase, new medications to understand, and staff demands for higher pay and benefits… The “out-go” is quite astonishing when given full consideration.

Do more with less, indeed.

The siren call of industry beckons, with it’s clean, sanitary labs, research assistants, and “normal” working hours. And the pay isn’t too bad, either, relatively speaking.

Now, marry all of this to the absolute mountain of debt according to a Physician’s Foundation study and report from the Association of American Medical Colleges in March of 2011, that average debt load is over $150,000. Most physicians incur this debt while attending medical school, residency, and internships. Given all that, it becomes no surprise that fewer and fewer bright people are looking to become doctors – it’s just not the profession it used to be.

Document, document, document

Physicians spend a greater proportion of their time on their computers documenting case notes, pre-certifying patient therapies, refilling prescriptions, and entering ICD-10 codes than ever before.

That time that could be spent on seeing patients or researching a confounding case, but instead they must meet these requirements of the government, or insurance companies. And remember – all insurance companies have their own procedures, forms, terminology, and rules, which only adds to the confusion and frustration.

Doc asleep at computer

You may ask yourself “why don’t they just hire a person to do all that for them?” And that’s a fair question, but let’s think about it for a moment – who can do this work better? The person that actually DOES the work, or someone else taking dictation from them? Will he/she remember everything that happened during the visit during dictation? Will the transcriptionist have the shades of meaning at their fingertips?

And at a very base level, given that their payouts are being reduced daily, how can they afford extra staff?

I know that given what we see on television and in the movies about rich doctors, that last thought may be suspect in your mind. But think about the spectrum of all livelihoods – we all fall somewhere in that spectrum. There’s only one Warren Buffet or Bill Gates in this world, and only one “poorest person on earth.” Everyone else falls somewhere in between.

Regarding insurance companies – while generalizations are dangerous – for the most part, the people that answer the phones these days are maybe high-school graduates being paid minimum wage, working in a bullpen situation, and reading from scripts on their computer screens. They have no medical training to speak of, and (anecdotally) don’t enjoy their jobs. When job satisfaction is suspect, then commitment to doing it well falls into that line as well. They are not normally empowered to make decisions that do not fall within some very strict guidelines.

And remember – the guidelines are set up to save the company money, and are not necessarily in the best interest of the patient.

So when so the physician, who’s had many years of training and experience has to explain to this “customer service” representative about why a person needs yet another expensive blood test to see how the prescribed medications are impacting the liver and kidney functions, well… Let’s just say, it’s not the best use of valuable time, which only adds to the frustrations of the day.

Put yourself into their shoes for a while. In your own job, how do you feel when you’re challenged by a person with much less experience, knowledge and training? For all of us, it can be frustrating; for a physician, it can be simply overwhelming.

It’s all on a spectrum, and it’s all relative.

Next post: a closer look at the numbers, and research abstracts, links, and opinions on the physician burnout phenomenon.

 

 

Keep_Calm