Well-being assessment: Burnout, depression, suicide

For the full video, go to MedicalWorldNews.com.

Physician burnout is a problem. Just like the suicide of a doctor. But often the way we confuse these two crises is not accurate and undermines efforts to confront the problems. Medical World News® spoke with Christine Yu Moutier, MD, Chief Medical Officer of the US Foundation for Suicide Prevention, to discuss these topics. The transcript below has been edited for length and clarity.

Medical World News® (MWN):

Can you discuss some of the key differences between physician burnout, depression, and suicide? Sometimes these are grouped together, but they are not necessarily the same thing. Can you explain?

Yu Moutier: I’m really glad you posed the question that way. As a national suicide prevention expert…I actually started and my interest in suicide prevention more broadly, in my own personal and professional experiences as a medical student or resident, then dean of the faculty of Medicine at the University of California, San Diego, where I was really doing my best at the local facility level to address wellness, as well as suicide prevention for medical students, residents, and physicians of the faculty. And I think there’s been a lot of confusion of any form of distress. Research is very weakly linked…. We have just published data which shows that among health workers and trainees suffering from burnout alone, depression alone or a combination of burnout and depression, it is really only the group that suffers from depression, whether or not burnout is present, which has these higher risk factors for suicide such as suicidal ideation.

MWN: Do you think it’s useful? Or does it hurt the conversation to group them together sometimes?

Yu Moutier: I think the main thing that concerns us when it’s all lumped together in one big confounded group is that the main difference between depression and burnout is that depression is a very serious medical condition that has life-threatening consequences, if it is untreated, and well-researched treatments that can be used to fight depression. And so what worries us is that if, for example, a doctor who is really badly depressed is only recognized by himself or by someone who is trying to support that person as being in a state of burnout, he may or may not make a referral for actual treatment. …

Self-care and peer-to-peer strategies, and debriefing – all of these things are essential… for all of us. But we wouldn’t want to miss the opportunity to effectively address and treat the medical condition of depression.

MWN: How powerful is this stigma attached to mental health care versus the ability to practice medicine?

Yu Moutier:I think the stigma is still alive. And there is a lot of confusion. And there are many current and historical reasons why these barriers are still in place. … The bottom line is that mental health is part of human health, just like physical health. And we would never [assume] that a physician with diabetes or hypertension, or cancer or other physical health issues, produces 100% of the time. We know there are gradations of symptoms and different ways in which different types of symptoms can affect a physician’s performance, depending on their scope of practice. And that’s a very… nuanced thing. And in fact, most doctors, especially the older we are… the more likely we all are to manage one or more medical and/or psychiatric conditions. And there should be no presumption of impairment unless there is proof of it. I think that’s…a big misunderstanding that we really need to reframe and correct.

MWN: What would you like to tell GPs about this?
Yu Moutier: Anyone who is a doctor and a front-line health worker, especially in primary care, you know better than anyone that you and all your colleagues are human beings, that mental health is very dynamic and depends on a whole set of factors related to things like your genetic load, your early childhood experiences, all the things we know are multifactorial determinants of a complex health outcome, like any mental health issue. … . We can become much more proactive, and it’s not that it’s all about the individual. We need institutional change; we need these issues in the Medical Licensing and Hospital Privileges Boards changed. We need access to confidential and appropriate treatment, all of that. But it also takes our own efforts as individuals, not just for ourselves, but to be on the lookout for colleagues that you might notice who are struggling, and to really take the mindset that we are part of a community together; we can make a difference. We don’t need to be their doctor or therapist, just a colleague and friend; if we approach someone… we notice that they are not in their usual state of health, to just ask kind questions, to let them know that you are there to support them. It should be normal to get the help and support we need.

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