MENTAL HEALTH
MEDICAL BURNOUT: BREAKING BAD By Dharam Kaushik, MD
*This article first appeared in AAMCNews and is reprinted with permission.
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s the threat of COVID-19 wanes, health care workers are burned out and suffering. Here’s what one surgeon thinks should be done. The year was 2007, and I was a surgical resident at the University of Nebraska Medical Center. Joseph Stothert, MD, PhD, was the chief of trauma service. “Dr. Kaushik, did you see the consult in the ER?” Dr. Stothert looked into my eyes as if staring into my soul. “Not yet, Dr. Stothert,” I replied, picking up the patient’s chart. “They paged me two minutes ago.” Dr. Stothert shook his head and headed to the ER, where he saw the patient even before I did. Joseph Stothert was a phenomenal trauma surgeon, the medical director of the Omaha Fire Department and a brilliant leader who saved countless lives throughout Nebraska. He died by suicide in March 2021 after spending more than a year on the front lines in the war against COVID-19. For me and countless other residents that Dr. Stothert trained, his death will never be just a tragic statistic among so many during this pandemic. Rather, he will be remembered as one of the finest surgeons in the country, whose skill was matched only by his kindness and compassion. A recent Washington Post/Kaiser Family Foundation survey of 1,327 front-line health care workers in the United States during the COVID-19 pandemic revealed that medical burnout has reached epidemic proportions. An overwhelming 55% of front-line health care workers reported burnout (defined as mental and physical exhaustion from chronic workplace stress), with the highest rate (69%) among our youngest staff — those ages 18 to 29. That same age group also reported the highest negative impact of the pandemic on their mental health (75%), though a majority of all health care workers (62%) reported some mental health repercussions. Multiple survey data now show that health care workers responsible for providing direct care for COVID-19 patients are more likely to have depression, anxiety and mental distress. These mental health issues may be related to psychological distress from witnessing COVID19-related deaths, extra-long work hours and work-life imbalance. Health care workers have been working nonstop without a full appreciation of their sacrifices. Many have suffered financial distress as well, including salary cuts and furloughs.
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SAN ANTONIO MEDICINE • October 2021
Furthermore, systemic racism, violence against Asians and child care crises for women in medicine have taken a tremendous toll on the mental and physical health of these minoritized groups during the pandemic. For women in medicine, there has been no respite from work, whether it’s on the front lines with COVID-19 or solving their child care challenges. When experienced in such a sustained and extreme form, burnout can have devastating consequences — not only on the workforce, but also on patients. Burned-out doctors and nurses can even threaten patient safety and the quality of health care delivered. The Washington Post/Kaiser Family Foundation survey found that 26% of health care workers in hospitals are angry and 29% have considered leaving the medical field. These are the warning signs of a smoldering epidemic of burnout among front-line medical professionals. National, institutional and departmental leadership should not put the burden squarely on staff to “do meditation apps, practice mindfulness, get 10% off on gym memberships or count your steps for wellness.” Instead, they must recognize the insidious nature of burnout and develop the necessary tools to prevent and treat it. Five practical changes we can implement rapidly 1. Recognizing burnout is the first step toward finding solutions. We need to have a mindset of “we are all in this together.” It can start at the departmental level with peer-to-peer coaching sessions during which faculty, residents and trainees have an opportunity to voice their feelings and get advice from peers and mental health experts on coping with burnout and promoting wellness.
