ESSAY CONFRONTS PHYSICIAN STRESS AND BURNOUT

Sourav Sengupta, MD, MPH, lecturing.Sourav Sengupta, MD, MPH, lecturing.

ESSAY CONFRONTS BURNOUT AND STRESS AMONG PHYSICIANS ESSAY CONFRONTS BURNOUT AND STRESS AMONG PHYSICIANS

RESONATES ON A NATIONAL SCALERESONATES ON A NATIONAL SCALE

BY ELLEN GOLDBAUMBY ELLEN GOLDBAUM

n essay by Sourav Sengupta, MD, MPH, assistant professor of psychiatry and pediatrics, detailing how he worked through issues of stress with the help of a therapist, is resonating on a national scale. Last March, JAMA Network published online his essay, “Rebuilding More of Me.” Sengupta wasn’t sure how the essay would be received, but in the weeks following its publication, he received personal email messages from dozens of physicians around the U.S. who reached out to share perspectives and their experiences. Altmetric (a citation-impact measurement) rated the essay in the top 5 percent of publications. In less than a month aft er publication, it had been viewed more than 6,500 times and downloaded more than 500 times. Sengupta received emails from physicians at every career stage, telling him it was a relief to know that others have also gone through this kind of stress and have succeeded. A

Diffi culty in fi nding help It’s no secret that physicians have stressful jobs. Figuring out how to mitigate and deal with that stress can be a key part of a successful medical career. But while individual physicians seek and fi nd help for their mental health issues privately, the prevailing public perception among physicians is that it just isn’t done. A few years ago, Sengupta, who also treats patients, had reached a point where he knew that escalating professional and personal demands were impacting his eff ectiveness. His essay describes the barriers he encountered in trying to access the help he needed. “I am an attending physician in the fi eld from which I need support,” he writes. “Many of the best clinicians and treatment settings are not options. I know them too well.” Once he found a psychotherapist he could work with confi dentially — who wasn’t a colleague — he began to open up. Sengupta writes: “[The therapist’s] willingness to acknowledge that clinical work is stressful and can become toxic establishes a life raft upon which I can hoist myself, build new strategies, and shape a diff erent perspective.”

Documentary spurs action Prior to publishing the essay, Sengupta didn’t consider formally sharing his experience with others. He had received help, the struggle had lessened, and he was ready to move on. That changed in December 2018, when he attended a screening of the provocative documentary “Do No Harm: Exposing the Hippocratic Hoax.” The event was organized by Christian R. DeFazio, MD ’94, clinical assistant professor of emergency medicine and director of the emergency medicine residency program; Carolyn A. Wiech, MD ’07, clinical assistant professor of emergency medicine and assistant director of the emergency medicine residency program; and Susan M. Orrange, PhD, assistant dean for education and resident services. Lauren Dube, DO, an emergency medicine resident, is credited with bringing the documentary to their attention. The fi lm and the following panel discussion addressed the issue of physician mental health and suicide. Among the alarming statistics discussed were:

> Suicide accounts for 26 percent of deaths among physicians ages 25 to 39 compared to 11 percent of deaths in the same age group in the general population > 45.8 percent of physicians reported experiencing at least one symptom of burnout > Doctors commit suicide at a rate more than twice the national average > A study of more than 4,000 medical students at seven schools found that more than half of all students experience burnout while in medical school > Approximately one of every nine students reported having suicidal thoughts while in medical school > Suicide accounts for 26 percent of deaths among physicians ages 25 to 39 compared to 11 percent of deaths in the same age group in the general population > 45.8 percent of physicians reported experiencing at least one symptom of burnout > Doctors commit suicide at a rate more than twice the national average > A study of more than 4,000 medical students at seven schools found that more than half of all students experience burnout while in medical school > Approximately one of every nine students reported having suicidal thoughts while in medical school

Don’t be afraid to ask for help The event struck a chord. Of the 300 people in attendance, the vast majority were trainees, including medical students, medical residents and fellows. As Sengupta listened to the discussion that followed the screening, he realized he needed to share his story. “One of the most distressing themes in the discussion aft erward was how scared or resistant or hesitant the trainees were about seeking any therapeutic support,” he says. “I had the chance to share a little of my experience and a number of residents privately came up and wondered aloud if it might be helpful for more attendings and medical education leaders to open up a bit more about these kinds of things. “I eventually wrote the essay for a very particular reason,” he further explains. “There were hundreds of trainees in the room, but the vibe around seeking support was quite negative. It wasn’t that people thought physicians shouldn’t get help, but that there were lots of factors that would probably keep them from seeking help, such as stigma, having enough time, and concern for how it might impact their careers. “My hope was that I could convey to other physicians what actually happens when you work with a therapist— that it’s a collaborative process that can lead to really positive outcomes.”

Seeing others struggle Sengupta, who directs UB’s child and adolescent psychiatry fellowship program, has a close-up view of the diffi culties that students, especially medical residents, undergo. “I do see them struggling sometimes,” he says. “Medicine is such a challenging fi eld to be in in this day and age. Trainees are such a critical part of the system, and at the same time, they may need more support than they are getting. It can be a tough system to work in. You can lose track of what brought you into the fi eld.” Among the factors contributing to physicians’ reluctance to seek help are the traits that led them to medicine in the fi rst place, Sengupta says. “Who is the type of person that ends up wanting to be a physician and then succeeding?” he asks. “We are pretty intelligent and we’re hard-working, but we are probably not talking about the struggles we’re having. We’re internalizers.” At the same time, the nature of medical training itself also contributes. “The training values toughness and grit and perseverance. That shouldn’t be to the exclusion of getting help and support, but somehow it can be translated into that,” Sengupta says. “Taking care of oneself can seem to represent weakness or incompetence. Sometimes it’s the message that is given or sometimes it’s a message that trainees perceive. “Doctors are supposed to be larger-than-life fi gures— take in everything, be wise and be helpful,” he adds. “We do a really good job of stigmatizing ourselves, when, really, getting support when needed could help us get back on track to fi nding meaning in helping others.”

Change noted with trainees Sengupta knows, however, that the challenges to changing the culture are signifi cant. For one thing, he says, trying to fi nd someone who can help is complicated and sensitive. “How interesting would it be if we created some sort of way for physicians who are struggling to communicate with each other . . . a support group of sorts?” he ponders. In the essay, Sengupta describes how he shared his experience with his trainees; it came up in the context of a broader conversation about self-care. Aft erward, he noticed a change in the way they interacted with him. “I sense a subtle shift in the way some of them approach me—they are a bit more willing to discuss challenges and vulnerabilities, and are more open to refl ection and selfimprovement,” Sengupta says. “A few clinicians even ask for help in fi nding therapists for themselves, allowing me to transform my process of seeking help into a way to help others.”