Physician, Heal Thyself....

"It's still a taboo topic to some degree. Sometimes people are afraid: 'Is this going to affect my licence? Is this going to affect my reputation?' It's a stigma, for sure."
Francoise Mathieu, expert, compassion fatigue Ottawa address, Canadian Medical Foundation

Françoise is director of Compassion Fatigue Solutions inc., whose aim is to offer consulting and training to helpers on topics related to self care, wellness, burnout and compassion fatigue. She is a Certified Mental Health Counsellor and a Compassion Fatigue specialist.

"One of the reasons why I came [annual meeting, Canadian Medical Association] is I'd like some advice with how to deal with it. We're all trying to balance trying to take care of ourselves. I think it's an issue that affects all physicians."
"Sometimes we feel like we need to be stronger than we actually are. You let things go on and on without reaching for help."
Alika Lafontaine, anesthesiologist, Grande Prairie, Alberta

A University of Ottawa medical school teacher, director of physician health at the Canadian Medical Association spoke of the experiences that doctors are often exposed to in their medical practise in empathy with their patients as being "quite horrific". He recalls his feelings when he himself worked in pediatric oncology, twenty years earlier, as a resident. That experience convinced him his medical career would be better spent elsewhere.

'Elsewhere' happened to be in psychiatry where now he treats many other physicians for issues relating to their mental health, namely compassion fatigue and psychological burnout. If left unaddressed, said Dr. Derek Puddester, these issues are capable of turning many doctors' thoughts to suicide. Many physicians are so preoccupied with their professional requirement to care for their patients, they remain in denial about the state of their own health.

"That huge red flag isn't seen until the symptoms are very severe", he explained. Many health professionals, on the other hand, faced with severe burnout or compassion fatigue decide to turn their attention to other types of work. They may take extended sabbaticals, resulting in up to hundreds of millions of dollars in cost for the universal health care system, according to Lee Gould, president of the Canadian Medical Foundation.

Compassion fatigue is characterized as an erosion of the capacity to tolerate emphatic emotions and difficult patient situations which can manifest itself as a seeming desensitization to patient issues and difficulties in adjusting and coping with the emotional strain, at work and at home. Those emotional depressions tend to accumulate over time and successive experience, until they resemble post-traumatic stress disorder.

Compassion fatigue strikes more often those in the health care field working in oncology, child welfare and palliative care, unsurprisingly. Ms. Mathieu, expert in the symptoms and stresses of compassion fatigue, pointed out that people who focus on working with animals also experience similar symptoms of compassion fatigue, much of it caused by the evidence of trauma and abuse of vulnerable animals.

Burnout, prolonged stress, frustration leading to physical and emotional exhaustion are all hallmarks of compassion fatigue. Doctors are particularly vulnerable not only through exposure to the pain and heartache of their patients, but as a result of overwork on their part. A few additional hours of work weekly can increase significantly opportunities of burnout.

Ms. Mathieu pointed out that the five medical groups most affected by burnout tended to be emergency room doctors, internal medicine specialists, general practitioners, neurologists and oncologists.

According to statistics quoted by Ms. Mathieu, about 40 percent of oncologists (cancer specialists) experience profound emotional exhaustion with their work in some form, and about 50 percent of Ontario oncologists specifically reported being overcome with feelings of low personal accomplishment.

Moderate to severe burnout affects roughly 46% of all doctors in Canada. A Canadian Physician Health survey found a third of physicians reported feelings of depression. Canada is hardly alone in recognition of this medical-personal phenomenon.

A recent Australian study found about 54 percent of medical residents exhibited symptoms of compassion fatigue, while 69 percent suffered from burnout, and 71 percent expressed lower-than-average job satisfaction. And a U.S. study resulted in identifying that close to 7 percent of surgeons reported having had suicidal thoughts in the last year. At the same time, 60 percent of those individuals claimed they would not seek help because they feared repercussions at work.

In 2013, the Canadian Medical Foundation and the Canadian Medical Association founded the Canadian Physician Health Institute. It stands as the only institute of its kind in the world, according to Dr. Puddester. "Canada is a global leader in physician health. I think we should be very proud of that." Moreover, the problem is so acute that medical schools now pay attention to physician health, offering increased training to aid doctors to cope with potential emotional stresses.

Coping mechanisms to ward off compassion fatigue and burnout include reducing workload, reducing exposure to trauma, increasing workplace training and engaging in positive habits such as mindfulness-based meditation. All common sense self-help techniques, but for a physician, perhaps difficult to achieve. And according to Ms. Mathieu newer medical school graduates representing the "millennial" generation are aware of and attempting to achieve better work-life balance.

That's one problem afflicting the health community, and here's another, not spoken of too frequently, but equally devastating to those in the professional medical-health field: drug and alcohol abuse. And this is what the US National Library of Medicine

National Institutes of Health has to say about this issue:

The pathways toward development of substance abuse and dependence problems in healthcare professionals (HPs) vary by group. For example, though professionally discouraged, self-diagnosing physicians have reported prescribing controlled substances for themselves [1]. Due to drug access, a significant number of pharmacists tend to self-medicate and have the opportunity to titrate their drug use [2], a practice that can perpetuate the fallacy that pharmacological knowledge of drug action is an effective strategy to prevent addiction. In addition to drug access and a social environment promoting drug use [3] people who choose nursing as a profession may report a higher rate of family history of alcoholism and drug abuse than other HP groups [4]. Finally, perhaps more so than any other group of HPs, the greatest threat in dentistry may be alcohol consumption not controlled substance use [5]. Given the increasingly stressful environment due to manpower shortages in the healthcare system in general, substance induced impairment among some healthcare professions is anticipated to grow [6]. While a number of studies provide some foundation for our understanding of the epidemiologic and etiologic processes contributing to substance use by HPs, rarely have recent studies sought to examine the relative importance of risk factors on alcohol and drug (AOD) use across a sample of major groups of HPs. The major aim of this study therefore was to investigate the risk factors contributing to AOD use by HPs within the context of self-reported past year alcohol and drug use at different levels of use: any alcohol and drug use and a substantial level of alcohol and drug use. Early identification is essential as patient and provider well-being may be at risk [7]. Just like evidence for alcohol [8], cocaine [9], and illicit drugs [10], drug dependent HPs represent a specific subtype of drug abuser who have access to licit drugs. Knowing those HPs who may be at greatest risk for substance abuse, may facilitate the development of more tailored and effective educational and intervention strategies for this subtype of addict