The burning issue of physician wellbeing

Being able to spot the signs of burnout is easy, or is it?

Miles and miles of print have been devoted to discussing doctors’ mental health. Endless studies citing percentage rates of burnout and suicide and addiction and awfulness. We should do something about it. Of course we should.

But the difficulty lies in the fact that most of us are not stockpiling the paraquat, or self-administering benzodiazepines. We are pottering along in our “respectable” lives, winning the bread and delivering the bacon back to the homestead, with a nod and a smile for the butcher and baker along the way. We are “grand”, when we are asked. Or “good” even, if we feel that the asker needs a bit of a pep up. We are not in the 44 per cent of doctors experiencing burnout. There’s a whole 56 per cent of us who aren’t, so of course we’re fine. The crazy ones are the “other ones”, not us.

Besides, we would know if we were going a bit mad, wouldn’t we? We are used to watching for the telltale signs of psychological distress in our patients. Our psychiatry textbooks made it clear to us that a person needs to meet very strict diagnostic criteria to warrant an ICD10 F33 or F41.9. We have seen the accompanying photograph to every single newspaper article ever written about mental illness, with the woman sitting against a wall holding her head in her hands. It is abundantly clear to us who is mentally unwell and who isn’t.

And if we are marching into our important jobs every day and having a bit of banter with the receptionist, and sharing baking tips with the nurse, and popping into the shops on the way home wearing our carefully handcrafted facemasks, sure we’re grand. Aren’t we?

There is a small chance, though, that we may in fact be one of the 44 per cent, and not have a single clue. After a long day at work, I often bemoan the lack of insight in my patients who do not seem able to connect their physical complaints with their mental distresses. They are sometimes willfully blind to the link between their pernicious back pain and their failing marriage.

I sometimes see similar self-blindness amongst my friends and colleagues and, let’s face it, myself. But I have had to address my own emotional and psychological demons, because I am a divil for the somatisation, with multiple and various physical symptoms which worsen with stress. Initially my physiotherapist would tactfully ask me if I was sleeping okay, as she developed callouses on her knuckles from kneading out the knots of tension in my paraspinal muscles. Now she comes straight out and says “stressed, huh?” and we chat and grunt our way through a physiotherapy session. It took me a long time to accept that I might be suffering from that most insufferable of conditions, a functional disorder. But now I am glad that I have a tangible alarm system built into my body, which wails at me with pain when my stress levels go up. Nothing like a bit of searing neck pain to gently cajole me into acknowledging that things are all getting a bit mentally too much.

Lots of people don’t have a body as unsubtle as mine, however. Their muscles don’t rudely interject and shout “help” and “stop” when their brains get full. Their teeth don’t grind themselves to a shred when their psyche is in agony. Or maybe they do, but they don’t cop on to the cause and effect. And so, for many doctors, they continue in the assumption that they must be “totally fine”.

They are aware of the faint rumblings around them, rumours of PTSD and insomnia and Covid-anxiety. They attended that webinar about how to look after your mental health and all that, but they were painting the room at the same time so they weren’t really concentrating. They know there was some talk of a number you could phone for counselling, but that was probably for patients, wasn’t it, or maybe for those ‘doolally’ doctors, not them.

Or, possibly more likely, they haven’t been watching any of the webinars or reading any of the emails, and know nothing about any phone numbers, because they are done with work when they get home and can’t bear the thought of hearing the word “Covid” one more time that day.

Their email inbox is bursting at the seams with unread messages from the ICGP/IMO/IHCA and all the other acronyms that they wish would simply disappear.

WhatsApp is a wasteland of unanswered and unwanted notifications. They have more than enough to be getting on with, caring for children and parents and in-laws while frantically ignoring the insidious and invidious terror rising inside them. They do not read the miles and miles of print about doctors’ mental health. They’re grand.

ICGP’s Health in Practice Programme: Tel: 087 751 9307 or Email: andree.rochfort@icgp.ie

The Practitioner Health Matters Programme: (01) 297 0356 confidential@practitionerhealth.ie

Contact details for EAP providers in your area https://healthservice.hse.ie/filelibrary/staff/employee-assistance-programme-contact-details-for-counsellors.pdf