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MENTAL HEALTH MENTAL HEALTH

MEDICAL BURNOUT: and never complain.” If you complain, you are seen as not resilient. trainees feel an immediate bond with their faculty. Providing trainees a

It is ingrained early on in medicine to “keep doing what you are told
safe place by actively listening and then following through with action
BREAKING BAD This mindset is harmful and can create feelings of despair and self- is the single most critical thing we can do as mentors.
4. Institutional leadership needs to implement a comprehensive ac-
judgment. How can we be compassionate toward our patients when
we are so critical of ourselves? By developing a bond through shared
a culture change from dealing with acute mental health issues to promot-
experience, peer-to-peer coaching can assist someone going through tion plan to promote wellness and prevent burnout. This may require
By Dharam Kaushik, MD
feelings of loneliness and isolation. This strategy can also remove the ing programs to improve physician wellness and resilience. In 2019, the
*This article first appeared in AAMCNews and is reprinted with permission.
hierarchy typically seen in medicine, especially in surgical specialties. American Medical Association launched the “Joy in Medicine Recogni-
A kidney cancer. Depending on the complexity of the cancer, these are tion Program,” which encourages institutional leadership to improve
I am a urologic cancer surgeon with a focus on surgery for advanced
s the threat of COVID-19 wanes, health care workers are
physician wellness and reduce burnout by implementing workplace
burned out and suffering. Here’s what one surgeon thinks
should be done. long, tedious surgeries — sometimes taking eight to 12 hours. I have changes that improve practice, teamwork and peer support efficiency.
experienced burnout on multiple occasions. Acknowledging and dis-
5. Hospital leadership should establish a provider wellness com-
The year was 2007, and I was a surgical resident at the University cussing it is the first step. We as health care workers should understand mittee from different departments and include physicians and ad-
of Nebraska Medical Center. Joseph Stothert, MD, PhD, was the chief that it is okay to be vulnerable, and a system of peer-to-peer coaching vanced practice providers. Each department could potentially have
of trauma service. “Dr. Kaushik, did you see the consult in the ER?” can help us understand these vulnerabilities. one “wellness champion” who could discuss issues specific to that de-
Dr. Stothert looked into my eyes as if staring into my soul. “Not yet, There is good data that people who experience adversity or a trau- partment but who could also be the wellness contact for other faculty
Dr. Stothert,” I replied, picking up the patient’s chart. “They paged me matic event often find a sense of personal growth as they work through and residents in the department. Hospitals can work with the provider
two minutes ago.” Dr. Stothert shook his head and headed to the ER, their trauma. This phenomenon is called “post-traumatic growth.” We wellness committee on prioritizing space — a dining room, small gym
where he saw the patient even before I did. see this in world-class endurance athletes who have psychological sup- or meeting room — for wellness-related conversations. If these minor
Joseph Stothert was a phenomenal trauma surgeon, the medical di- Furthermore, systemic racism, violence against Asians and child care port and can build upon their strengths to surpass perceived physical changes are meaningful and enhance health care workers’ wellness,
rector of the Omaha Fire Department and a brilliant leader who saved crises for women in medicine have taken a tremendous toll on the and emotional limits. The only difference between health care workers hospitals should investigate the creation of electronic-free environ-
countless lives throughout Nebraska. He died by suicide in March mental and physical health of these minoritized groups during the and endurance athletes is that the latter have support from their peers, ments. These can be modeled after airport sleeping/nap pods. Federal,
2021 after spending more than a year on the front lines in the war pandemic. For women in medicine, there has been no respite from coaches and psychologists. Health care workers, by contrast, often state and city governments should support such programs and pro-
against COVID-19. For me and countless other residents that Dr. work, whether it’s on the front lines with COVID-19 or solving their grapple with their trauma isolated and alone. We can change that. mote research into optimizing health care worker wellness. Such col-
Stothert trained, his death will never be just a tragic statistic among child care challenges. laborative efforts could even advance the science of burnout during
so many during this pandemic. Rather, he will be remembered as one When experienced in such a sustained and extreme form, burnout 2. A mental health resources page on each department’s website this pandemic.
of the finest surgeons in the country, whose skill was matched only by can have devastating consequences — not only on the workforce, but with a list of outreach programs and contact information for anony- In the first year of the pandemic, more than 3,600 U.S. health care
his kindness and compassion. also on patients. Burned-out doctors and nurses can even threaten pa- mous psychological health support would be the next step. A re- workers died. Anthony Fauci, MD, chief medical advisor to the Biden
A recent Washington Post/Kaiser Family Foundation tient safety and the quality of health care delivered. cent Medscape report found that almost 40% of U.S. physicians had administration, said it best: The deaths of so many health care workers
survey of 1,327 front-line health care workers in the United States dur- The Washington Post/Kaiser Family Foundation survey found that no workplace support to deal with grief and trauma. Health care work- due to COVID-19 are “a reflection of what health care workers have
ing the COVID-19 pandemic revealed that medical burnout has 26% of health care workers in hospitals are angry and 29% have con- ers are working extra-long hours, and some of them may not have the done historically, by putting themselves in harm’s way, by living up to
reached epidemic proportions. An overwhelming 55% of front-line sidered leaving the medical field. These are the warning signs of a smol- time or feel safe discussing their emotional and mental health with the oath they take when they become physicians and nurses.”
health care workers reported burnout (defined as mental and physical dering epidemic of burnout among front-line medical professionals. peers. For them, an anonymous method of accessing mental health re- Health care workers are an indispensable and resilient part of the
exhaustion from chronic workplace stress), with the highest rate (69%) National, institutional and departmental leadership should not put sources is critical. nation’s workforce — and have saved countless lives, before the pan-
among our youngest staff — those ages 18 to 29. That same age group the burden squarely on staff to “do meditation apps, practice mind- demic and during it. Understanding medical burnout and having
also reported the highest negative impact of the pandemic on their fulness, get 10% off on gym memberships or count your steps for well- 3. Program directors, associate program directors and faculty strategies at the organizational level to prevent it will help avoid future
mental health (75%), though a majority of all health care workers ness.” Instead, they must recognize the insidious nature of burnout members should be offered training on supervising with empathy and catastrophes. We need to get the system of “preventing burnout and
(62%) reported some mental health repercussions. and develop the necessary tools to prevent and treat it. fostering a genuine dialogue with their trainees (medical students, promoting wellness” up and running before the next pandemic hap-
Multiple survey data now show that health care workers responsible residents and fellows) on burnout and wellness. We need to move away pens. It will also be an authentic tribute to those “COVID-19 war-
for providing direct care for COVID-19 patients are more likely to Five practical changes we can implement rapidly from the perfunctory “How are you doing? — I’m fine” model to an ac- riors” like Dr. Stothert.
have depression, anxiety and mental distress. These mental health is- 1. Recognizing burnout is the first step toward finding solutions. tive engagement in conversation. Trainees deserve our full attention to-
sues may be related to psychological distress from witnessing COVID- We need to have a mindset of “we are all in this together.” It can start ward their emotional and mental health, even if it is for only a few Dharam Kaushik, MD is an associate professor in urology
19-related deaths, extra-long work hours and work-life imbalance. at the departmental level with peer-to-peer coaching sessions during minutes. Being “present” in conversations with trainees is a genuine act and the program director of the urologic oncology fellowship
Health care workers have been working nonstop without a full appre- which faculty, residents and trainees have an opportunity to voice their of kindness, as it demonstrates that their well-being is our priority. “Tell in the Department of Urology at UT Health San
ciation of their sacrifices. Many have suffered financial distress as well, feelings and get advice from peers and mental health experts on coping me how you are really doing through this pandemic? You have my un- Antonio and the Mays Cancer Center at UT Health San Antonio MD
including salary cuts and furloughs. with burnout and promoting wellness. divided attention” is a powerful open-ended question and can help Anderson. He is a member of the Bexar County Medical Society.

14 SAN ANTONIO MEDICINE • October 2021 Visit us at www.bcms.org 15