Clinician who sought mental health help shares journey
The struggle clinicians face in helping their patients, performing their required paperwork and maintaining a family life, all while maintaining mental and emotional health, while not new, has grown more challenging in recent years.
As early as 1964, researchers studied this ongoing battle, providing limited details in the American Journal of Psychiatry of a clinician who took multiple narcotics as he dealt with problems at home and work.
More recently, a 2017 study in the Annals of Family Medicine concluded primary care physicians spend almost 6 hours a day on EHRs which contributes to the clinician burnout rate that now sits above 40%. In addition, a report in the Journal of the American College of Cardiology earlier this year found 24.3% physicians are divorced, and for female doctors, work hours are a factor in these marriages dissolving. Though HHS recently introduced a series of initiatives that it said it hoped would alleviate some of the physicians’ burden, experts said widespread adoption of the strategies are not likely.
The struggle between work and home is all too familiar to Sourav Sengupta, MD, MPH, director of the child and adolescent psychiatry fellowship program and assistant professor at the University at Buffalo Jacobs School of Medicine. He recently wrote an essay that appeared in JAMA where he discussed his struggles at balancing his professional workload and social and familial responsibilities and how he ultimately realized he needed professional help to overcome these difficulties.
Healio Primary Care asked Sengupta to share more insight from his experiences, so that others in the medical community may realize that there should be nothing wrong in reaching out for help and addressing their own health needs.
Sengupta knew at a young age that he wanted to help people overcome behavioral health issues. But after several fulfilling professional experiences that assisted many in this area, as well as getting married and becoming a father, he told Healio Primary Care he gradually came to the realization he also needed mental health help.
“I could not shake the feeling of just continually treading water. Pulling me down was all the documentation and meetings and all the things that took me away from the relationship with the patient — all the weight of so many mismatched expectations,” he said. “This wasn't how I'd envisioned a career: staying late at the office just to make sure that billing codes were justified in my documentation. While these responsibilities are important, I don’t think I had anticipated how negatively this side of medicine would impact me.”
“When my wife sat me down and shared her concerns — that I was losing touch with her and our kids, that I didn't seem happy at all, that this moment seemed a lot like previous points in my life when I had struggled to connect meaning with daily life — I knew I needed professional help,” he continued.
Sengupta admitted he was concerned he would happen upon patients or colleagues on his way to therapy sessions. Research suggests the fear of such patient and colleague encounters is just one reason why some clinicians who acknowledge they need behavioral health counseling fail to do so.
A study based on a convenience sample of 2,106 female physician-parents that appeared in General Hospital Psychiatry found almost half felt that they had met the criteria for mental illness but had not sought treatment. The main reasons for avoiding treatment cited included a belief they could handle the problem on their own, finite amounts of time, fear of reporting to a medical licensing board and the mindset that diagnosis was “embarrassing or shameful.”
Sengupta was not involved in the study but said that although state medical boards “serve essential and challenging functions,” these boards making decisions that could impact a clinician’s career based on the answers to mental health questions are a partial disservice.
“These questions discount the possibility that a physician that has experienced mental illness might be better attuned and able to connect with and help patients that are struggling in a myriad of ways. I am disheartened by the results of the study of female physicians' perceptions of seeking help and support, and it makes me think we have a long way to go to normalize healthy help-seeking behaviors in our field,” he said in the interview.
Sengupta said he was able to find a therapist who understood his privacy concerns and that clinical work can be burdensome and trying. Working together, he and the therapist crafted a plan that pushed Sengupta’s negative thoughts about not always focusing on work from his mind, mended relationships and allowed him to resume an old hobby, woodworking.
“After a while I felt a bit indignant at my earlier concerns and wondered why I had been so worried and decided to be more open about it. I am confident there is a fair amount of privilege involved in me being able to do so now, but I suppose I felt it was an opportunity to live a bit more authentically and perhaps help others be more open or feel more supported in getting help when they needed it,” he told Healio Primary Care.
Sengupta offered some advice to clinicians who may not think they need help or perhaps are afraid to: “To be a better healer, a whole healer, to better help your patients, do what you can to make sure you are well or at least working on being well. But at a more basic level, I think we need to acknowledge the limits of our abilities. Let's face it: we're not the best at assessing and addressing our own core emotional challenges. Getting some outside perspective and support and direction provides a map back to feeling well.”
During a presentation at ACP’s annual meeting earlier this year, Richard M. Wardrop III, MD, PhD, professor and vice chair of education and faculty development at the University of Mississippi Medical Center and chair of ACP’s Wellness Committee echoed some of Sengupta’s sentiments.
“Ask for help if you need it, [since] this is a sign of strength and maturity. Remember that burnout, depression and substance misuse disorders are not personal failings of will, strength or spirit. If you have a problem, have it treated. Never think that you are alone. I know it may feel like it sometimes, but remember that help is around every corner,” he told attendees.
Other options towards well-being
Research provides a plethora of ways physicians can take to work to improve their well-being.
J. LeBron McBride, PhD, MP H, and family medicine practitioner in Georgia wrote in Family Practice Management that bringing what he called the “dead zone,” – parts of life that have been shut down such as compassion, emotions and family intimacy – back to life.
Some of his other suggestions include engaging in nonmedical or relaxation activities for 15 minutes a day, revisiting notes and cards of appreciation from patients and what he called “renewing discipline.”
“Often there are no quick fixes for what ails your patients; lifestyle changes have to be made,” he said. “The same is true for physicians. However, many physicians who are disciplined in their professional lives don’t practice this kind of discipline in their personal lives. It is often too easy to think that you do not have to do the same self-care that your patients do or that you are just too busy for it. But you need good exercise and health habits just like everyone else, perhaps even more so because of the stress of your profession.”
Wardrop added a few more ways that might help physicians get back on their feet mentally.
“Build a base of gratitude because if you move your feet in that direction, your mind will likely follow,” he said. “Physicians should also understand that they have intrinsic value, not just to their families, loved ones, friends and members of the community, but also to their patients. They look to you, they see the value in you, even if they don’t say it at every visit.”
He also suggested honoring personal values; right-sizing and calibrating expectations: of yourself, patients, and staff; reframing self-reported feedback (eg, instead of “I didn’t do that well.” say “I am proud of what I did and will look for ways to improve.”) and keeping personal commitments that are important.
Wardrop also suggested that relieving physicians’ administrative burden by “right-sizing the EMR” or reducing the input PCPs need to provide would improve well-being, a thought shared by Sengupta.
“If we are not able to get a handle as a health system on the bureaucratic and logistical aspects of medicine, we are going to have difficulty in having new generations of physicians feel connected to and fulfilled by the work,” Sengupta said.
“We need to think about broader, systemic improvements to our health care system that help physicians reconnect with the joys of doctoring. I shouldn't have to choose between staring at a computer screen without interacting directly with my patients during appointments and staying up late every night completing documentation,” he said.
Sengupta concluded with a hope that given the ups and downs of the profession, clinicians feel it is acceptable to share their feelings.
“Even if those systemic changes were made, and the system were healthier, every day we deal with life and death, emotional highs and lows. We should all be allowed to struggle with these experiences, to acknowledge the struggle, and to be able to reach out to a helping hand to guide us through the struggles when we need it.” - by Janel Miller
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Disclosures: Sengupta reports no relevant financial disclosures. Please see the studies for those authors’ relevant financial disclosures.