Neha Sharma, a 28-year-old professional from Lucknow, had been finding it difficult to sleep or concentrate at work. She would often burst into tears and contemplated quitting her job.The timely intervention of friends, who took her to a psychiatrist, helped Sharma sail through the crisis.
Ironically, Sharma herself is a doctor, part of a growing tribe of young medicos who find it difficult to achieve a work-life balance, resulting in a low sense of personal accomplishment, emotional exhaustion, cynicism and depersonalisation (lack of empathy for a patient). It is referred to as "physician burnout".
Dr Nand Kumar, professor of psychiatry at AIIMS, told TOI he sees two to three medical students and doctors every month. "They come for counselling or suggestions. But detailed examination and discussion often reveal sub-clinical depression or burnout," he said, adding that reported instances of burnout or depression among doctors was rare about a decade ago."Work pressure was always there. When I was doing my residency , we would party and share our problems with friends, which helped us cope and find solutions. But today's generation, including doctors, are mostly self-centred, more ambitious, and technology takes away most of our time. Hence, there is pent-up emotion which leads to psychological
Rajesh Sagar, another senior psychiatrist at AIIMS, said cases reported to psychiatrists are only the tip of the iceberg. "Most doctors don't come out in the open to discuss their problems. Many take to self-medication. And, in rare cases, we have also witnessed attempted, or complete, suicide on failing to cope with the pressure," he said.
Last week, the Resident Doctors' Association (RDA) of AIIMS wrote to the institute director seeking a counsellor for residents. The RDA president, Dr Harjeet Singh Bhatti, said AIIMS has been witnessing one suicide annually over the last few years. "Many more suffer in ignominy . If steps are not taken to ensure the mental well-being of doctors, it will turn into a crisis situation soon," Dr Bhatti said.
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So, what makes the doctors more vulnerable to burnout than other professionals? Experts from Harvard Medical School point out that the higher incidence of burnout among doctors could be linked to internal traits, such as compulsiveness, guilt, self-denial, and a medical culture that emphasises perfectionism. Dr Vivek Chouksey, president of the Federation of Resident Doctors' Association of Delhi, agrees. "Young professionals employed in public hospitals, where the patient burden is very high and resources are scarce, face a hapless situation. We work more than 12 hours a day and longer in emergency scenarios.There is no time for study or recreation," he said, adding that all hospitals should have a yoga centre, gym and other options to de-stress, and psychological help, if required.
If a doctor is exhausted or stressed, the risk of patient harm grows. Tait Shanafelt, recently appointed chief physician wellness officer at Standford University School of Medicine in the US, has shown that as physicians suffer, so do patients. Burnout, he explains, has been found to contribute to physician errors, higher mortality among hospitalised patients and less compassionate care.
A study in Mumbai involving 500 doctors had found almost 45% of the professionals emotionally exhausted and 66% suffering from depersonalisation. The study , published in an indexed medical journal named Cureus, revealed 87% had scored low on "personal accomplishments" and 63% had scored moderately on satisfaction levels with
Lack of growth opportunity and work pressure cause burnouts among private practitioners too. Among the specialists, experts say, anaesthetists are the worst affected mainly due to lack of recognition. "The suicide rate among anaesthetists is much higher," said a doctor, adding even psychiatrists tend to get depressed. It is advised that hospitals should first and foremost accept the problem of physician burnout.
Encouraging doctors to talk about their problems, improving the work environment, addressing issues like poor doctor-patient ratio and lack of resources, encouraging recreational activities, and providing professional help, where needed, can help.
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Mental/ emotional health is not recognised as a problem on par with physical health and unfortunately, is stigmatised. We need a much larger no of psychiatrists, counsellors, psychoanalysts (almost absent in India) etc and stigma of mentally not being well removed.