How to deal with depression and burnout
Earlier this year, Medscape released its Physician Lifestyle & Happiness Report 2018 on lifestyle habits and happiness among physicians and surgeons. Overall, 32 percent of orthopaedic surgeons rated themselves as very or extremely happy at work, and 54 percent rated themselves as very or extremely happy outside of work (Figs. 1 and 2).
The natural reaction of many competitive physicians is to compare themselves to those in other specialties. I suggest a more constructive approach: Exploring ways in which all orthopaedic surgeons could become happier at work and outside of work.
According to the Medscape survey, “Orthopaedists, at 20 percent, were among the least likely of all respondents to report that they would seek professional help for burnout, depression or both.”
My experience is that orthopaedic surgeons often feel they can go it alone, that they can push through any adversity like many other parts of their training and careers, or that they don’t need help getting through a period of burnout or situational depression. David Hanscom, MD, a spine surgeon, has described how suppressed anxiety and stress can lead to chronic pain, mind-body syndrome, or neurophysiological disorder. Dr. Hanscom has shared his own personal story and perspectives in several articles, “Back From the Edge: Coping with Physician Stress,” “Physician Suicide: My Journey,” and “A Surgeon’s Perspective on the Hoffman Process.”
Neuroplasticity occurs in all our brains and can lead to anxiety disorders, depression, post-traumatic stress disorder, and other physical ailments. All humans respond differently to acute and chronic stress or injury, and ailments vary based upon the affected tissues—muscle, tendons, joints, and nerves. This also applies to mental and emotional stress and injury. Yet, we are often unaware of the effects of chronic stress and repetitive trauma on our brain pathways.
Orthopaedic surgeons are experts in treating the musculoskeletal conditions of chronic and acute injury, overuse, and disease. We are not, generally, experts at burnout, depression, and other mental and emotional conditions. Emotional exhaustion and depersonalization (two of the three components of the Maslach Burnout Inventory) result from chronic mental stress and emotional injury. Because many of us deal with our patients during very trying times in their lives, it may be difficult for us to maintain our own mental and emotional health. In addition, many of us have experienced varying degrees of abuse, bullying, harassment, and sleep deprivation.
Despite, or perhaps because of, our lack of expertise in these areas, we are less likely to seek professional help. An article by Liselotte N. Dyrbye, et al, highlights that a correlation exists between state medical licensure application questions about mental health and physician reluctance to seek help due to concerns about repercussions to medical licensure. The authors write, “Physicians working in a state in which neither the initial nor the renewal application was consistent were more likely to be reluctant to seek help (odds ratio, 1.21; 95 percent confidence interval, 1.07-1.37; P = .002 versus both applications consistent).”
How can we as orthopaedic surgeons and as an organization address depression among ourselves and our colleagues? Consider doing one or more of the following:
- Lessen the stigma. Encourage open discussion, participate in medical education, and share real stories.
- Lobby against credentialing and licensing that requires reporting of private health information for physicians.
- Intervene. Be willing to have conversations, take next steps, and assist a colleague.
- Make it easier for your colleagues to speak up and seek help earlier, as well as limit the repercussions to their jobs or careers.
- Create organizational resources, set up links or outsource assistance to trusted people or organizations.
Contributors to burnout and unhappiness
Contrary to popular belief, burnout is not the direct opposite of happiness. Burnout is characterized by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment. Research shows that approximately 30 percent of physicians will acknowledge burnout. Fig. 4 lists the most frequent factors that contribute to burnout among orthopaedic surgeons, according to the Medscape survey.
What are factors that contribute to your burnout? Try to identify them so you can learn how to address them. If you are already burned out, you will likely already feel overwhelmed. Take it one step at a time. If you are in a leadership position, do anything you can now to improve these challenges for yourself and others.
A recent study published in Quartz analyzed happiness trends among high schoolers dating back to 1991. Researchers found that “teens who spent more time seeing their friends in person, exercising, playing sports, attending religious services, reading or even doing homework were happier. However, teens who spent more time on the internet, playing computer games, on social media, texting, using video chat, or watching TV were less happy.”
For physicians, screen time also includes electronic medical records (EMRs). EMRs are a major contributing factor to burnout among physicians. It’s no surprise that physicians who spend more time on medical records and clerical tasks are less happy than those who get to interface more with patients. The study suggests that the additional time that these physicians spend watching TV or on their phones or tablets may also be correlated with unhappiness.
Naturally, depression or unhappiness can lead to isolation, with physicians choosing screen time over time spent with people. Successful behavior theories for breaking this cycle are based on small tangible efforts rather than dramatic steps. Getting outdoors away from screens, even if you remain in isolation, can have positive effects. Consider setting limits on the duration of your screen time and avoid sites or activities that falsely suggest that others “have it better” or that contain depressing content.
For pearls on how to limit the negative effects of social media, which can be similarly applied to screen time, visit the blog of Jon Cabin, MD, at https://surgeonmasters.com/blog/steps-to-control-social-media.
Editor’s note: This article is the first of a two-part series on physician happiness. The second article will appear in the July issue of AAOS Now.
Jeffrey M. Smith, MD, is an orthopaedic traumatologist in San Diego and an AAOS Communities in Motion volunteer.