Physician Wellness

Physician wellness is often unaddressed in day-to-day practice. As medicine grows more complex, new stresses and demands are placed on healthcare providers. Only recently has the literature begun to investigate the role of burn out, compassion fatigue, and moral distress on healthcare providers. These phenomena do not just affect physicians, but also nurses, social workers, and other providers.

Burnout is an emotional and behavioural impairment from chronic exposure to high levels of occupational stress.[1] In its totality, it is a syndrome of emotional exhaustion (tiredness, somatic symptoms, decreased emotional resources, and a feeling that one has nothing left to give to others), depersonalization (developing negative, cynical attitudes and impersonal feelings towards their clients, treating them as objects) and lack of feelings of personal accomplishment (feelings of incompetence, inefficiency and inadequacy). Burnout can also be seen as a “contagious syndrome” in a social context, and especially when working along colleagues who are disillusioned and verbally complain of burn out.[2] The most common cause of physician burnout is excessive administrative workload.[3]

  • Mindfulness-based stress reduction courses reduce physician burnout and improve mental well-being for a broad range of healthcare providers.[4]

Compassion fatigue is generally described as caregiver exhaustion as a result of cumulative and progressive absorption of a patient’s pain and suffering.[5] This frequently results in emotional and physical exhaustion from providing patient care. It is associated with a gradual desensitization to patient stories, increased clinical errors, poorer quality of care, and vicarious trauma.[6]

Moral distress is psychological distress that occurs “when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action.“[7] The idea was established in the 1980s in the nursing literature, and is a leading cause of nursing burnout and attrition.[8][9] However, this concept can be extended into all healthcare professions. The role of a psychiatrist is particularly susceptible to this, as we are frequently asked to make judgments of dangerousness, and also assess the need for coercive treatments.[10]

Moral Distress and the Importance of Psychiatric Ethics

“Dangers lie on all sides. If the patient whom we deemed safe to return home were to kill him- or herself or others or be the perpetrator of a mass shooting, the evaluating psychiatrist would be held responsible for predicting the future. Yet if we fail to balance this responsibility to society with responsibility to the patient, we run the risk of becoming the psychiatrists complicit in the Nazi extermination of the mentally ill and the hospitalization of political dissenters in the Soviet Union.”

Jennifer Huang Harris, MD

Between 300 to 400 physicians die by suicide each year in the United States. Physician suicide rates in Canada are unclear and not well studied. Male physicians have rates that are slightly higher than non-physician men, while female physician rates are 3 to 4 times higher than non-physician women. The majority of physicians who die by suicide are living with a mental disorder. Between 10 to 15% of physicians who die by suicide are thought to have received no treatment at all.[11]