Is physician resilience really physician wellness?

It’s been about a decade since medical associations around the world began beating the drum of physician wellness.  For good reason.  Statistics and studies from the Canadian Medical Association and others show that physicians have higher rates of suicide, suicidal ideation, depression, burnout and other mental health conditions than the general population. The number of resignations, vacancies and burnouts during the COVID-19 pandemic alone is alarming.

This should alarm us for three reasons:

·      First, it is a symptom of an unwell healthcare system;

·      Second, these are the people we entrust to care for us and our loved ones in times of need; and

·      Third, physicians are people too and deserve compassion and empathy like anyone else when they struggle.

In essence, if physicians are unwell, it may hinder you from being well.

There are things we can do about it, but also things we can’t because only the physicians themselves can.

If we believe the studies that suggest physicians are unwell, we should talk to our politicians and medical schools about it.  If something threatens our healthcare system and, as a result, our own health, we should be concerned and demand a robust discussion about how to fix it.  We can do that part by calling our elected officials, calling regulatory bodies that govern physicians, and asking questions of our medical schools. We need these folks to fix the root cause of the problem - an over-burdened, under-resourced healthcare system that has transferred meaningful autonomy from physicians and other key healthcare workers and to management, bureaucrats and politicians.

Physicians themselves, however, may need to take care of much of the rest.  They need to figure out for themselves if efforts made by their own associations, regulators, departments, and educational institutions are making any difference.  Physicians in nearly every jurisdiction have a variety of private, usually self-funded, associations that advocate for them.  They can play a helpful role in looking after otherwise very busy physicians.  While they have traditionally focused much of their time tending to the financial health of physicians, to much success, they have turned their mind in recent years to physician wellness beyond dollars and cents.

But have those efforts yielded results?  One could argue awareness is a start.  Slowly but surely people are learning about physician wellness issues.

Beyond that, are they helping themselves enough to make a difference?

Case in point, a young emergency room physician in Quebec took her own life in January 2021.  Sadly, this is all too common.  The response from some medical associations was to take to social media to declare the loss tragic and to tell the world that resources are available to help physicians in need.  This type of response is questionable for a few reasons:

·      First, it’s been done before.  Sadly, this is not the first tragic loss yet the response of a tweet expressing condolences seems to be repeated each time.  It’s not working and the stakes are too high to keep trying it.  At best, the social media post is sincere but naïve.  At worst, it’s part of a flawed communications plan that harms the reputation and relevancy of that organization;

·      Second, it has an obvious tinge of victim-blaming as if to say this person may not have chosen to take her own life had she just visited a website first.  Doctors, of all people, should understand that those who are in distress to such an extent that they have suicidal ideation may not be in the frame of mind to navigate the internet to find a helpful website;

·      Third, it totally ignores the bigger issue at play.  Doctors may be used to treating symptoms but they are also expert diagnosticians.  They can often find the root cause of a problem – or at least try.  Doctors know very well that the root cause of the growing physician wellness problem is a healthcare system that is: a) increasingly taking away their autonomy in favour of easy-to-follow algorithms; b) moving decision-making power away from those within the system that have been properly trained and toward those with political or financial control; c) disrespects their unique expertise and skill by assuming all of them are capable of the same things; and d) replaces them with other providers at a fraction of the cost but also a fraction of the training. 

·      Fourth, their own culture is one that values putting the health of their patients above their own, putting in excessively long-hours, seeing a high volume of patients, and seeing reward in financial compensation rather than self-care.  Deteriorating physician wellness is a symptom of an ailing healthcare system as well as an unhealthy culture.  Their professional culture sometimes tries to treat the symptoms of this problem rather than the root cause. They do this by talking about building tolerance or resilience but we all know the ability to tolerate or withstand something doesn’t solve the problem and actually deteriorates over time. Building tolerance and resilience seems to ignore the diagnosis that most physicians and their associations already know about.

It was philosopher Jiddu Krishnamurti that said, “It is no measure of health to be well adjusted to a profoundly sick society.”

We can do our part to address physician wellness issues but whether the action and response from physicians’ own organizations is satisfactory in addressing the root cause of this problem is up to physicians themselves.  We wish them, and us, well.