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Physician Burnout: Depression And Suicide In Surgeons

I wrote last year in USA Today about the impact of physician burnout. Not only do doctors suffer, but so do their patients.

Burnout starts early in residency, with entering interns having a depression rate of 4 percent, similar to the general public. But after the first year of residency, that number balloons to 25 percent.

Now another study adds fuel to this disturbing trend. A paper published in the Archives of General Surgery looks at the prevalence of physician burnout in surgeons:

In a national survey, one in 16 surgeons reported contemplating suicide, researchers reported.

An increased risk of suicidal ideation was linked to three factors: depression, burnout, and the perception of having made a recent major medical error …

… But only about one in four of those who reported thinking about taking their own lives sought psychiatric or psychologic help.

The rate of suicidal ideation in surgeons, at 6.3 percent, was almost double of that in the general population (3.3 percent).

Physician burnout is a phenomenon that’s often ignored. The practice environment is deteriorating, with increasing time pressures and worsening bureaucratic burdens. Little of this is addressed in the national health conversation, or in the recently passed health reform law. Read more »

*This blog post was originally published at*

Should Doctors Work Weekends?

Peter Orszag wants doctors to work weekends. The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:

Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or a television network that didn’t measure its ratings. Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones.

And he’s right, to a point.

I’ve pointed to studies showing that mortality rises on the weekends, in part due to skeleton staffs that hospitals employ on Saturday and Sunday. And, since Mr. Orszag is an economist, the cost factor is noted. Tests that get pushed off until Monday cost the health system serious dollars. The problem I have is that Mr. Orszag, like most health reformers, offers doctors little incentive in return. Read more »

*This blog post was originally published at*

Physician Burnout Isn’t New

Dr. Wes and Kevin, M.D. have both written reviews of the documentary film “The Vanishing Oath.” I started the process rolling of trying to get the film shown locally. No date yet, but looks like it will happen before the year is out. 

This is not a new phenomenon in medicine (or any profession). Dr. Robert Goldwyn wrote a nice essay on the some of the issues that can lead to burnout, though not once did he mention burnout specifically. The title says much:

“I Bargained on Working Hard as a Surgeon, Not Working Hard to Be Able to Work Hard as a Surgeon”

The preceding title is a quote from a letter written by a resident in the last year of his training (S. A. Teitlebaum, August 20, 1994). It reflects the gloom besetting the young in particular but certainly not them exclusively. We all are uneasy about our futures, professionally and economically. Bandied in the corridors at a national meeting was a dismal figure: 1:100,000, the presumed proper ratio, as determined by Health Maintenance Organizations, of plastic surgeons to population. That 1 million Americans need only 10 plastic surgeons seems wrong and idiotic to me, but it makes good economic sense to health providers and insurance companies. Their coffers swell as they collect the same or higher premiums while curtailing what they provide. Read more »

*This blog post was originally published at Suture for a Living*

On Leave From The “Life-Inflicted” Battle

Here on this balcony, in Hilton Head, South Carolina, the wind is cool, the air typically thick with humidity, my wife reading a novel by my side. Inside the rental, our children are winding down after days of sun, sand and sea. Their bodies scrubbed pink by salt water and ocean breezes, their faces glowing with sun. My daughter’s lovely blonde hair is more blonde than usual.

I am on leave, in a sense. I am not, however, in the armed forces. Furthermore, I am not at a conference or working at all (except for a little writing, which is as much breath as work.) I am, in fact, celebrating my 20th wedding anniversary on a trip suggested and planned by my love. 

I have accomplished little that the world would view as substantial this week. I have viewed it as a kind of sabbath. I have enjoyed my family, played on the beach, eaten far too much and delighted in every single, solitary minute…and Oreos.

“Sabbath,” “on leave,” “R&R” – however one describes it, we must remember to do it — we need it – because life is a kind of battle. Many well-educated, peaceful post-moderns think that’s far to bellicose a description, but the truth remains: Life is a struggle that rises to the description of battle with stark regularity. Read more »

*This blog post was originally published at*

Heart Disease And Working Overtime

The European Heart Journal studied 6,000 British civil servants and followed them for 11 years. They found that working an extra 3 to 4 hours a day is associated with increased coronary heart disease.

The researchers controlled and adjusted for lifestyle, cardiac risk factors, and other factors that would skew the results, and still found that people who worked 3 to 4 extra hours a day had a 60 percent increase in risk for heart disease. Read more »

*This blog post was originally published at EverythingHealth*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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