Caring for our caregivers

The COVID-19 pandemic brought the conversation around mental health and the effects of burnout on our physicians and medical community to the forefront. We’ve become increasingly aware that those treating patients must also look out for their own health and well-being. In this podcast, Dr. Jon Novick, medical director of OMA’s Physician Health Program, and Dr. Judy Suke, a family physician focused on medical psychotherapy, discuss the impact of physician burnout and the role the health-care system plays in ensuring our medical community remains in good mental health. Though progress has been made with reduced stigma, resistance and fear around accessing care, Drs. Novick and Suke note more must be done to ensure physicians receive adequate support to take care of themselves and each other. 

Transcript

Spotlight on Health – Caring for the Caregiver

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Georgia Balogiannis: In this podcast the Ontario Medical Association looks at current issues of interest in health care. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us. I'm Georgia Balogiannis for the Ontario Medical Association. 

The past two years have highlighted how doctors have been selflessly supporting and protecting the public, but who is caring for the caregiver? In this episode, physicians discuss the mental health challenges faced by healthcare workers and the steps that need to be taken to ensure a healthy medical community.

Dr. Jon Novick is a psychiatrist, psychoanalyst and addiction medicine specialist, and the medical director for the Ontario Medical Association's physician health program. Dr. Judy Suke is a family physician with a private practice focused exclusively on medical psychotherapy.

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Dr. Jon Novick: There has been an evolution in the kinds of needs that physicians have had. There's a big set of newer needs that fall under the heading of burnout. And as far as how things have changed over time, with respect to access, and awareness, I also think that — certainly since the pandemic, but also over the past let's say five or more years — there's been a greater recognition that not only do treaters deserve to have access to necessary treatment, but that it is increasingly okay for treaters to be seeking that care. So, there's really been an evolution in terms of our understanding and acceptance.

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Dr. Novick: Luckily, we're living during a period of time where there has been greater awareness for issues of mental health and a steady reduction in stigma, although I think that there's still a lot of room to go. Just because you're a physician doesn't mean that you're immune to all the conditions that everybody can suffer with. And again, especially given the rise in burnout which has essentially doubled based on the information that we've gotten during COVID — much of the world, certainly in North America, is aware that there's a lot of suffering going on, and that it is something that needs to be addressed, and that it is okay to address it.

There's still a lot of internalized stigma, there's still a lot of resistance, there's still a lot of fear about seeking help. But at the same time, I think that people are more willing to seek help, and the access is greater. And I think also people are getting the message that, one, you're not alone; two, there's help out there; three, shame gets in the way of seeking help and that, in the end, people are better off getting the help that they need rather than suffering in silence, which has led to disastrous consequences.

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Dr. Novick: Even just a few years ago, a lot of the focus on burnout was around, you know, what can an individual physician do? How can they improve their resilience? How can they build their wellness? And while the intentions are good there, and while there are certainly lots of things that individual physicians can do to optimize their well-being, it also sent this incorrect message for a while that doctors were burnt out because they weren't taking enough care of themselves. And it really is that the system, which is quite complex, is not supporting and taking care of the physicians to the degree that's necessary.

There are a lot of factors that come into play in terms of physician burnout, and many if not all of them have to do with the environment. So, a burnout — it is helpful to think of burnout as an occupational illness or injury. This question of resilience also comes up. I also like to think that resilience is a factor, but it might be that it's because doctors are so resilient that they’re vulnerable to burnout.

You can't get into medical school, residency, et cetera, et cetera, if you already don't have a large subset of strengths, including personal resilience. These go along with some of the personality factors among physicians — perfectionism, dedication to work, a strong desire to help — which can translate into difficulties saying no, setting limits, prioritizing themselves, their personal wellness, health, and family. It renders the physician vulnerable to the system or multiple systems taking advantage of that willingness, that resilience, that dedication, those abilities. It's not like it's all consciously conspiring to do that, but it happens.

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Dr. Novick: My hope would be, and some of this applies to everybody in general, not just physicians, that there wouldn't be a lot of resistance to reaching out for help; that the barriers — which include internalized stigma, fear of consequences, varying types of denial — that those things could be minimized, so that people have a greater ability to access care.

There is right or a better care out there that’s suitable for physicians, given the kind of work that they do. But it really has to be at all levels of the medical system. So, not just in terms of education — and in the beginning, emphasizing the importance of wellness and health and seeking appropriate and timely care — but on the other side early recognition, let's say by leaders for example.

Peer support has been shown to have a really great impact in terms of physician wellness, supporting physicians facing a lot of different issues. Lessons learned from the development of peer support programs is that you also have to go out there and connect with the physician who may be in need. And so, it was really important that the peer support program folks went to the physician potentially in need to engage and offer services. And it would be really great if there was a shift such that it wasn't just left up to somebody having to fall to a certain level and feeling so desperate to seek help, that help would arrive before that point.

It's really about the system and its many components taking care of the physician just as much as the physician is taking care of the people in the system.

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Dr. Judy Suke: I have a interest, passion, and a focus in supporting physician wellness. Probably about 80 percent of my patients currently are physicians and I take referrals from a few institutions.

Physicians that are presenting are presenting with anxiety, sadness, grief, and stress. Stress, especially now because of what they've gone through in the pandemic, but long-standing before the pandemic physicians presentations have increased needs within the last few years as do the rest of the populations due to just a shared experience of some difficult times, whether or not it be workplace staffing shortages and the strains to the quality of care that they strive to deliver, increased call shifts, less sleep, more stress at home due to increased roles like so many in so many other professions at this time.

So much of public health is shifting the culture of medicine towards humanizing every person within the medical culture. And through seeing our shared humanity I think the culture of medicine can shift in a positive direction. That might be a small part of a very complex issue we're facing in this health care crisis.

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Dr. Suke: I see people when they have their mental health supported, their stressors supported, when they have tools and techniques for dealing for difficult times, that their ability to be the doctors they want to be is higher, it's greater, and it gives them more pleasure to grow and do more of what they want to be doing. I think that people enter medicine because they want to help and being able to return someone to that place of being able to be the caregiver. We need to be able to allow ourselves to take care of number one, to be able to take care of the number two, three, four, and onwards.

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Dr. Suke: The hope would be that physicians and health care workers fear less the stigma of reaching out, that they could more comfortably and openly share where they're at with peers, professional circles to get that collegial support, which we know is massively protective and important, and to create a culture where… where this dialogue is welcomed and normal and natural and... and not judged.

As much as the system is broken now, it's a very complex problem that needs a lot of angles tackling it at all levels. And a definite part of that is within the culture of medicine itself, and embracing the need to support our own wellness. And as much a part as is all of the system components that are stressing the ability to do that, which is where we need everyone's support. That's where we need the help. And I think it's against the culture of medicine to, like, openly ask for that.

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Dr. Suke: I grew up in a medical community and had an inspirational mom who was a trailblazer physician in her own time, who very much cared deeply about all of her patients, but also her colleagues, from physicians to nurses to every single support staff in the hospital she worked. And I grew up with a great appreciation through her of how important a healthy workplace culture is to supporting patient care, which is ultimately which she cared so deeply about.

She was a pioneer and I will happily share her name, Dr. Nancy McKee. She was a pioneer not only in surgery and research but also in modeling to me what the culture of medicine needed to move towards. And she was very much, as all of her peers would agree, very much showed her humanness and embraced others and took people where they were at and worked with them there. So, it's her spirit that I will carry on in this work and hope to share and let that philosophy, hopefully, grow within medicine — that we got to take care of each other.

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Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. To learn more about the Ontario Medical Association, please visit oma.org.

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