Physician wellness

Coping with the stress of medical practice

Physician health: Putting yourself first

Originally published September 2015
P1504-1-E

Physicians have the knowledge and skills to be healthy. Yet, while they care for their patients, their own physical and mental well-being may suffer. The medical community recognizes that physicians are at their best when healthy, and encourages physicians to look after themselves and ask for help when they need it.1

What puts physician health at risk?

The very nature of medical practice can contribute to physicians’ stress. A regular work day can be emotionally draining as doctors witness suffering, fear, pain, tragedy, and death. They may also experience mental stress from dealing with increasing patient care demands, constrained resources, remuneration issues, mounting paperwork, and frustration in trying to meet the conflicting needs of patients and healthcare organizations.2

Physicians’ intrinsic personality traits often make it easy for them to ignore their own health needs. Typically doctors are high achievers, independent, and self-sufficient.3 They can be perfectionists, with a tendency to overwork. These characteristics allow them to let work become their priority, neglecting their own care and personal lives.

The culture of medicine may deter physicians from caring for their health. From the beginning of their medical career, students and residents are exposed to long hours and heavy workloads. This is often seen as the only way to achieve success.4,5 Doctors report feeling pressure from colleagues and patients to prove their medical competence by always appearing well and able to cope. Many are reluctant to take sick leave or sufficient vacation. Some fear that asking for help may be seen as a sign of weakness and so hesitate to discuss their health concerns with others.6

These factors — the nature of medical practice, the personality traits of physicians, and the culture of the profession — can make doctors vulnerable to stress, fatigue, depression, anxiety, substance abuse, burnout, and impairment. In addition, physicians face the same stresses and difficulties as any other individual. They may, for example, experience family difficulties, financial problems, relationship issues, workplace challenges, or social isolation, all of which can erode their ability to cope.

Why healthy physicians are essential

The medical literature indicates that physicians who are unwell physically or mentally may not practise effectively or safely.7

The Canadian Medical Association’s Code of Ethics makes it a fundamental responsibility of physicians to maintain and promote their own health.8

Some regulatory authorities (Colleges) recognize the importance of physicians being aware of their state of health. For example, the College of Physicians and Surgeons of Ontario advises its members that, "Because physicians cannot serve their own patients if they are not well, physicians may have to put their own needs for wellness ahead of the needs of individual patients or the public as a whole in some circumstances. Physician wellness is also important for its own sake independent of any responsibility to others."9

Research also shows that physicians’ health can affect both patient care and the healthcare system. A 2013 Canadian study found that doctors who follow preventive health practices themselves are likely to influence their patients to do the same.10

The focus shifts to prevention

The approach for supporting physicians’ physical and mental health is shifting from a focus on mental health and substance abuse to improving self-care and preventing illness.

The shift has started in medical schools and clinical training. Younger generations have indicated that a balance between their professional work and their personal lives is the most important factor when establishing a fulfilling career in medicine.11 In response, some universities and residency programs have developed wellness resources and revamped medical curricula to help students and residents practise good self-care in their daily lives.12

Medical associations and organizations are also promoting good health habits. Several provincial physician health programs and other groups offer resources to help physicians incorporate self-care into their lives. For example, the CanMEDS Physician Health Guide, by The Royal College of Physicians and Surgeons of Canada, offers advice specific to physicians for maintaining relationships, parenting, using emotional intelligence, managing stress through mindfulness, coping with an adverse event, and making financial plans.13 The CMPA Good Practices Guide contains practical advice on good self-care habits that help physicians practise safely and avoid medical-legal difficulties.

Physician health programs

Contact information for each of the provincial physician health programs is available on the Canadian Medical Association website at cma.ca. Go to the Practice Management & Wellness section, then to Physician health and wellness.

The courage to ask for help

Even physicians who normally cope well may need help at times. Some, for instance, may find it difficult to carry on if they become over extended in their everyday work or if they face events such as a patient safety incident or a death in their family.

Doctors should try to be self-aware, recognizing when their health requires care. They should consider their care options, such as taking time away from work, adjusting how they work, or seeking outside help and advice including treatment.

Physicians must allow themselves to reach out for help — from speaking with a trusted colleague, institution administrator, life or practice partner, friend, or religious advisor — to contacting the local provincial physician health program — to obtaining professional treatment from a family physician, psychologist, psychiatrist, or other healthcare provider.

Some doctors must overcome barriers before seeking help. Many may have trouble accepting the patient role and being away from work. Others may think they will prevail over their difficulties with time and consequently delay seeking help. Many must overcome fears that their problems will become public, damage their reputation, and result in the loss of their medical licence.

Medical students and residents should also get help when stressed. They can contact their faculty advisor, the dean’s office at their medical school, or the wellness program at their institution. Many physician health programs also serve students and residents.

The CMPA can help, too

The CMPA has more than 100 years of experience assisting physicians with medical-legal difficulties. We know these matters can create undue stress, impair health, and affect physicians’ ability to practise. Members have told us that simply calling the Association and speaking to one of our medical officers, who are licensed physicians, reduced their stress and improved their well-being. By getting information and support from our specially-trained experts, members can see their situation in the proper perspective.

 
 

References

  1. Wallace, J.E., Lemaire, J.B., Ghali, W.A., "Physician wellness: a missing quality indicator," November 14, 2009, www.thelancet.com, Vol. 374. Accessed May 4, 2015 from: https://soci.ucalgary.ca/sites/soci.ucalgary.ca/files/Wallace_in_Lancet.pdf
  2. Ibid.
  3. Wiskar, K., "Physician health: A review of lifestyle behaviors and preventive health care among physicians," British Columbia Medical Journal, 2012, Vol. 54, No.8. Accessed May 4, 2015 from: http://www.bcmj.org/mds-be/physician-health-review-lifestyle-behaviors-and-preventive-health-care-among-physicians
  4. Gautam, M., "Medical misconception #11: Doctors are healthy," The Medical Post, April 21, 2015. Accessed May 4, 2015 from: http://www.canadianhealthcarenetwork.ca/physicians/life-travel/medical-misconception-11-doctors-are-healthy-39203
  5. Wiskar, K., "Physician health: A review of lifestyle behaviors and preventive health care among physicians," British Columbia Medical Journal, 2012, Vol. 54, No.8. Accessed May 4, 2015 from: http://www.bcmj.org/mds-be/physician-health-review-lifestyle-behaviors-and-preventive-health-care-among-physicians
  6. Wallace, J.E., Lemaire, J.B., Ghali, W.A., "Physician wellness: a missing quality indicator," November 14, 2009, www.thelancet.com, Vol. 374. Accessed from: https://soci.ucalgary.ca/sites/soci.ucalgary.ca/files/Wallace_in_Lancet.pdf
  7. Ibid.
  8. Canadian Medical Association, CMA Code of Ethics, 2004, Sections 5, 10, 53, 54. Accessed May 4, 2015 from: https://www.cma.ca/En/Pages/code-of-ethics.aspx
  9. Ontario College of Physicians and Surgeons of Ontario, Duties: To themselves and colleagues, Wellness. Accessed May 4, 2015 from: http://www.cpso.on.ca/Policies-Publications/The-Practice-Guide-Medical-Professionalism-and-Col/Principles-of-Practice-and-Duties-of-Physicians/Duties-to-Themselves-and-Others/Duties-To-Themselves-and-Colleagues-Wellness
  10. Frank, E, Dresner, Y., Shani, M., Vinker, S., "The association between physicians’ and patients’ preventive health practices," Canadian Medical Association Journal, May 14, 2013, Vol. 185, No.8. Accessed May 4, 2015 from: http://www.cmaj.ca/content/185/8/649.long
  11. 2012 National Physician Survey, Results for medical students, results for medical residents, question 15, p. 44. Accessed May 4, 2015 from: http://nationalphysiciansurvey.ca/surveys/2012-survey/survey-results/
  12. For an example, see Student Wellness, University of Ottawa, Faculty of Medicine, Student Affairs Office: http://www.med.uottawa.ca/Students/StudentAffairs/eng/wellness_sw.html
  13. Puddester, D., Flynn, L., Cohen, J. eds. Royal College of Physicians and Surgeons of Canada, CanMEDS physician health guide: A practical handbook for physician health and well-being. 2009. Accessed May 4, 2015 from: http://www.royalcollege.ca/portal/page/portal/rc/canmeds/resources/publications/

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.