Physician wellness and suicide prevention
An interview with Ottawa’s Derek Puddester
In the last year, a spate of articles have reported that 400 doctors commit suicide annually in the US — about the size of an entire medical school graduating class. The subject received wide coverage here in Canada and with reason: rates in this country are also high.
Interviewed by CTV, Dr Derek Puddester, associate medical director of the Ontario Medical Association’s Physician Health Program and associate professor at the University of Ottawa said: “The concerns here mirror those in the United States. We've known for a number of decades that physicians have a higher risk of attempted and completed suicide. One of the unique things about Canada is we have a lengthy history of trying to reach out and support doctors right from the very beginning of their careers to try to prevent such tragedies."
A medical graduate of Memorial University from Newfoundland, Dr Puddester completed his residency in psychiatry at McMaster University. He’s devoted much of his career to physician wellness and co-authored the popular and useful CanMEDS Physician Health Guide with Leslie Flynn and Jordan Cohen. The chapter called “Physician Health Care Needs: Unique Issues” deals with mental issues and physician suicide.
Dr Puddester has been recognized for leadership in physician health by the Canadian Association of Interns and Residents through the creation of the Dr Derek Puddester Resident Wellbeing Award, given annually to a person or program that has made a significant contribution to the improvement of residential health and wellness.
What is “physician health?”
Not so long ago “physician health” meant rehab for substance abuse when problems occurred on the job. The contemporary concept, Dr Puddester points out, is “a holistic and broad construct,” one that encompasses everything from physical and mental health to colleagues caring for one another.
He reminds the profession that physicians receive care differently than other people. They are “physician patients” and do not behave like someone with no medical training. Yet to rely on his or her own medical knowledge or elicit off-hand advice “in the corridor” is a mistake, he says.
Dr Puddester strongly believes that doctors must have a family physician that they see regularly since these periodic health examinations may provide physicians the only opportunity to have a consultation with a health professional.
He calls on health economists who scoff at annual health exams to remember that, while the general population may visit a doctor’s office as many as four or five times a year, physicians often try to answer their own health related questions which leaves the annual exam as the only contact with another doctor who is actually responsible for their health.
Ups and downs
Doctors have an uneven record when it comes to monitoring their own health. Among populations with hypertension, only 56 percent of physicians have their blood pressure monitored, compared with 77 percent of those who are not doctors. On the other hand, physicians are more contentious about having regular colonoscopies though less diligent about fecal occult blood testing.
Dr Puddester offers some helpful nuts-and-bolts advice on planning a primary care visit. He reminds you to treat yourself with the care and compassion with which you hope your patients treat themselves and to arrive at an appointment ready to be seen. He suggests bringing a family member with you, making a list of health concerns in advance, and bringing samples of all prescription and non-prescription medications just as you’d like your patients to do. He believes this kind of regular physician care and attention to stress management are crucial components to preventing physician suicide.
In an effort to provide anonymous, free, easy-to-access support for doctors, Dr Puddester teamed up with colleagues to create ePhysicianHealth.com, an online resource that provides information for doctors on subjects like burnout and depression, anxiety, relationship with self, boundaries and resilience. He believes firmly in doctor resilience and the lasting power that well-placed support can have to refresh that resilience when it’s been weakened by stress or trauma. An interview with Dr Puddester follows.
Do you have an eye for spotting which medical students have what it takes to meet the demands of the profession and those who don’t? What do you look for?
Increasingly, the goal of admissions committees is to use a blend of qualitative and quantitative data to help them recruit learners who will be able to cope with the demands of training and many years of practice. But often, learners who have demonstrated resiliency will “catch our eye.” Those who have experienced life stressors appreciate what it means to be vulnerable, have insight into their own healthy and maladaptive coping strategies, and have managed real-life failure and/or challenge successfully tend to be resilient.
Editor’s note: Dr Puddester cited an article which reports on the nine core personal competencies for medical students that have been endorsed by the Association of American Medical Colleges (AAMC): ethical responsibility to self and others, reliability and dependability, service orientation, social skills, capacity for improvement, resilience and adaptability, cultural competence, oral communication and teamwork.
Do you think that the old psychological profile of the doctor as an all-knowing authority still lingers? What professional image do you think would best serve doctors in the context of their own health and well-being?
It’s been a long time since I have seen that sort of psychological profile! Most physicians I trained and work with are highly collaborative, quite humble and very much in touch with their human side. I think the profile you describe may be more in keeping with outdated stereotypes from the 50s or perhaps a very small minority of practitioners. I see most physicians now as very genuine, compassionate, and engaged practitioners who approach care with a sense of partnership. This aligns well with Canada’s sense of social responsibility in medicine.
Female doctors have a higher rate of suicide than their male colleagues. How can women physicians be best supported?
Suicide rates in the profession are very hard to study well due to methodological challenges (rates are already low, deaths are often not reported as suicides), but the gender difference has been consistently noted in the literature.
I often see women physicians who are already working very hard professionally… and seem to have more than their share of the responsibility for child rearing, eldercare and homemaking. This does seems to be shifting, however, as more families have a more equitable approach to family/household duties.
What issues do you think are the most challenging for colleagues to recognize in other doctors and how best can doctors support each other in these issues?
Litigation and complaint are serious issues and tap into the dreaded sense physicians have of real or perceived failure. After all, almost everything we do is for our patients and their families, and should we make an error it can resonate deeply… and painfully.
Personal health issues are also challenging to face and often are minimized by physicians and the profession. It would be nice if we took other doctors as patients, provided them with the same care we offer to all patients, and bear in mind that they work in a hazardous profession.
Besides that, going through normal life stressors, transitions and tragedies happen to physicians like everyone else. However, physicians tend to have precious little “wiggle room” in their lives to manage and process these issues. Without surge capacity, physicians’ schedules may contribute to these things not being processed in a healthy fashion. Whenever we see a colleague going through strain, stress or change we ought to simply reach out as friends and colleagues, and ask how are they doing… and can we help in any way.
I’d like to end with a question about the value of play! How can doctors use play to invigorate their own mental health?
Play is an essential part of the human spirit and one we often lose touch with during intense training and practice. Keeping in touch with our playful selves keeps us real, open to wonder, curious and creative, and welcoming of growth. I think we’d all be better off with regular recess and nap time, even well into our senior years of practice!
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