Physician Workplace Health Begins with Respectful, Value-free Dialogue

In the spring of 2016, CivicAction, a non-partisan group of senior executives, corporate and community leaders, released a report suggesting that 1.5 million people in the Greater Toronto and Hamilton area have experienced mental health issues that, if left unchecked, could result in a $17 billion loss in productivity over the next 10 years.

That report received a lot of attention. It wasn’t the first to come out and name workplace bullying as a identified mental health challenge [link to harris poll] but it was the first to put such a hefty dollar figure on the comprehensive cost of mental illness in lost productivity to the economy.

According to the Canadian Mental Health Association, 1 in 5 Canadians will experience a mental health issue and approximately 8 per cent of adults will suffer from a major depression at some point in their lives.  Mental illness is a leading cause of disability in Canada. Mental health stigma continues to feed discrimination and creates a serious barrier to discovery, care and acceptance of people who need help.

Physicians and workplace health

The annual suicide rate in Canada is 4,000, nearly 11 people a day.  Suicide touches every demographic across the county, but one stands out in sharp relief: Physicians kill themselves more than any other occupational group. 2004 data published in the American Journal of Psychiatry found that male doctors are 1.4x, and female physicians 2.3x, more likely to kill themselves than the non-physician population. The authors cautioned the higher female rates could be due to publication bias. Data in Canada is lacking.

There is no secret that the world of medicine has been created as a hard an unforgiving place: intense competition, relentless study, long working hours, and the constant demand of the sick combine to create a high stress environment that demands only the best that practitioners can bring. Scaffold into it a belief system that sees weakness as inferiority and it’s a natural recipe for disaster as people, being human, come face to face with their own humanity. With no support nets to catch them and held back by stigma from getting the necessary help, physicians can spiral out of control without seeking the help they need.

Dr. Gigi Osler, President-Elect of the Canadian Medical Association speaking before the FMWC at the 2017 AGM addressed the shockingly high physician burnout rate of up to 60 per cent for women physicians (overall 54 per cent) and noted that emotional exhaustion emerges as an early burnout sign for women.

This should come as no surprise; add to the unrelenting expectations of the world of medicine the unrelenting expectations of the roles of mother, spouse, and/or daughter for an internal combustion guaranteed to rock the charts.

This isn’t because the job of medicine is so difficult it can’t be done, or that the practice of medicine can’t be structured to recognize the human participants in the system. It’s because the system isn’t working and it’s breaking the people that support it and affecting their mental health.

Researchers put the genesis of the decay in medical school to the “hidden curriculum”, “the unwritten, unofficial and often unintended lessons” that are passed along from instructors to students through watching and mimicking behaviour. These behaviours magnify over the course of medical education and residency, and harden into practice, grow into systems and are taught to and replicated by the next generation over and again.

And then there’s ongoing workplace tension…

Over the past several months, Canadian physicians have been undergoing an assault on their integrity by the government over the proposed changes to the tax code that regulates small business in Canada. The language being used by the government in its messaging has focused on concepts of “fairness” and “integrity” and has implied that physicians are tax-cheats because they take advantage of tax tools that other Canadians take part in: farmers, lawyers, accountants. Tax tools that were collectively and legitimately bargained for. It has been nothing short of ugly.

It is particularly demeaning that as women gain greater access to leadership roles and decision making positions in medicine, characterizations of physicians as dishonest and greedy are the more dominant images in the public discourse, and not the struggling new “Dr. Mom”, with only weeks, maybe a couple of months of maternity leave behind her before she’s back at work, delivering other people’s babies and caring for the sick.

Prime Minister Justin Trudeau marked World Mental Health day with a statement from his Office:

“We also recognize that women face particular challenges in the workplace, and bear a disproportionate responsibility for mental health care. We all benefit when women participate fully in our economy and our communities, and we must do more to build workplaces that are free of discrimination, and safe and healthy for people of all gender identities.”

Women physicians are working mothers, working daughters or spouses, and workplace harassment of physicians as tax cheats, particularly in public, is unbecoming of a feminist government.

We call upon the government of Canada to do its part to improve workplace bullying in the health care environment by engaging in respectful, value-free dialogue and inclusive, collaborative consultations with all employee groups.We all have a role in reducing workplace stress.

If you are thinking of taking your life or know of someone who needs help, please contact:

Canadian Association of Suicide Prevention

Further reading:

Wounded Healers : National Post Special Feature

Doctors are facing a health care crisis of their own : Huffington Post

Medical Students face an "alarmingly high" rate of depression, study finds : CBC News

Why Doctors Kill Themselves : Dr. Pamela Wible