Four years ago, in 2019, a young doctor’s post titled ‘Ugly side of becoming a surgeon’, went viral on social media, as she suffered from burnout during her residency in Plastic surgery. “Never thought I would say that I am broken, I give up. I surrender. I am handing back my dream of becoming a plastic surgeon. I’ve lost my ambition”, those were the distressing words in her viral post.

In the year 2017, a gastroenterologist committed suicide. His wife said, he never had depression and was very busy with work and had always been. Before his tragic death, he was worried about his practice, finances, his competence; he would come home and just lie down flat, remaining detached from his family. Yet, he continued working! One evening, he got really upset as one of his patients died despite all the efforts and this shook him to the point that he took his own life. In retrospect, all the signs were there, but no one in the family could pick it up!

It is known to everyone that the professionals with highest suicide rates are ‘Doctors’ which is the biggest irony!

In a world where we are hailed as life saving heroes, our own well being often takes a back seat. The main reason behind them taking such drastic step is burnout syndrome. It is a state of emotional, physical, and mental exhaustion resulting from prolonged stress and overwhelming workload accompanied with a sense of feeling helpless and hopeless. I bet; all doctors have been through many dark seasons. If we carefully dissect the reason for these, some common themes emerge. Work is often the critical, exacerbating, and perpetuating factor. Doctors spend a vast majority of their lifetime at work and what happens there, influences all other aspects of their life including marital, personal and social life.Each year, Medscape releases a doctor burnout and depression report, and the prevalence of burnout has emerged to be worse than ever in 2023. In the survey, 53% of doctors complained of burn out compared to 42% in 2018. Comparing genders, 63% of females reported burnout compared to 46% of men.

Whether it’s emotional exhaustion from constantly having to defend their authority and proving themselves every time; being overlooked for leadership opportunities; having different expectations of behaviour; being interrupted or talked over in meetings; or as betrayal (moral injury) by an organization failing to uphold stated codes of conduct; women’s relative disempowerment to men puts them at higher risk of distress. Studies have shown clear links between race and gender based microaggressions in healthcare workplace distress.

“I’ve become a negative person, which I wasn’t before.”

“For me, doctoring in a broken place required a sustaining belief that the place would become less broken as a result of my efforts. I no longer can hold this belief”.

These are the words of doctors, who participated in Medscape study.

A recent study conducted by the Indian Medical Association, released on Doctor’s Day, 1st July, 2023 showed that 82 per cent of doctors in India are under stress and nearly two thirds of doctors feel burned out. A high burnout is seen more commonly in females in India too, because of reasons stated previously and probably because of higher expectations in the domestic settings. Study also shows that, burnout scores of the postgraduate (specialty) and super specialty doctors were higher than their graduate counterparts. This was expected as number of specialists are limited, they are subjected to more working hours leaving very less time for family life and recreation. Also seen in this study is that most of the practitioners are unhappy with the remuneration offered by the profession. About three-quarters of the patients are not covered by insurance and they pay for their own treatment. Many patients are unable to provide adequate compensation due to the financial restraints. The medical fee is lower in India than other developed countries. These multiple factors have led to intense dissatisfaction among the medical community, which is a cause of great concern.

What is causing burnout is not merely a reaction to a medical condition, but rather to the diseased systems for which we work. Everyday there is a new form, policy, guideline, software; dictating, restricting, modifying clinician activities formulated by those who do not see patients. In today’s modern medicine, a doctor is just one of the many commodities. The ever increasing commercialisation, encroaching corruption in health industry, take over of hospitals by politicians and businessmen has caught doctors in complex web of healthcare business. The joy, purpose of practicing medicine has been codified, sterilised, protocolised, industrialised and regimented. The altruism of young doctors has been replaced by shackles of efficiency, productivity, and key performance indicators.

The rising doctor burnouts especially in India can be attributed to limited resources including shortages of medical supplies, equipment, and staff, ever increasing administrative burden with heavy paperwork, lack of support from superiors or colleagues leading to feelings of isolation and job dissatisfaction.

Nowadays, the fear of medical litigation and potential legal consequences is also restricting doctors form taking up challenging cases where complications already exist or an unfortunate event is likely to happen, despite their best efforts.

One must understand that Burnout doesn’t come suddenly like a bolt of lightning; it’s a gradual, insidious erosion of the spirit. It leads to somatic symptoms like interpersonal problems, insomnia, irritability, and suicidal ideation. It has been linked to risk factors of cardiovascular diseases, type II Diabetes, high levels of cholesterol, glucose, triglycerides, uric acid and electrocardiography (ECG) abnormalities.

Medicine was always a high stress profession and the pandemic made it worse. According to a recent study (2021) by the US Centers for Disease Control and Prevention (CDC), post COVID-19, more than half of public health workers have reported symptoms of at least one mental health condition like depression, anxiety, and post-traumatic stress disorder (PTSD). The study also highlights the fact through these alarming statistics that one in ten covid warriors, who saved countless lives, are contemplating ending their lives!

Doctors and medical students, often find it difficult to seek help as they fear that seeking professional mental health help might affect their prospects as a doctor. To suppress their feelings, sometimes they fall prey to self-destructive behaviours succumbing to alcohol abuse, turning dependent on antidepressants and smoking and so on. In general, they are trained early in their training to mask the pain, to maintain a stoic stance about illness, and this perpetuates the denial of their own health vulnerabilities. Sometimes they overwork, because they feel guilty that they are letting down their patients. In an era of cut-throat competition, a doctor’s unrealistic expectations of perfectionism leads to self denial of the symptoms.

The Call for Change:

It’s time to lift the curtain on this silent epidemic and call for action. We owe it to our doctors, to create a nurturing environment that promotes both their well-being and that of their patients. Let’s look at some key areas where change can make all the difference:

• Work-Life Balance: Striking a balance between work and personal life is Implementing reasonable work hours and encouraging doctors to take time off for rest and rejuvenation ensures they can give their best to their patients.
• Support and Empathy: Instituting peer support programs and counselling services can create safe spaces for doctors to express their emotions and seek help. Empathy from colleagues and superiors can be a powerful balm for a weary soul. There is a need to set up good psychiatric care for the medical professionals and the The National Council for Mental Health should design training programs focused on the mental well- being of healthcare professionals.
• Streamlining Administrative Tasks: Embracing technology and innovative solutions can ease the burden of paperwork, freeing up valuable time, for doctors to focus on what they do best – healing.
• Celebrating Successes: Recognizing and appreciating the efforts of our doctors can boost morale and reignite the passion that drives them to excel.

It’s not just the responsibility of institutions, we, as a society, need to recognize and appreciate the sacrifices these doctors make daily for our well-being. We must show empathy and gratitude for their tireless efforts.

We are witnessing a time, where more doctors are quitting practice, committing suicides and less youngsters are joining the medical stream adding to already existing shortage of healers. This is a dangerous situation to deal with and we must try to fill the holes in system. So, let’s embark on a journey of transformation, where we prioritize the well-being of our wounded healers, alongside that of the patients.. As they continue to dedicate their lives to saving ours, it’s time for us to extend a helping hand to ensure their own well-being is not forgotten. Together, we can build a healthier, more compassionate, and thriving healthcare ecosystem – one that truly celebrates and protects the heroes who walk among us.

References

https://www.dailymail.co.uk/news/article-6667445/The-ugly-plastic-surgeon-Doctor-reveals- quit-dream-six-figure-job.html

https://www.dailymail.co.uk/news/article-6699623/Plastic-surgeon-resigned-high-profile- role-details-broke-her.html

https://www.medscape.com/slideshow/2023-lifestyle-burnout-6016058

https://www.google.com/amp/s/health.economictimes.indiatimes.com/amp/news/industry/maj ority-of-doctors-facing-mounting-stress-and-burnout-july-1-is-doctors-day/101407596

https://www.google.com/amp/s/www.outlookindia.com/national/-mental-health-where-s-the- time-anyway-doctors-in-india-have-a-common-tale-to-tell-news-301623/amp

https://www.cdc.gov/niosh/learning/publichealthburnoutprevention/module-1/outline.html

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