We commend Mark Bernstein for his brave yet disturbing description of a neurosurgeon in an advanced state of burnout and depression.1 Physicians have an increased risk of depression, suicide and substance abuse.2 They are especially vulnerable because of the demands of caring for the ill, managing a practice, pursuing lifelong education in a rapidly changing field, and the litigious environment in which they work. Physicians in distress face emotional exhaustion, cynicism, feelings of ineffectiveness and depersonalization.3 Studies have revealed that two-thirds of Canada's physicians consider their workload too heavy, and more than half say that personal and family life has suffered because of their career choice.4 In a recent CMA survey of 2251 doctors, 45.7% of the respondents reported an advanced state of burnout.5The profession is aware that mental health problems can begin in medical school and worsen during residency, when fatigue and emotional exhaustion are often the norm.2 Yet the topics of burnout, stress and poor mental health are not easy to discuss openly. The stigma of mental illness and the potential impact on professional status inhibit disclosure. We therefore strongly support the CMA initiative on Physician Health and Well-Being6 and the need to change the culture to address the barriers to disclosure.
Sarita Verma Associate Dean, Medical Education Leslie Flynn Assistant Dean, Postgraduate Medical Education Queen's University Kingston, Ont.
References
- 1.Bernstein M. Neurosurgical depression. CMAJ 2003;169(9):943-4.
- 2.Tyssen R, Vaglum P, Gronvold NT, Ekeberg O. Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study. Med Educ 2001;35(2):110-20. [DOI] [PubMed]
- 3.McCue JD. The effects of stress on physicians and their medical practice. N Engl J Med 1982; 306: 458-63. [DOI] [PubMed]
- 4.2001 Physician Resource Questionnaire results. Ottawa: Canadian Medical Association; 2001. Available: www.cmaj.ca/cgi/content/full/165/5/626/DC1 (accessed 2004 May 18).
- 5.The National Post [Toronto]: 2003 Aug 20.
- 6.Canadian Medical Association. Physician health and well-being [policy statement]. Ottawa: The Association; 1998. Available: http://www.cma.ca/index.cfm/ci_id/3211/la_id/1.htm (accessed 2004 May 18).