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Pearls


To best care for your patients, take care of yourself

Regular practices that promote reflection are crucial to a psychiatrist’s compassion and self-preservation

Vol. 11, No. 03 / March 2012

Discuss this article at www.facebook.com/CurrentPsychiatry

Every psychiatrist has experienced professional highs and lows. Whether helping a schizophrenia patient return to college, collaborating effectively with nursing staff, or achieving board certification, doctors—like everyone else—thrive on success. These accomplishments motivate us to help others and advance our careers.

However, psychiatrists also are vulnerable to ego insults associated with unavoidable negative and sometimes disastrous outcomes of their work. Doctors fail to "cure" every patient, may be “fired” by a patient, or may lose a patient to suicide.

Physicians spend so much time caring for their patients that they often neglect their own health. Self-care is not a core competency for trainees and many residency programs ignore this important issue. Negative outcomes can have profound effects on physicians, including shock; crying/grief/sadness; changed relationships with colleagues; disassociation from the event; crises of faith in education, training, and competency; shame and embarrassment; fear of reprisal; grandiosity; or a belief that the physician should have been all-knowing. Even when a patient commits suicide, the impact of this difficult and painful event on the clinician often is ignored.1 Physician suicide rates have been reported to be higher than those of the general population.2 Barriers to self-preserving treatment include:

Time constraints. Many doctors work up to 80 hours per week. Self-preservation does not become a priority for professionals until a lack of self-care interferes with their personal or professional life.

Limited resources. Physicians, like the general public, find it difficult to get appointments with primary care physicians and psychiatrists. Some doctors feel guilty about taking a slot from another patient or failing to see one of their own patients during that time. Simply finding a provider who is comfortable treating another doctor may be a challenge.

Stigma. It can be embarrassing for doctors to admit they are human, are vulnerable, and have health care needs. Fear of scrutiny for having an illness such as depression is so severe that surveyed psychiatrists said they would rather treat themselves than seek professional help.3

Psychiatrists who face sensitive emotional material on an hourly basis are susceptible to internalizing their work. For those who work with the vulnerable and victimized, meeting our own needs is fundamental to our ability to thrive. Regular practices that promote reflection are crucial to a psychiatrist’s compassion and self-preservation. Suggestions for appropriate self-care are described in the Table.

Table

Psychiatrists’ health: Guidelines for self-preservation

Practice

Examples

Define your professional role and know your level of competency

Work within the confines of your skill set Refer patients to more specialized physicians when you feel their illnesses are outside your scope of expertise Consult colleagues for help with difficult cases

Respect your own boundaries

Delineate professional and personal boundaries Reflect on "shades of gray" or ambiguity Seek reinforcement from a supervisor

Ask for help

Clearly articulate your needs to supervisors, colleagues, family, and friends Create a positive environment among colleagues

Be demanding of yourself and others

Expect yourself and others to live with honesty, integrity, and compassion Identify the source of any inability to maintain these standards Correct your behavior when your work is substandard

Treat depression

Find time to visit a mental health professional Seek out a physician skilled at and comfortable with treating physicians

Keep balance in life

Foster hobbies Exercise on a routine basis

Disclosure

Dr. Farrell reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

References

1. Hausman K. Psychiatrists often overwhelmed by a patient’s suicide. Psychiatric News. July 4 2003.

2. Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry. 2004;161(12):2295-2302.

3. Balon R. Psychiatrist attitudes toward self-treatment of their own depression. Psychother Psychosom. 2007;76(5):306-310.

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