Pulse
Briefs
Students Under Stress
Fourth-year University of Minnesota medical student Pete Stiles got a worried call from his mother. She had been listening to a program about burnout and suicidal thinking among medical students on Minnesota Public Radio. “Are you OK?” she asked. Stiles assured her that he was.
Preventing Physician Suicide
The American Foundation for Suicide Prevention has released a documentary designed to educate medical students and physicians about depression and suicide. Struggling in Silence: Physician Depression and Suicide chronicles the stories of physicians lost to suicide as well as the accounts of a medical student, surgeon, and neurologist all of whom have suffered from depression. It also explores the professional policies and cultural stigma that prevent physicians and medical students from seeking help for this illness, which if left untreated, can lead to suicide. In addition to the documentary, an educational video on medical student depression and suicide has been designed specifically for use at medical schools.
Both films are available on DVD. For more information about physician suicide or to order the DVDs, visit the American Foundation for Suicide Prevention website, www.afsp.org.
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Evidently, though, quite a few of Stiles’ classmates might not be. Results of a survey of more than 4,000 students at seven U.S. medical schools published in the September 2 issue of
Annals of Internal Medicine found that nearly half reported feeling burned out in the past year and 10 percent reported suicidal ideation.
The fact that so many said they felt burned out was not surprising to James Pacala, M.D., assistant professor of family medicine and community health, who was one of the guest commentators on the program. Pacala cited a number of stressors he believes contribute to medical student burnout including the increasing amount of medical information (it doubles every 15 years) that’s available and the current push in medical schools for students to do volunteer work. He also said he thinks students might be more inclined to report feelings of burnout today than when he was a student in the early 1980s because they have greater awareness of the importance of self-care and mental health.
One of the things Pacala does to alleviate the pressure on students is to consciously point out his own failings—the bad outcome or blown diagnosis. “I think that it’s important to show students that they are human and mistakes are going to be made,” he told the radio audience.
He pointed out that medical educators need to push for excellence: “I don’t think anybody wants a doctor who took it easy in medical school,” he said. Yet he also noted that educators need to emphasize wellness. “We want to train doctors, but we also want to train healthy doctors.”—Carmen Peota
Extreme Jobs
An article published in the Harvard Business Review in 2006 about a study of top earners in the United States found that “extreme jobs” were on the rise. The authors defined extreme jobs as those that require someone to work 60 or more hours a week, travel regularly, maintain fast-paced and unpredictable schedules, and respond to client demands around the clock. Sounds like the lifestyle of many physicians.
The authors concluded that people in these positions tend to be passionate about their work and feel exhilarated rather than abused by the demands of their jobs. But they warned of the personal toll such jobs can take and questioned how long such a pace can be sustained.
A Call for Slower Medicine
Coined by geriatrician Dennis McCullough, M.D., the term “slow medicine” describes an approach to elder care that emphasizes “wiser decision-making regarding formal medical interventions.”
Rather than waiting until there’s a crisis that precipitates what McCullough calls “the cinematic drama of hospital emergency rooms,” he advocates attending to elder patients’ day-to-day needs—offering emotional support and social stimulation, providing better nutrition, and making sleeping, moving, bathing, dressing, and voiding easier, among other things. “Slow medicine is just this caring process of slowing down, being patient, coordinating care, and remaining faithful to the end,” McCullough writes in his book My Mother, Your Mother: Embracing “Slow Medicine,” the Compassionate Approach to Caring for Your Aging Loved Ones.
Although the book’s focus is elder care, McCullough has a message for physicians who work with patients of all ages. If they are to truly work with each individual patient, they need to understand the emotional, psychological, and spiritual aspects of medicine as well as the high-tech side.
A Matter of Hours
In 2003, the Accreditation Council for Graduate Medical Education placed limits on the number of hours a resident could work in a week, the idea being to try to prevent mistakes by sleep-deprived physicians-in-training.
But are the duty reforms having an effect on patient morbidity and mortality? And are they really changing the way residents work? The answer is still out.
Two studies that appeared in the Journal of the American Medical Association in September 2007 examined mortality among Medicare patients and patients in Veterans Affairs hospitals during the first two years following the reforms. Both looked at patients who had acute myocardial infarction, congestive heart failure, gastrointestinal bleeding, or stroke or who were hospitalized for general, orthopedic, or vascular surgery. The authors found that the work-hour reforms were not associated with any significant improvement or decline in mortality among Medicare patients. However, they did find a significant relative improvement in mortality for the nonsurgical patients who were seen in VA hospitals.
As for whether residents are actually working fewer hours, Harvard researchers found that interns commonly reported noncompliance with the new requirements during the first year of the reforms. However, the researchers did find that mean work duration decreased from 70.7 to 66.6 hours per week and that mean sleep duration increased 22 minutes, from 5.91 hours to 6.27 hours per night. The findings were reported in a September 2006 issue of JAMA.
Although some sleep experts have advocated further reducing the number of hours residents work, an article in the September 10, 2008, JAMA suggested that the effect of workload on clinical outcomes, rather than total work hours, should be studied before further changes are proposed. “Little attention has been given to the optimal workload for a given set of hours worked,” wrote the University of Chicago authors. They suggested that reductions in on-call admissions be used as a strategy to alleviate sleep deprivation and ensure better compliance with the current duty-hour requirements.