SGEM Xtra: Everybody Hurts, Sometime

Subscribe: RSS

Date: February 15th, 2022

Guest Skeptic: Dr. Tim Graham is a Clinical Professor of emergency medicine at the University of Alberta, and Associate Chief Medical Information Officer, Edmonton Zone, of Alberta Health Services from Edmonton, Alberta.

Reference: Graham T. Physician heal thyself. CMAJ 2021

TRIGGER WARNING:

As a warning to those listening to the podcast or reading this blog post, there may be some things discussed that could be upsetting. The SGEM is a free open access project trying to cut the knowledge translation down to less than one year. It is intended for clinicians providing care to emergency patients, so they get the best care, based on the best evidence. Some of the material we are going to be talking about on this episode could trigger some strong emotions. If you are feeling upset by the content, then please stop listening to the podcast or reading the blog. There will be resources listed at the end of the blog for those looking for assistance.

Dr. Tim Graham

This is an SGEM Xtra episode. Tim approached me about an article he wrote and published in the Canadian Medical Association Journal (CMAJ). The title of the article was “Physician, heal thyself” and was in the humanities section of the October 2021 issue. This article resonated with many people and was the 6th most read CMAJ article of 2021.

Tim thanked his wife, Dr. Samina Ali, in the CMAJ article and on the podcast. Samina has been a guest skeptic on the SGEM. She is the one who suggested Tim share his story to reach an even wider audience.

In this SGEM Xtra episode, Tim tells his experience with burnout. This is a topic we have discussed many times on the SGEM and I have shared my personal experience with burnout.

SGEM Xtra: The Water is Wide
SGEM#289: I Want a Dog to Relieve My Stress in the Emergency Department
SGEM Xtra: CAEP Wellness Week 2019
SGEM Xtra: On the Edge of Burnout
SGEM Xtra: Don’t Give Up – The Power of Kindness
SGEM#178: Mindfulness – It’s not Better to Burnout than it is to Rust
SGEM Xtra: Five Tips to Avoid Emergency Medicine Burnout

A 2015 study by Shanafelt et al of US physicians showed that more 50% had at least one symptom of burnout. The highest prevalence of burnout was reported by emergency physicians.

COVID19 has been hard on the health care system. Medscape just published a 2021 survey of 13,000 physician from 29 specialties and emergency physicians were still #1 reporting the highest level of burnout.

People have made a distinction between burnout and moral injury. Journalist Diane Silver describes moral Injury as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.” It is something that tears us apart at the fabric of what it is to be a physician.

Tim discusses how he started getting suicidal ideations and what he did to try and address these thoughts. This included seeking professional help, medication, and lifestyle changes. Some interventions helped more than others. Tim reports he is now in the best place mentally and physically than he has been in many years.

Tim also gives some advice to prevent others from going through a similar experience. This includes a wellness tool kit that starts with a healthy diet, regular exercise and good sleep. Two things he found really helpful were meditation and yoga.

Suicidologist: Dr. Tyler Black

When preparing this SGEM Xtra episode, I suggested to Tim we get an expert in mental health to give us some more information on the topic. I’m not an expert in this area and reached out to Dr. Tyler Black. Tyler is a suicidologist, emergency psychiatrist and pharmacologist from Vancouver.

Dr. Tyler Black

Tyler provided a definition for suicidologist. He discussed burnout and the association with suicidal ideation in physicians (Menon et al JAMA 2020. Tyler gave some potential reasons why physicians do not seek mental health care (stigma, colleges/regulatory bodies, access to care, etc). He also described how we can help each other and ourselves stay mentally healthy.

Tyler was also asked what he would do if given a blank cheque to address this problem of physician burnout. He would spend the money on research and getting scribes to interact with the EMR and not buy muffins for the break room.

Tim was asked at the end of the podcast what he would tell his younger self. I challenge the SGEM audience to think about what you would say to your younger self. Here is what Tim would say:

“I would tell young me that no matter how important I think work is, I am really just another cog in the never-ending gears of the health care system. Once internalized, this knowledge was liberating, and it gave me permission to prioritize myself and my well-being. In the end, if you die tomorrow, your employer will replace you, but your loved ones cannot.”

The SGEM will be back next episode doing a structured critical appraisal of a recent publication. Trying to cut the knowledge translation window down from over ten years to less than one year using the power of social media. So, patients get the best care, based on the best evidence.