Jun 3, 2020
Candrice R. Heath, MD, and Nicole B. Washington, DO, MPH, spoke
with Psychcast host Lorenzo Norris, MD, about physician mental
Heath is affiliated with Temple University Hospital,
Philadelphia. She has no disclosures.
Washington disclosed serving as chief medical officer and
founder of Elocin Psychiatric Services, a telemedicine company that
provides care to physicians. Dr.
Norris is a consultation-liaison psychiatrist and medical
school dean affiliated with George Washington University,
Washington. He has no disclosures.
And stick around for Renee
Kohanski, MD, who talks about expectations.
- Physicians often delay seeking mental health treatment.
Compared with the general population, the risk of suicide is 2.27
times higher in female physicians and 1.4 times higher in male
- The COVID-19 pandemic has created additional risk factors for
all physicians, including those on the front lines and others whose
clinical practices and home lives have changed because of the
- Prevention and mitigation of mental illness start with
understanding your own risk factors and stressors and trying to
address them before they become overwhelming.
- During the best of times, physicians are at risk for anxiety,
depression, and substance use disorders. The syndromes of
demoralization and burnout should be seen as prodromes to clinical
diagnoses, such as major depressive disorder. An estimated 300-400
physicians die from suicide each year.
- Prevention of mental illness starts with identifying one’s
stressors, such as balancing personal and professional demands on
time; knowing one’s risk factors, such as a history of substance
use and previous episodes of distress or psychiatric diagnoses; and
thinking about the phases of disaster response. When it comes to
the COVID-19 pandemic, are you surging with adrenaline, hitting a
plateau, or experiencing a decline?
- Dr. Washington suggests that her patients focus on what they
can control in their lives, because uncertainty and loss of control
of our usual routines contribute to stress, anxiety, and fatigue.
It is also helpful to reflect on past periods of hardship and
resilience to identify strengths and previous strategies used to
- Physicians who are not on the front lines are experiencing
different forms of hardship, such as financial stress from
furloughs and loss of patient volume. There may also be guilt about
not addressing the pandemic in the same way as frontline
physicians. Even without direct patient care of COVID-19, it must
be acknowledged that the impact of the pandemic is everywhere.
- Most physicians delay seeking mental health treatment. This may
particularly occur for physicians with better “lifestyles,” such as
dermatologists, who some may view as suffering less. This pandemic
is a reminder that all physicians need to take care of themselves,
regardless of specialty.
- We are all adjusting to the “new normal,” so in times like
this, it is helpful to seek practices such as mindfulness and
“radical acceptance,” the latter of which is part of
dialectical behavior therapy.
- Accepting reality with judging and setting expectations at a
realistic level can help prevent suffering.
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