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      In his comments on my article,
      • Hoffer EP
      America's health care system is broken: what went wrong and how we can fix it. Part 3: hospitals and doctors.
      Guan Yang Kang, MD, tells us that Chinese physicians are overworked and attributes an outbreak of sudden deaths among young and middle-aged members of the profession to the stress of long hours and inadequate time off. Dr Kang's comments provide a good opportunity to segue into a discussion of the effects of stress on American physicians. Each year, over 400 physicians in this country take their own lives. Although, among the general population, low-skilled workers have the highest rates of suicide (often attributed to alcohol and drug use),
      • Windsor-Shellard B
      • Gunnell D
      Occupation-specific suicide risk in England 2011-2015 [e-pub ahead of print].
      the rate of suicide by physicians is higher than that of other professionals. Compared with the general population, the rate of suicide is 1.4 times higher among physicians who are men and 2.7 times higher among physicians who are women.
      • Schernhammer ES
      • Colditz GA
      Suicide rates among physicians: a quantitative and gender assessment (meta-analysis).
      Why is this the case? Burnout has been increasingly recognized as a problem for physicians compared with other professionals.
      • Shanafelt TD
      • West CP
      • Sinsky C
      • et al.
      Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017.
      There are many contributing factors. Long work hours and substantial educational debt add to stress. The poor design of most electronic medical records adds long, unrewarding hours of clerical work to the physician's already heavy workload. Physicians lose professional autonomy as a result of endless requirements to fulfill seemingly pointless mandates of insurers and regulators and having to spend considerable time seeking authorization for tests and treatments. The culture of medicine is too often one of “no mistakes allowed,” and this leads to isolation and self-blame after errors or poor outcomes. The reluctance of many, if not most, physicians to seek help for burnout and other emotional ills puts them at risk for abusing substances, dropping out of the profession, and committing suicide. The culture of medicine must change to allow for acceptance that physicians, too, have need for emotional support and to foster help instead of isolation. Seeking help to deal with burnout and depression should be seen as a sign of strength rather than weakness.

      References

        • Hoffer EP
        America's health care system is broken: what went wrong and how we can fix it. Part 3: hospitals and doctors.
        Am J Med. 2019; 32: 907-911
        • Windsor-Shellard B
        • Gunnell D
        Occupation-specific suicide risk in England 2011-2015 [e-pub ahead of print].
        Br J Psychiatry. 2019; (Accessed Nov 15, 2019): 1-6https://doi.org/10.1192/bjp.2019.69
        • Schernhammer ES
        • Colditz GA
        Suicide rates among physicians: a quantitative and gender assessment (meta-analysis).
        Am J Psychiatry. 2004; 161: 2295-2302
        • Shanafelt TD
        • West CP
        • Sinsky C
        • et al.
        Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017.
        Mayo Clin Proc. 2019; 94: 1681-1694

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