Occupational stress: Doctors may suffer when unable to save lives
Posted on Thursday, November 29th, 2012 at 1:03 pm by Life Matters Media
Physicians who treat the terminally ill may suffer from emotional stress when unable to save patients’ lives. Burnout and compassion fatigue are two serious forms of occupational stress physicians may suffer, according to research by Michael Kearney, M.D.
Kearney, a palliative care physician at Santa Barbara Cottage Hospital in California, describes burnout as “the end stage of stresses between the individual and the work environment.” Compassion fatigue is “secondary post-traumatic stress disorder, or vicarious traumatization — trauma suffered when someone close to you is suffering.”
Health care journalist Jane Brody addresses the stress and anxiety oncologists struggle with in a new article for The New York Times. Brody writes, “A doctor with compassion fatigue may avoid thoughts and feelings associated with a patient’s misery, become irritable and easily angered, and face physical and emotional distress when reminded of work with the dying.” Compassion fatigue may lead to burnout.
Up to 60 percent of practicing physicians report symptoms of burnout.
According to Brody: “Patients and families may not realize it, but doctors who care for people with incurable illness, and especially the terminally ill, often suffer with their patients. Unable to cope with their own feelings of frustration, failure and helplessness, doctors may react with anger, abruptness and avoidance.”
Physician suicide linked to occupational stress
According to Crystal Phend, senior staff writer for MedPage Today, ”Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems.”
Phend cites a study by Katherine J. Gold, M.D., of the University of Michigan in Ann Arbor, who found that problems with work were three times more likely to have contributed to a physician’s suicide than a nonphysician’s. Mental illness was also 34 percent more common before a suicide among physicians.
Up to 60 percent of practicing physicians report symptoms of burnout
“The results of this study paint a picture of the typical physician suicide victim that is substantially different from that of the nonphysician suicide victim in several important ways,” Gold wrote for General Hospital Psychiatry. ”Inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians.”
Although physicians have more access to health care, they may be reluctant to seek help. ”I think stigma about mental health is a huge part of the story. There is a belief that physicians should be able to avoid depression or just ‘get over it’ by themselves,” Gold wrote.
More than 200 of the 31,636 suicide victims reported in the National Violent Death Reporting System from 2003 to 2008 were physicians.
Meditation may help physicians
A 2008 study published by the Journal of Palliative Medicine, in which researchers studied 18 oncologists, found that physicians who viewed their work with patients as both biomedical and psychosocial found end of life more satisfying than those with a more biomedical perspective.
“Physicians, who viewed their physician role as encompassing both biomedical and psychosocial aspects of care, reported a clear method of communication about end of life care, and an ability to positively influence patient and family coping with and acceptance of the dying process,” the researchers concluded.
“In contrast, participants who described primarily a biomedical role reported a more distant relationship with the patient, a sense of failure at not being able to alter the course of the disease, and an absence of collegial support.”
Kearney recommends “mindfulness meditation,” a Buddhist-influenced practice for physicians suffering from stress. “The doctor is able to recognize he’s being stressed, and it prevents him from invoking the survival defense mechanisms of fight (‘Let’s do another course of chemotherapy’), flight (‘There’s nothing more I can do for you — I’ll go get the chaplain’) and freeze (the doctor goes blank and does nothing).” He claims that even 8-10 minutes a day of “mindfulness meditation” can help.
Learn more from the Life Matters Media Newswire:
Religious struggle with faith and fact
Posted on Friday, August 24th, 2012 at 6:08 pm by Life Matters Media
Many of deep religious faith face an internal conflict when the dying process begins to overtake loved ones. The Rev. Tarris Rosell, the Rosemary Flanigan Chair, professor at Central Baptist Theological Seminary and of the Center for Practical Bioethics, has addressed this dilemma in a blog post for ABC News.
Faith and reason seem incompatible to many religious, writes Rosell, because allowing hospice care or assisted death seems both faithless and cruel. While doctors often spout grim facts, the many religious continue to cling to hope.
Rosell recounts a disturbing story he read about a father who refused to let his daughter enter a hospice. The father believed his religion commanded him to save her.
Rosell writes: “I read this and wondered what sort of religion that man followed, ascribed to, and how badly he had misconstrued its actual teachings. I’m guessing that Dad and daughter had not talked this over, nor consulted faith leaders, in advance of her illness and dying. Too bad.”
Compassion is a constant in all religions, writes Rosell. “None of the world’s major religions insist on futile medical treatments or require adherents to demand of doctors what will not benefit patients. Religions differ on many matters of fact and faith; but most all of them teach compassion, the virtue of comforting the afflicted, and accepting the inevitability of physical death.” He believes the faithful actually act faithfully when compassion is the highest goal.
He offers some practical suggestions:
2. Give a copy of your advance directives to your faith leader(s), with a request to discuss them together sometime — and then make an appointment to do so.
3. Become familiar with the scriptures and teachings of your faith tradition, particularly as they address dying and death. Initiate a small group study of these issues with other persons in your community of faith.
4. Initiate an adult religious education event at which a local expert on these matters (e.g., a clinical ethicist, a palliative care or hospice provider, a healthcare attorney, a hospital social worker or chaplain) is invited to speak. Have advance directive forms available for distribution and use, along with a notary public.
5. Ask your faith leader about the possibility of observing a day of worship focused on advance care planning and compassionate care of the dying. Introduce her or him to “Compassion Sabbath” (www.practicalbioethics.org) or other available resources for such an observance.
6. Volunteer to lead an interfaith initiative on advance care planning with other congregations in your community. Introduce this concept and resources to the regional interfaith coalition. Ask that they consider launching a community-wide effort to increase advance care planning to improve quality of care for the dying.
Learn more about hospice care at the Life Matters Media Newswire.
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