Promoting physician health in a performance-based profession

The medical resident had been working at the hospital for three days straight without sleep. His wife paged him, wondering if he would be coming home that evening. It was Christmas Eve, after all. Deeply fatigued, the resident responded with a question of his own: “Who is this?”

When you are so tired you forget you’re married, that’s a problem, suggested Dr. Jeff Blackmer, reflecting on that evening during his residency years ago. A physician on the edge of hallucinating is in no state to provide medical care to patients. Blackmer also recalls that his colleagues at the time didn’t see a problem. Extreme fatigue was part of being a doctor. Since then, the medical profession has come to recognize the importance of physician health and well-being.

“But I still don’t think we are where we need to be yet,” said Blackmer, vice-president of medical professionalism for the Canadian Medical Association (CMA), during a session at the Canadian Conference on Physician Health in Ottawa.

Medicine remains a performance-based profession, noted Blackmer. Output still trumps well-being. The adversity faced by an overworked resident is still considered by many to be character building. Doctors are still expected to be mentally tough, perhaps unreasonably so. But when a doctor’s work makes them unhealthy, it can affect everyone around them.

“Unhealthy physicians find it difficult to be professional,” said Blackmer.

The lines between physician health and professionalism and the health care system can get rather blurry at times, noted Blackmer. Challenges in medical systems and conflicts with governments put doctors under stress. Doctors under constant stress may act unprofessionally at times. Unprofessional behaviour among doctors leads to job dissatisfaction and burnout. Unhappy doctors are less likely to engage in activities to improve health care at the system level. “This is a cyclical thing, and we need to be addressing all of these aspects,” said Blackmer.

Healthier physicians provide better medical care, said Dr. Jeff Blackmer.

Image courtesy of Mark Holleron/CMA

From the physician perspective, it is vital that leaders in the profession promote a unified vision of a healthy, vibrant and engaged workforce, noted Blackmer. Leaders should aspire to be role models of behaviour that promotes physician well-being, despite the high level of demand for physician services.

“We see people in a position of authority act a certain way, and we think that’s the way we should act as well,” said Blackmer. Unfortunately, at times, some senior physicians have exhibited less-than-model behaviour. Blackmer cited the unfortunate bullying of some younger physicians in Ontario who disagreed with their senior colleagues at the Ontario Medical Association over contract negotiations with the province’s government. The fact that some physicians earn far less than others with the same education, training and responsibility has also lead to infighting.

“We don’t like to talk about this much in polite company, but it does lead to difficulty in our relationships,” said Blackmer. “This fighting over money brings out the worst in all of us, unfortunately.”

Other forms of incivility have also been difficult to eradicate, noted Blackmer. Some specialists, for example, still denigrate other specialties, considering colleagues in other areas of medicine to be less intelligent or skilled.

“I thought we were getting past that, but unfortunately, I still hear these stories,” said Blackmer.

Discord within the profession helps no one, noted Blackmer. Medicine should strive to create a culture of respect and collegiality, one that champions self-care and support. Such a culture will lead to healthier physicians, which will ultimately lead to healthier patients.

“If we can’t treat each other with kindness and civility and respect — before we get that house in order — we can’t start talking about team relationships or our relationships with the system. We’ve got to get it right between each other,” said Blackmer.

To help on this front, the CMA is developing a charter of shared values for physicians. The goal is to identify values that unite the profession. “I want everyone to be able to take that document out when things get rough, and say this is what we all agreed to; this is what we all said we would uphold.”