Burnout and the Self-Disclosure of Psychiatrists

May 20, 2019

Psychiatrists' knowledge about how the mind works may be the “secret ingredient” to help reduce burnout in other physicians.

We are pleased to present this Q & A with H. Steven Moffic, MD, a speaker at the American Psychiatric Association Annual Meeting in San Francisco. Dr Moffic’s presentation will cover how burnout may be changing the self-disclosing of the mental health status of psychiatrists and other physicians.

Psychiatric Times: The title of your presentation on burnout and self-disclosure seems intriguing. Why did you select this topic?

Dr Moffic: Actually, it is one of several presentations of the session chaired by Robert Marin, MD, titled “Psychiatrists’ Views on Self-Disclosure of Mental Illness: Symposium Data on When, Why, and How to Disclose?” This is the third annual session that Dr Marin and I have put together to discuss our own self-disclosure. Other presentations in this session are on clinical depression and substance abuse in psychiatrists.

It seems like a paradox that psychiatrists are so reluctant to self-disclose their mental disorders to other colleagues and the public. After all, to reduce the stigma of mental illness for our patients, we encourage them to self-disclose to others, yet we often don’t follow our own advice. Hence, our own reluctance to self-disclose may be unintentionally contributing to the persistence of the stigma of mental illness.

PT: What aspects of this topic do you plan to cover?

Dr Moffic: I’m going to cover the epidemic of burnout in psychiatrists and other physicians because it may help open the door to more self-disclosure. How is that possible? It is because burnout is not yet considered a diagnosable mental disorder, at least in the United States, although it is in a few European countries. By putting burnout somewhere between normality and mental illness, it thereby doesn’t have the stigma of full-blown mental illness. Even the statistic that about 50% of us are burning out to some extent normalizes that condition just in terms of the numbers and that the majority of us are suffering from it.

That the stigma doesn’t seem to exist toward burnout makes it easier for psychiatrists and other physicians to personalize the risk and what to do about it. For instance, I did not have a second thought about revealing my own burnout in a video for the American Psychiatric Association’s website on Well-Being Resources, as well as a previous one about 3 years ago for Psychiatric Times.

In general, when we recognize our burning out, it is easier to look for solutions to the problem. I know it did so for me, so I will present my own story about how I left an oppressive system and felt much better emotionally, almost instantly. Fortunately, Psychiatric Times is also publishing a variety of self-disclosure stories this year.

PT: How is this topic relevant to psychiatrists who consider themselves “general” clinicians?

Dr Moffic: Since about half of “general” clinicians seem to have some degree of burnout, it is certainly relevant to our own well-being to know how to recognize, share, and address it. For the other half, since we are ethically our “brothers’ (and sisters’) keepers,” we can be compassionate supporters and helpers. I am a co-editor of a new book, Combatting Physician Burnout: A Guide for Psychiatrists, due out in September from American Psychiatric Association Publishing, so I will also preview some of that in my presentation.

This challenge certainly has repercussions for patient care. New studies indicate that not only does the mental health of burning out psychiatrists worsen, but so does their quality of care for patients. Indeed, it seems that patients can recognize burnout in their psychiatrists by noticing some withdrawal and/or irritability in their “bedside manner.”

PT: Why should psychiatrists stay informed about this topic?

Dr Moffic: Since the recommendations on how to prevent and treat burnout are still evolving, it is essential to stay abreast of new findings in this epidemic. For instance, though it would seem that developing more resilience, generally considered a “good” for anybody, would help protect against burning out, the opposite may be true at times. After all, we psychiatrists and other physicians inevitably build up resilience during our challenging training experiences and ensuing failures in helping patients as much as we hope to do. Increasing resilience seems to cause us to try to just “plow through” difficult systems when we should be trying to change them for the better or leave them. Or, our own desire for perfection tends to make us blame ourselves instead of the system, whereas research indicates that perhaps 80% of the etiology of burnout is related to the system and only about 20% to our own vulnerabilities-all the while recognizing that each system is different and each of us is different psychologically.

We also hope that “normalizing” of the self-disclosure of burnout will spread to full-fledged mental disorders because, for now, revealing mental illness to colleagues can be detrimental to job security and even one’s state medical license, let alone having colleagues who might betray our trust. Once I had a colleague warn: “Enemies will stab you in the back; friends will stab you in the stomach.” I saw that come true more than once. Psychiatrist administrators and leaders need to model compassion and care for colleagues, as well as provide adverse consequences to colleagues who hurt one another. Given our high suicide rate, even our own lives may depend on it.

Finally, we psychiatrists, and our knowledge about how the mind works, may be essential to help reduce burnout in other physicians. So far, a decade or more of other specialties addressing this epidemic has resulted in only occasional success. Although we have been relatively late to recognize and join the challenge, we may be the “secret ingredient” that has been missing.

H. Steven Moffic, MD, has won numerous professional awards for his administrative, clinical, educational, journalistic, and artistic work in psychiatry. Among these awards is that of the 2016 Administrative Psychiatrist Award, intermittently given jointly by the American Psychiatric Association and the American Association of Administrative Psychiatrists. He is also an Editorial Board Member of Psychiatric Times. Ever since he retired from clinical and administrative work in July 2012, he has devoted some of his advocacy work to reducing burnout in psychiatrists and other physicians through numerous articles and presentations. He also just edited a book on another underserved topic, Islamophobia and Psychiatry (Springer), and is now editing a sequel on Anti-Semitism and Psychiatry. His other current advocacy cause is the psychiatric aspects of climate and is a co-editor of a book in progress on the topic for American Psychiatric Association Publishing.