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Physicians in the 21st Century: Between Identification With Medicine as a Calling and Self-Diagnosing Burnout, Depression, and Anxiety

      To the Editor:
      The father of medicine, William Osler said: “The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions or powders, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish.”
      Jager et al's
      • Jager A.J.
      • Tutty M.A.
      • Kao A.C.
      Association between physician burnout and identification with medicine as a calling.
      article, published in the March 2017 issue of Mayo Clinic Proceedings, raised an important association between physician burnout and identification with medicine as a calling. The authors randomly selected and surveyed 2263 physicians from all specialties between 2014 and 2015, using the American Medical Association Physician Masterfile. About one-third of the respondents experienced burnout symptoms. Those who reported burnout symptoms were less likely to be engaged in their profession, find satisfaction, or recognize the importance of their work.
      • Jager A.J.
      • Tutty M.A.
      • Kao A.C.
      Association between physician burnout and identification with medicine as a calling.
      An absent sense of calling in medicine correlates with burnout and other psychopathological illnesses. The relationship between burnout and symptoms of depression has been studied, and their theoretical similarity in the work setting has been supported.
      • Ahola K.
      • Hakanen J.
      • Perhoniemi R.
      • Mutanen P.
      Relationship between burnout and depressive symptoms: a study using the person-centered approach.
      • West C.P.
      • Shanafelt T.D.
      • Kolars J.C.
      Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents.
      Previous studies found that burnout, emotional exhaustion, and depersonalization are more common among physicians than among the general US population.
      • Shanafelt T.D.
      • Boone S.
      • Tan L.
      • et al.
      Burnout and satisfaction with work-life balance among US physicians relative to the general US population.
      We surveyed medical trainees (students, residents, and fellows) at a medical university between 2013 and 2014 and incorporated screening tools for major depression disorder (MDD) and generalized anxiety disorder (GAD).
      • Mousa O.Y.
      • Dhamoon M.S.
      • Lander S.
      • Dhamoon A.S.
      The MD blues: under-recognized depression and anxiety in medical trainees.
      A total of 462 responded to the survey, and we compared the results to age-matched controls from the National Health and Nutrition Examination Survey database. The prevalence of a positive screen for MDD and GAD was more than 5- and 8-fold higher in medical trainees, respectively.
      Even though Jager et al
      • Jager A.J.
      • Tutty M.A.
      • Kao A.C.
      Association between physician burnout and identification with medicine as a calling.
      excluded medical residents from their study, we reported both critical psychopathological issues in current and future health care professionals.
      • Mousa O.Y.
      • Dhamoon M.S.
      • Lander S.
      • Dhamoon A.S.
      The MD blues: under-recognized depression and anxiety in medical trainees.
      In addition, both populations work and train under similar medical environments and challenges. As a result, we propose that medical trainees who experience depression and anxiety are likely to experience burnout and are less likely to identify with medicine as a calling. Both physicians and medical trainees may not self-recognize such symptoms and potential illnesses, or may not seek help because of concern for stigma. Interventions are needed at all institutional levels to keep physicians in all specialties, the young vulnerable trainees, and their patients away from the adverse mental health consequences of the medical profession. Lacking the sense of calling can be a critical marker of mental health illnesses.
      In this era of fast-moving science and everyday challenges, it is important for every physician and trainee to remember Dr Charlie Mayo's words: “Medicine is a profession for social service and it developed organization in response to social need. Medicine gives only to those who give, but her reward for those who serve is finer than much fine gold.”

      References

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        (Accessed May 18, 2017)
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        Association between physician burnout and identification with medicine as a calling.
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        • Perhoniemi R.
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        Relationship between burnout and depressive symptoms: a study using the person-centered approach.
        Burnout Res. 2014; 1: 29-37
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        Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents.
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        • Shanafelt T.D.
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        • Tan L.
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        Burnout and satisfaction with work-life balance among US physicians relative to the general US population.
        Arch Intern Med. 2012; 172: 1377-1385
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        • Dhamoon M.S.
        • Lander S.
        • Dhamoon A.S.
        The MD blues: under-recognized depression and anxiety in medical trainees.
        PLoS One. 2016; 11: e0156554
        • Mayo Clinic
        Sharing Mayo Clinic.
        (Accessed May 18, 2017)

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