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Introduction Burnout, substance abuse, and mood disorders are prevalent among neurology residents. Increased recognition of concerning behaviors might encourage more access to mental health resources and reduce burnout. Methods We created an educational resource reviewing burnout, substance abuse, and mood disorders for neurology residents. This resource included an online module (control) and a role-play scenario offered only to one cohort (intervention). Online surveys assessed knowledge as well as confidence in the ability to recognize concerning behaviors. A practical assessment using a previously published “Stressed Resident” video was also conducted among resident cohorts. Results Of neurology residents, 18 participated in the activity, with nine in the control group and nine in the intervention group. In the postvideo survey, the residents who participated in a role-play activity outperformed a control cohort of their peers when identifying signs of burnout, mood disorders, and substance abuse portrayed in the video (84% vs. 72%; t test, p = .01). Residents indicated increased confidence in the ability to recognize symptoms of maladaptive stress as well as identify resources for themselves and peers. Participants demonstrated no difference in knowledge-based questions scores on pre- and postactivity assessments. Discussion Our educational resource improved resident ability to recognize signs of maladaptive stress and to identify residents that are a risk to patient safety. The activity is easy to implement and can be easily adapted outside neurology. Limited sample sizes may limit the ability to demonstrate this tool's impact on knowledge of burnout, substance abuse, and mood disorders.

Some doctors with severe congenital colour vision deficiency (CCVD) may experience difficulty in colour discrimination that can affect their decision-making. In the absence of evidence-based guidelines, learners with CCVD are arbitrarily debarred from specialising in some disciplines. This cross-sectional, anonymous, questionnaire-based study asked specialists from all over the country if doctors with CCVD should avoid specialising in their respective disciplines. Of 218 responses, 80 (36.7%) said they should avoid it, citing colour discrimination as critical. The 32 (14.7%) participants who were unsure and 106 (48.6%) who said that CCVD would not be a problem gave reasons that mirrored those in the literature: the degree of deficiency is variable; experience helps; automation, history-taking, close observation, good illumination, contrast, touch, and peer-corroboration can reduce dependency on colour. Awareness of the deficiency and finding ways to compensate for it during training may mitigate errors and safeguard patients. Instead of blocking people with CCVD from admission to some specialties, specialists should consider these findings and support learners who are aware of their deficiency and still wish to specialise in a particular discipline.

Addressing physician suicide requires understanding its association with possible risk factors such as burnout and depression.To assess the association between burnout and suicidal ideation after adjusting for depression and the association of burnout and depression with self-reported medical errors.This cross-sectional study was conducted from November 12, 2018, to February 15, 2019. Attending and postgraduate trainee physicians randomly sampled from the American Medical Association Physician Masterfile were emailed invitations to complete an online survey in waves until a convenience sample of more than 1200 practicing physicians agreed to participate.The primary outcome was the association of burnout with suicidal ideation after adjustment for depression. The secondary outcome was the association of burnout and depression with self-reported medical errors. Burnout, depression, suicidal ideation, and medical errors were measured using subscales of the Stanford Professional Fulfillment Index, Maslach Burnout Inventory-Human Services Survey for Medical Personnel, and Mini-Z burnout survey and the Patient-Reported Outcomes Measurement Information System depression Short Form. Associations were evaluated using multivariable regression models.Of the 1354 respondents, 893 (66.0%) were White, 1268 (93.6%) were non-Hispanic, 762 (56.3%) were men, 912 (67.4%) were non-primary care physicians, 934 (69.0%) were attending physicians, and 824 (60.9%) were younger than 45 years. Each SD-unit increase in burnout was associated with 85% increased odds of suicidal ideation (odds ratio [OR], 1.85; 95% CI, 1.47-2.31). After adjusting for depression, there was no longer an association (OR, 0.85; 95% CI, 0.63-1.17). In the adjusted model, each SD-unit increase in depression was associated with 202% increased odds of suicidal ideation (OR, 3.02; 95% CI, 2.30-3.95). In the adjusted model for self-reported medical errors, each SD-unit increase in burnout was associated with an increase in self-reported medical errors (OR, 1.48; 95% CI, 1.28-1.71), whereas depression was not associated with self-reported medical errors (OR, 1.01; 95% CI, 0.88-1.16).The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.

Background The UK government has prioritized reducing the harmful effects of excessive alcohol consumption on mental and physical well-being. Aims To assess self-reported alcohol consumption amongst doctors at an acute London Trust. Methods An opportunistic, anonymous, survey was conducted by Postgraduate Education Fellows over 2 weeks in December 2018. This included all grades of doctors from Foundation Year One to Consultant. The survey consisted of nine questions, modified from the alcohol use disorders identification test (AUDIT) and CAGE questionnaire. Results Of 446 doctors within our institution, 109 completed the survey (24%). Fourteen per cent of those surveyed abstained from alcohol, 21% drank monthly or less, 31% drank between two to four times per month, 25% drank two to three times per week and 9% drank greater than four times per week. In the preceding 2 years, 9% reported being unable to do what was expected of them on at least one occasion due to alcohol. Five per cent were concerned about alcohol affecting their performance. Two per cent were annoyed by criticism of their drinking, 9% felt guilty about drinking and 4% needed an eye-opener. Eighteen per cent wanted to reduce their alcohol consumption; however, 43% of the 109 doctors surveyed were uncertain where to seek help. Conclusions Twenty per cent of surveyed doctors reported consuming potentially hazardous levels of alcohol and 18% of respondents wanted to cut down. Forty-three per cent were unaware of sources of support. Our findings suggest a role for collaboration between Occupational Health departments and Postgraduate Education teams to support doctors misusing alcohol.

We are suffering a global sleep-loss epidemic. The health consequences within an individual are well characterized. But does society suffer just as much? Here, I discuss how insufficient sleep erodes our societal fabric as much as it does our biological fabric, and offer some prescriptive remedies.

Physicians suffer from most medical conditions at the same rate as their lay peers. However, physicians' self-care is often sacrificed for patient care. This third article in our series examines physician and trainee illness and impairment. Presenteeism, physician impairment, and substance use disorder (SUD) are defined. We call attention to the potential for harm of dated cultural norms, which often fuel physicians' neglect of their own health and development of ill-advised coping skills.Although any medical condition may become a functional impairment, the primary cause of physician impairment is SUD. Alcohol and prescription opioids top the list of substances used in excess by physicians. Although SUD is less prevalent in residency, we focus on the rise of marijuana and alcohol use in emergency medicine trainees. A nonpunitive model for the prevention and treatment of SUD in residency is described.Physicians are ethically and legally mandated to report any concern for impairment to either a state physician health program or a state medical board. However, recognizing physician SUD is challenging. We describe its clinical presentation, voluntary and mandated treatment tracks, provisions for protecting reporters from civil liability, prognosis for return to practice, and prevention efforts. We underscore the need to model healthy coping strategies and assist trainees in adopting them.In closing, we offer our colleagues and trainees today's to-do list for beginning the journey of reclaiming your health. We also provide resources focused on the practical support of ill and/or impaired physicians.

Background Doctors are at an increased risk of suicide compared with the general population, and there is a current lack of formal education on suicide prevention for peers and colleagues. This educational project aimed to increase suicide awareness for medical students through simulation. Methods A simulation scenario was designed centred around a junior doctor (a qualified doctor who has not yet completed specialist postgraduate training) disclosing thoughts of suicide. The scenario and debriefing were designed using learning objectives and constructive alignment theory. Senior medical students participated in the scenario, which was followed by a facilitated debriefing and the provision of a framework for discussing suicide with a colleague. Quantitative and qualitative student feedback was collected and analysed. A simulation scenario was designed centred around a junior doctor colleague found distressed at work and disclosing thoughts of suicide RESULTS: A total of 35 students participated in the simulation over six sessions. Feedback indicated that students felt this subject was important and that the learning objectives had been achieved. Discussion This simulation scenario focusing on suicide awareness for senior medical students has provided opportunity for open discussion and reflection on the topic and has increased the awareness and understanding of suicidality in colleagues. This is one step in the direction of preventing further deaths by suicide in health professionals.

BackgroundUnderperforming doctors have been the focus of sustained interest from the media, policymakers, and researchers. GPs are more likely to be the subject of a complaint than any other type of doctor in the UK, and the management of concerns in primary care needs improvement, yet more is known about how concerns are managed in secondary care.AimAlthough formal policies for NHS England’s management of concerns are clear, little is known about how these are put into practice. This study explores how concerns are identified, investigated, and managed at a regional level.Design and settingA qualitative study of the management of concerns in primary care across eight area teams.MethodThe study comprised two main strands: in-depth interviews with NHS England staff; and the analysis of case file data.ResultsThe process for raising concerns was identified as inconsistent and disparate, with potential weaknesses to address. The concerns process was flexible. A trade-off between adaptability and consistency was evident, but the correct balance of the two is difficult to establish. Performance concerns were most common, followed by behaviour. Conduct was the next most frequently raised concern, and a small number of health cases were identified. Outcomes of cases appeared to be dependent on the doctor’s engagement and response rather than necessarily the nature of a concern or the consequences of a doctor’s actions.ConclusionThe way practices handle complaints and concerns remains unexamined, even though they are a key route for patient complaints.

Physician well-being is a complex and multifactorial issue. A large number of tools have been developed in an attempt to measure the nature, severity, and impact of both burnout and well-being in a range of clinical populations. This two-article series provides a review of relevant tools and offers guidance to clinical mentors and researchers in choosing the appropriate instrument to suit their needs, whether assessing mentees or testing interventions in the research setting. Part One begins with a discussion of burnout and focuses on assessment tools to measure burnout and other negative states. Part Two of the series examines the assessment of well-being, coping skills, and other positive states.

Medical regulators have a responsibility to protect, promote, and maintain the health and safety of patients. Here, we compare and contrast the processes for addressing concerns about doctors in four countries with legal systems based on English common law: the UK, Australia, the United States, and Canada. The legal provisions underpinning each jurisdiction’s disciplinary processes depict distinctive outlooks from the different authorities as each works toward the same goal. The initial stages of the investigation process are broadly similar in all of the jurisdictions examined. Each process, however, has subtle differences with regard to its comparators. Factors include how matters of discipline are framed, the constitution of disciplinary panels, and how the perceived independence of these panels all philosophically affect the public safety remit of each regulator. This work constitutes the first comparison of international regulatory frameworks for the profession of medicine.

Background: Moral injury, which is described as the psychological distress that results from actions, or lack of them, that go against one's beliefs or values, has become front and center among issues facing the practice of emergency medicine. Although it predates the COVID-19 outbreak, the pandemic has played a significant role in the increased rate of burnout, and even suicide, among emergency physicians. Case Reports: This paper includes several clinical vignettes to highlight incidents that may occur in the emergency department (ED) when physicians experience violations of their moral codes, leading to distress and moral injury. These scenarios explore the conflicts posed between competing bioethical principles such as beneficence, nonmaleficence, end-of-life decision-making, medical futility, respect for self-determination (autonomy), resource scarcity and triage, duty to care, and physician impairment. Discussion: There are significant similarities between moral injury and post-traumatic stress disorder (PTSD), with some authors describing moral injury as a subset of PTSD. We explore these commonalities to provide coping mechanisms and mitigation strategies for those suffering from moral injury. Conclusion: Physicians experiencing moral injury may benefit from the many available evidence-based treatments for PTSD to identify and manage moral injury and to support patient care and personal well-being.

By nature, the field of physiatry is directed toward the evaluation and treatment of medical conditions that are at once impairing to physical and/or functional performance of the affected individual, and thereby potentially disabling. The traditional focus becomes one of minimizing the impairment and the disabling consequences of disease. They physiatrist armed with this perspective and clinical experience is also ideally suited to evaluate the extent of impairment and associated disability in any particular case. Therefore this chapter is intended to provide the reader with an overview of the scope and content of physician activity directed toward the rating of physical and functional impairment arising out of illness or injury, and the physician's role in the disability determination process for the various U.S. disability systems that they may encounter in a typical physiatry practice. The topics addressed include:- Basic terminology and conceptualization of disablement- The role of the International Classification of Functioning, Disability, and Health (ICF) in unifying the terminology and classification of disablement- Relating impairment to disability compensation formulas- The major U.S. disability systems compared- Description and application of physician impairment rating guides- The independent medical examination (IME): elements and reporting expectations- The role of the physician as an expert witness- Legal considerations- Ethical considerations

In internationalen Studien weisen Ärzte, insbesondere Psychiater und Psychotherapeuten, eine hohe Prävalenz für Burnout, Depressivität und berufliche Gratifikationskrisen auf. Die empirische Datenlage in Deutschland ist hierzu bislang dünn. Ziel der Studie ist es Burnout, Depressivität und berufliche Gratifikationskrisen bei Psychiatern und Psychotherapeuten in Zusammenhang mit Arbeits- und Lebensumständen zu erfassen und mit Ergebnissen der Fragebogenerhebung unter Psychiatern und Psychotherapeuten 10 Jahre zuvor sowie unter Intensivmedizinern 2016 zu vergleichen. Methoden: Mittels Fragebogenerhebungen auf Kongressen wurden unter Psychiatern und Psychotherapeuten 2006 und 2016 sowie unter Intensivmedizinern 2016 soziodemografische-, berufs- und gesundheitsbezogene Daten erfasst. Zusätzlich wurden standardisierte psychologische Tests zur Erfassung von Gratifikationskrisen (ERI), Depressivität (BDI, BDI-II) und Burnout (MBI) verwendet. Ergebnisse: Es nahmen 2006 N = 1239 und 2016 N = 1088 Psychiater und Psychotherapeuten sowie 2016 N = 686 Intensivmediziner an der Befragung teil. Die Psychiater und Psychotherapeuten 2016 wiesen eine Prävalenz für Burnout von 4,9% (n = 51), für Depressivität von 12,3% (n = 125) und für Effort-Reward-Imbalance von 7,4% (n = 75) auf. Es zeigten sich Zusammenhänge mit dem Geschlecht und der Familiensituation sowie mit der Arbeitszeit, dem Tätigkeitsbereich, der Berufserfahrung und der Teilnahme an Supervision. Im Vergleich zu 2006 verbesserten sich 2016 die Gesamtwerte im ERI, MBI und BDI bzw. BDI-II signifikant. Intensivmediziner wiesen signifikant höhere Werte im ERI, MBI und BDI-II als die Psychiater und Psychotherapeuten auf. Diskussion: Die Ergebnisse geben Anhaltspunkte für Zusammenhänge psychischer Belastungen und Arbeitsbedingungen der Psychiater und Psychotherapeuten. Die Erkenntnisse liefern Ansätze für individuelle und institutionelle Verhältnisprävention.

State-based medical license applications often ask about mental health diagnoses and treatment in terms that stigmatize mental illness, which inadvertently discourages physicians from seeking care....

The prevalence rate of addiction among physicians is similar to the general population, with approximately 10% to 12% of U.S.-based physicians developing substance use disorders (SUDs) during their lifetimes. To address this public health concern, physician health programs (PHPs) have been created to facilitate the early identification, evaluation, treatment, and monitoring of physicians. Although a number of published studies provide outcome information from PHPs, there has been no comprehensive review of the related literature. The objective of this narrative review is to summarize the treatment outcomes, including treatment types, rates of relapse, rates of contract completion or extension, as well as licensure and work status rates of a nationally representative physician cohort and related subpopulations from a single dataset. Based on the studies included in this review, our findings reveal that physicians who completed their PHP contracts have more favorable treatment outcomes than members of the general population who receive mainstream treatment. In addition, our review describes unique features of physician rehabilitation facilitated by PHPs. However, further prospective research is needed to ensure a standardized and comparable dataset and facilitate performance improvement.

Importance Population-based findings on physician suicide are of great relevance because this is an important and understudied topic. Objective To evaluate male and female physician suicide risks compared with the general population from 1980 to date and test whether there is a reduction of SMR in cohorts after 1980 compared with before 1980 via a meta-analysis, modeling studies, and a systematic review emphasizing physician suicide risk factors. Data Sources This study uses studies retrieved from PubMed, Scielo, PsycINFO, and Lilacs for human studies published by October 3, 2019, using the search term “(((suicide) OR (self-harm) OR (suicidality)) AND ((physicians) OR (doctors))).” Databases were also searched from countries listed in articles selected for review. Data were also extracted from an existing article by other authors to facilitate comparisons of the pre-1980 suicide rate with the post-1980 changes. Study Selection Original articles assessing male and/or female physician suicide were included; for the meta-analysis, only cohorts from 1980 to the present were included. Data Extraction and Synthesis The preregistered systematic review and meta-analysis followed Cochrane, PRISMA, and MOOSE guidelines. Data were extracted into standardized tables per a prespecified structured checklist, and quality scores were added. Heterogeneity was tested viaQtest,I2, andτ2. For pooled effect estimates, we used random-effects models. The Begg and Egger tests, sensitivity analyses, and meta-regression were performed. Proportional mortality ratios were presented when SMR data could not be extracted. Main Outcomes and Measures Suicide SMRs for male and female physicians from 1980 to the present and changes over time (before and after 1980). Results Of 7877 search results, 32 articles were included in the systematic review and 9 articles and data sets in the meta-analysis. Meta-analysis showed a significantly higher suicide SMR in female physicians compared with women in general (1.46 [95% CI, 1.02-1.91]) and a significantly lower suicide SMR in male physicians compared with men in general (0.67 [95% CI, 0.55-0.79]). Male and female physician SMRs significantly decreased after 1980 vs before 1980 (male physicians: SMR, −0.84 [95% CI, −1.26 to −0.42];P Conclusions and Relevance In this study, suicide SMR was found to be high in female physicians and low in male physicians since 1980 but also to have decreased over time in both groups. Physician suicides are multifactorial, and further research into these factors is critical.

Benzodiazepines (BZD) are some of the most common medications in the world. Benzodiazepines useful in treating anxiety, insomnia, agitation, seizures, muscle spasms, alcohol withdrawal. Benzodiazepines are generally considered safe and well tolerated but are commonly misused and taken in combination with other drugs of abuse. The usage and prescription of BDZ in most developed countries are tightly regulated. This is however, not true in developing countries where these medicines are available over-the-counter (OTC). This study was carried out to assess the benzodiazepine use in Ayub Teaching Hospital Trainee doctors.This was a cross sectional study carried out in Ayub Teaching Hospital between January and December 2018. Sample size was calculated to be 276 using WHO sample size calculator. These 276 residents and house officers were selected using stratified random sampling to ensure the representation from every year of residency.Hundred and nine (48.7%) participants responded positively to the use of BZD. Male doctors were more likely 57 (52.3%) to use BZD as compared to their female colleges. Most of the doctors 71 (65.1%) purchased BZD over the counter without prescription. Alprazolam was the most preferred benzodiazepine by doctors regardless of their specialty and year of residency except in specialty of Anaesthesia in which prevalence of Midazolam was the highest. This preference of Alprazolam by doctors of all specialty was statistically significant (p=0.007).Because of the knowledge about medicines and tendency to self-treat, doctors are prone to BZD abuse. Doctors working in psychiatry are more likely to use BZD with Alprazolam the BZD of choice.

Objectives Determine whether words contained in unsolicited patient complaints differentiate physicians with and without neurocognitive disorders (NCD). Methods We conducted a nested case-control study using data from 144 healthcare organizations that participate in the Patient Advocacy Reporting System (PARS ® ) program. Cases (physicians with probable or possible NCD) and two comparison groups of 60 physicians each (matched for age/sex and site/number of unsolicited patient complaints) were identified from 33,814 physicians practicing at study sites. We compared the frequency of words in patient complaints related to an NCD diagnostic domain between cases and our two comparison groups. Results Individual words were all statistically more likely to appear in patient complaints for cases (73% of cases had at least one such word) compared to age/sex matched (8%, p 2 = 30.21, d.f. = 1) and site/complaint matched comparisons (18%, p 2 = 17.51, d.f. = 1). Cases were significantly more likely to have at least one complaint with any word describing NCD than the two comparison groups combined (conditional logistic model adjusted odds ratio 20.0 (95% confidence interval 4.9-81.7)). Conclusions Analysis of words in unsolicited patient complaints found that descriptions of interactions with physicians with NCD were significantly more likely to include words from one of the diagnostic domains for NCD than were two different comparison groups. Further research is needed to understand whether patients might provide information for healthcare organizations interested in identifying professionals with evidence of cognitive impairment.

This position paper has been substantially revised in collaboration with the Canadian Psychiatric Association’s Professional Standards and Practice Committee and approved for republication by the CPA’s Board of Directors on April 8, 2019. The original position paper,(1) now an historical document, was first approved by the Board of Directors on October 4, 1996.