The diagram, a schematic based on an important paper on the significance of physician wellness published in The Lancet, illustrates the empirically validated relationships between contributors (on the left) to negative physician outcomes (near the center) as well as the effects of them on our health care system (on the right). Our wellness matters, not only to ourselves and our families. We know from experience as well as research that 80% of physician burnout (“I’m tired, I feel ineffective, and I don’t care anymore”) can be attributed to system factors, some of which we can’t directly change. Peer support, however, can buffer us from burnout and promote a more just and supportive culture within which we can more easily flourish.
To flourish requires experiencing not only positive feelings of satisfaction in providing good care, of reward from interactions with patients and of contributions to positive patient health outcomes; we must also acknowledge and work through the distress or even secondary trauma we experience when patients have adverse events, when we make errors resulting in patient harm, or when our patients don’t get better, or they die.
How often do we reflect on how we are impacted by these events or by the cumulative effects of difficult situations in our daily work caring for patients with treatment-resistant or chronic illness or by having to make choices in the face of legitimate competing priorities or values? The fact that these experiences come with the job can lead us to dismiss their psychological impact, perhaps until anxiety, burnout or depression demand our attention. It is the emotional demands of our work that have the strongest negative relationship with physicians’ well-being, not the number of hours spent working, or the conflict between work and family life, or even work overload (though the latter was also found to negatively influence well-being). Yet we are ill-prepared by our training and the culture we practice in to deal with the emotional impact.
While PFSP is the most utilized physician health program in the country, only 15% of Canadian physicians reported accessing a physician health program in the five years preceding the Canadian Medical Association’s National Physician Health Survey published in 2018. Physicians perceive barriers to seeking support such as believing that the situation isn’t serious enough, shame/fear of being stigmatized, lack of time, concern about confidentiality, and uncertainty about how to access support.
Acknowledging these barriers, one of the most important findings from research is that physicians prefer to seek support for stressful situations from physician colleagues. Guided by these findings, the first formal one-on-one physician peer support program was launched in 2006 at Brigham and Women’s Hospital (BWH) in Boston under the leadership of Dr. Jo Shapiro.