Managing fatigue, relationships and digital technology

PFSP Perspectives

April 24, 2017

Contributed by: Vincent M. Hanlon, MD | Assessment Physician, PFSP

Late in 2016, the last physician with burnout was identified and treated – about 30 years after the term “physician health” was coined. It looked at first like a career change might be necessary, but the doctor responded well to a novel combination of drugs, talk therapy and Alberta Health Services workplace modifications. That doctor is, for the most part, happily back at work. The medical profession breathed a sigh of relief, and now the spotlight has shifted away from physician health back to sick patients.

On a more serious note, sincere thanks to all the family doctors and psychiatrists who continue to collaborate with the Physicians for Physicians (P4P) initiative of the Physician and Family Support Program (PFSP). These are our colleagues who take on physicians as patients or make themselves available for timely consultations. PFSP is grateful to all physicians who care for our colleagues, residents and medical students.

PFSP 2016 stats

Another year goes by. In 2016, 1,574 individuals received services through the PFSP, up 8% from the 1,445 served in 2015. During 2016, 735 physicians, 199 residents and 110 medical students phoned the PFSP helpline. The most common reasons for calling are relationship/family issues and mental health problems – primarily stress, anxiety and depression.

Provincial physician health programs like PFSP began to appear a generation ago. When I began working with PFSP in 2005, about 500 individuals per year accessed program services. We are witnessing among physicians a gradual increase in awareness and acceptance of our own health issues; in particular, more physicians are looking for help with their relationship difficulties and mental health issues.

My anecdotal experience

My past experience talking to physicians about their health bears witness to these changes. In 2008, I presented “Spirituality for surgeons” in seven minutes. Six years later I spoke about “Mindfulness for emergency physicians.” That was for 10 minutes, including Q & A. In 2017, I will address “Physician mental health for family doctors” in 30 minutes. I may not have enough slides to fill the time.

Research into physician health, including meticulous literature reviews such as “Physician Wellness: A Missing Quality Indicator” (Lancet, 2009) by the University of Calgary’s Drs. William Ghali, Jane Lemaire and Jean Wallace, have helped to stimulate interest, action, teaching and learning about physician health. Thanks to increasingly robust physician health literature, doctors in 2017 have a more clear understanding of the complex interconnectedness of their physical, mental and occupational health issues.

A number of problems remain part of the physician health landscape. I’ll mention just three that won’t disappear anytime soon:

  • Fatigue and insufficient sleep
  • Fraught and fractured relationships
  • Ambivalent relationship with digital technology

All three issues are implicated in good patient care, physician well-being, quality training and work environments. And all three, to some degree, are inter-related.

Fatigue

Getting sufficient quality sleep is a problem for many physicians over the course of their training and the span of their careers. Wakefulness during night work, recovery from off-hours work and the sleep disruptions of night call are challenges for residents, as well as mid-career and older physicians.

As a profession and as individuals, we continue the uneasy business of reconciling physician well-being and preparedness with long hours of work, ubiquitous fatigue, sleep disruption and good patient outcomes across diverse work scenarios and training programs. There is no holy grail of sleep and fatigue management. That is one of the conclusions in the report Fatigue, Risk and Excellence: Towards a Pan-Canadian Consensus on Resident Duty Hours (Ahmed, N et al. 2013).

Naps, micro-breaks within the working day, getting additional rest before anticipated night work, and a cool, dark and quiet (both aural and digital silence) sleep environment are all pillars of fatigue management.

Fraught relationships

Canadian psychiatrist Dr. Michael Myers, in the Handbook of Physician Health (American Medical Association, 2000) describes common (and still current) issues in the dysfunctional marital relationships of physicians:

  • Overwork as the cause and the result of relationship strains
  • Trouble communicating
  • Extra-relationship affairs
  • Alcohol
  • Mood and anxiety disorders

In my work as an assessment physician on the helpline, I frequently hear from physicians about their difficulties communicating with a spouse/partner. Another recurrent theme is difficulty parenting children – either their own or the children of their blended families. Providing care for and communicating with elderly parents also strains some relationships.

Former PFSP assessment physician and education consultant Dr. Sara Taylor recently published an e-book on the albertadoctors.org website: The Well-Being of Medical Relationships: Striking a Balance with Your Spouse, Colleagues & Self. In this brief and practical book, Dr. Taylor references the work of psychologist Dr. John Gottman and offers some practical tips to strengthen your marriage.

  • Develop rituals of connection (for example, making and eating food together).
  • Pay attention to daily partings and reunions with your spouse.
  • Schedule together time for you and your spouse.
  • Express gratitude to your spouse.
  • If you have children, discuss shared parenting goals.

Most of us are familiar with these strategies. Consistently attending to them in our intimate relationships is the hard part.

Digital disconnections

As skilled as we might like to think we are at multitasking and making timely virtual connections, Sherry Turkle, author of Reclaiming Conversation – The Power of Talk in a Digital Age, reminds us that our digital devices sometimes promise more than they deliver. Digital communication can compromise the quality of personal interactions and steal time from our flesh-and-blood encounters.

Some days, I feel overwhelmed. All those unread emails. A hundred new tweets to chase down. My scintillating social media presence to maintain. At the end of the day, I’m often left with little time and less desire for face-to-face conversations.

Here are some suggestions for you and your spouse/partner to consider:

  • Anticipate an upcoming conversation with your spouse or partner. Can you each identify a couple of ways in which digital technology has improved your relationship, or reduced your fatigue?
  • Are either of you aware of any detrimental effects this technology has on your sleep or your relationship? Any tips you would offer to other couples?

The moving challenges of digital technology at home and in the workplace will continue for the foreseeable future – even after Moses eventually comes down the mountain with the perfect electronic medical record.

The Alberta Medical Association stands as an advocate for its physician members, providing leadership & support for their role in the provision of quality health care.