Dr. Mamta Gautam is a physician executive coach, author and internationally renowned speaker. She is trained in CoActive Coaching from Coaches Training International and is a certified physician development coach.Dr. Gautam has a unique and deep understanding and appreciation of physicians. For twenty years, she was a psychiatrist in private practice in Ottawa and a clinical Professor in the Department of Psychiatry, University of Ottawa. She is a specialist in Physician Health and Well-being, and is hailed as “The Doctor’s Doctor.” She is the founding director of the University Of Ottawa Faculty Of Medicine Wellness Program. This program served as the template for the Canadian Medical Association Centre for Physician Health and Wellbeing, where she consults as an Expert Physician Advisor.
On February 27 Dr. Gautam will visit McGill to deliver two lectures, titled “Beyond Burnout to Resilience” from 9:35 to 10:25 a.m in the Martin Amphitheatre (room 504) at the McIntyre Medical Sciences Building and from 2:00 – 3:00 p.m in the Osler Amphitheatre (room A6.105) at the Montreal General Hospital.
Dr. Gautam sat down with us to answer four burning questions ahead of her visit.
Why is avoiding burnout and focusing on wellness such an important topic for medical students and physicians?
This is an important topic because there can be no health without physician health. The health care system relies on physicians, but does not effectively support them to be healthy and able to care for patients. Recent studies suggest that up to 50% of Canadian doctors and learners are experiencing symptoms of burnout. Burnout is an epidemic hiding in plain sight. We cannot allow this to be the new normal.
While not a psychiatric diagnosis, burnout can lead to serious problems such as physical illnesses, problems in relationships, and mental illnesses such as anxiety, depression and suicide. It also impacts our work, with associated increase in errors, reduced physician and patient satisfaction, and difficulties with recruitment and retention of physicians.
Since 1990, I have been helping the physician community by my clinical work in treating physician colleagues; raising awareness and working to reduce the stigma of mental health; designing and developing educational programs; urging colleagues to make self a priority; training and mentoring others to care for physicians; and creating programs for stress management, resiliency training, and mindfulness. The focus had been on treating individual physicians, as that was the only part that was under their control at the time. For decades, I met and lobbied with organizations to support the physicians working within. I am pleased to see that we have now reached the tipping point, at which we can stop blaming the doctors and expand our focus to system level interventions. I would strongly advocate for a model of shared responsibility where both the individual learner/physician and the health care system work together to keep physicians healthy and able to maintain the joy of medicine.
Definitely, this topic is often overlooked. Much of this is due to the stigma of mental illness and psychiatry. Nowhere is the stigma greater than within medicine. The culture of medicine promotes hardworking, perfectionistic, responsible behaviour in which we are urged to constantly put the needs of patients ahead of our own. Thus, admitting that one needs help can feel like a weakness or a failure. Doctors initially ignore symptoms and deny or hide problems. We see ourselves as Care Givers, not Care Receivers.
There is also a lack of awareness of burnout; many doctors tell me they have felt like this for so long and all of their colleagues feel the same – isn’t this normal? Then, many colleagues do not know where to go for help.
The system has long blamed the doctors for not caring for themselves. However, it is time that the system steps up to accept its share of the responsibility for these working conditions, and invest in their doctors.
I realized early on that the system in medicine was not supportive of physicians and their health.
As a pediatric resident, I was up all night one time, and admitted 12 patients. My last patient’s mother told me that I looked much sicker than her child who I had just admitted. I ended up going off sick with mycoplasma pneumonia, which turned into mycoplasma encephalitis. I suspect that my program director may have known that this would take some time for recovery, but I was asked to call in every day, during the only half hour I was awake daily, to let them know that I would not be able to come in that day.
A few years later as a psychiatry resident, I became very sick during a twin pregnancy, developing HELLP syndrome and slipping into a coma for a few days after the emergency C-section. Due to the rules about time off as a resident, I had to return to work with an open abdominal wound that had to be packed twice a day. Once I realized that I was actually going to survive, I made a commitment to advocate for physician’s health. However, I did not really know how I was going to do that.
The opportunity arose soon after when I filled in for a speaker who had to cancel at the last minute, and gave a presentation on depression to a room full of physicians. Three of them came up after to speak with me, telling me that they enjoyed my talk, that it felt as I were telling their story, and asked if I would see them as a patient. Those were my first three physician patients; thanks to word of mouth, all of my practice was focused on treating physicians within three months.
Maintaining our health is not rocket science. Here are three tips:
- Bridge the brain-heart gap. In our brain, we all know what we need to be doing, but there is a gap between that and what we give ourselves permission to do from our heart. Bridge the gap; do what we would tell our friend to do.
- None of us is immune. You can take any healthy, highly functioning person, and place them in an unhealthy environment and they too will become unhealthy. It can happen to any of us.
- Take care of yourself first. This is not a luxury or being selfish. It is truly an investment that allows us to be more available for others.
February 20, 2018