The Journal of the Arkansas Medical Society Med Journal Feb 2019 Final 2 | Page 7

out my practice,” he said. “The only work-related
stress in my life at that time was related to quan-
tity. You could never do ‘enough,’ so you just kept
doing more and more and more. I do think that
[pace] contributed to other stressors that I was al-
lowing to build up. My mental, physical, and emo-
tional health ended up on the backburner to deal
with other people’s health – a problem common to
doctors. When I finally hit the breaking point, they
were done with me. How does one go about telling
people they have issues or need help when they
fear exactly what I ended up with?”
“There are several drivers, if you will, that
lead to depression, which may lead to suicide,”
explained Dr. Messias, associate dean for faculty
affairs at the UAMS College of Medicine. “Accord-
ing to research done at the Mayo clinic, drivers for
physician distress include our heavy workload
and increasing job demands. Of course, chang-
es to the health care system have increased ac-
cess, which has increased workload. It becomes a
vicious cycle. Another driver is a lack of work-life
balance. Physicians, by nature, are hard-working
and demanding of themselves, but at some point
we need some boundaries around clinical time
and patient demands, so that we can have our
own lives, too.”
Dr. Messias included depression as a final
trigger to suicide, along with his own addition to
the list, alcohol and substance abuse. “It’s a
well-known fact that most people who commit
suicide are intoxicated at the time, so alcohol and
other drugs are a major factor in pushing people
not only to suicide, but to act on those impulses.
Other triggers include broken relationships
(with a spouse, teenagers, etc.) and access to
lethal means.
Seeing these warning signs in oneself or oth-
ers isn’t always easy. “We hear that the last per-
son to admit they have a problem is the person
with the problem,” said Dr. Birk, who, like many
other male surgeons who attempt suicide, did his
best to shoulder the burdens and was never cat-
egorized as clinically depressed. “I’m generally a
pretty pleasant guy, but looking back, there were
some warning signs. I was beginning to feel not
satisfied at work. It was becoming a drudgery,
These are hard statements that point to the
importance of recognizing and responding to the
signs of impending disaster. To find out just what
to watch and listen for in ourselves or our col-
leagues, The Journal spoke to a psychiatric expert
here in Arkansas, Erick Messias, MD, MPH, PhD.
where you can’t make anybody happy, so then
you’re not happy.”
Lightening the Load, Lessening the Stigma
Would lightening his professional load earlier
on in his struggles have been enough to keep him
from a suicide attempt? “It’s hard to say,” said Dr.
Birk. “I will say that at no time did my employer
come to me and encourage me to take a break.”
Mercy Health System, based in Missouri, has
developed an organizational-wide approach to
physician wellness that focuses on easing the load
physicians bear, among other benefits. To encour-
age professional wellness, the program (called
Rapha, translated “healer”), affords physicians
wellness retreats, workshops, education, and
other benefits. A January 2017 article in Catholic
Health Associations of the United States quoted
Mercy’s vice president of Mission for Mercy Clinic,
Michael Doyle, who described the intent. “[The
goal is to create an] environment for physicians
that offers support, intervention, and meaning in
the health profession.”
Here in Arkansas, Dr. Messias and others at
UAMS are heavily involved in increasing efforts
to support physicians’ mental health and wellbe-
ing. “It’s clear that the stigma has decreased over
the last few years,” said Dr. Messias. “Due to the
confidentiality of the process, I don’t have specific
numbers to back it up. It’s more important that
we make sure people feel comfortable that their
seeking support will not become public.”
Anonymity is key to preventive efforts, ac-
cording to Dr. Messias. The UAMS Faculty Well-
ness Program respects privacy while encouraging
a balanced lifestyle (emotional, intellectual, physi-
cal, social, occupational, environmental, financial,
spiritual health and wellness). It is directed by
Molly M. Gathright, MD, associate professor of
Psychiatry and assistant dean for Graduate Medi-
cal Education. Through this and similar programs
geared to students and residents, physicians and
other staff members are offered a free, confiden-
tial consultation with Dr. Gathright or, in the case
of residents, Puru Thapa, MD.
The University’s wellness programs are pat-
terned on research by The Mayo Clinic** and focus
on promoting positive engagement and reducing
burnout by 1) acknowledging and assessing prob-
lems, 2) implementing interventions and cultivat-
ing community, 3) providing resources that pro-
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