Thank you, members of the committee, for the invitation to speak today.
“I started watching the clock during the day and thinking more about how many more patients there are and how much time is left in the day. I knew I'd get through it, but I didn't know how I'd feel at the end of the day. Then it just started getting earlier and earlier, and one day, five minutes into the meeting, I was thinking, “Oh boy, it feels like I've been here for a while. I have a long day to go.””
These are comments that a physician colleague recently made to me. When we speak about the recruitment and retention of health care workers, we need to think about several things, and they include the psychological needs of our workers.
My name is Dr. David Gratzer. I'm a medical doctor and attending psychiatrist. I'd like to speak for a few moments this afternoon about burnout and about mental disorders. By way of background, I work at CAMH here in Toronto where I serve in clinical, administrative and educational roles. That said, the views I express today are not necessarily those of the hospital.
Let me take a few moments to talk about burnout, and I'll confess my bias. My roles involve physicians, so I see things through the prism of physician burnout and physician needs, but I think they're applicable across all health care domains.
As you know, physician burnout is a syndrome that is characterized by three things: emotional exhaustion, depersonalization and a reduced sense of personal accomplishment. To be a little bit more specific, emotional exhaustion is feeling used up at the end of the day, that there is nothing more to be offered to patients. Depersonalization is when clinicians no longer view patients as being people but more like objects, and a reduced sense of personal accomplishment, well, that one is clear, but I would add that it is often combined with feelings of ineffectiveness despite years of training and goodwill.
Though burnout has been problematic for years, as you know, everything with regard to physician issues has grown worse with the pandemic. The Canadian Medical Association's national physician health survey, which polls thousands of physicians from sea to sea to sea, suggested that about one in three physicians had been experiencing burnout. That was before the pandemic. As you know, since the pandemic has begun, those numbers have jumped up. The most recent survey suggests that about one in every two physicians, half of our physician workforce, is experiencing some element of burnout. Similar surveys for nursing, occupational therapy and other disciplines of health care have shown something similar. In other words, a bad situation, perhaps not surprisingly, has grown worse.
Let me pivot and talk about the pandemic and mental health disorders. As you know, there's been much attention in recent months to survey results showing that people are more anxious and that their mood is lower. As a psychiatrist, I find this interesting but not necessarily worrisome for most people. Again, I chose my words carefully. Most people have resilience and, as a result, while the pandemic might be stressful, while they might be worried about making rent or about their employment prospects, they will walk away from this relatively emotionally and psychologically unscathed.
But there are groups at risk. I can think of three. First are people who have had a history of mental health problems. Second are those with direct exposure to the virus and illness and third are those who have survived the illness. Many of our health care workers—too many of these health care workers—fall into all three categories and are thus at risk for or experiencing major depressive disorder, post-traumatic stress disorder and anxiety disorders.
The literature suggests that, long after the physical manifestations of SARS ended, there were the psychological manifestations. I think we're going to see something similar with COVID-19. The point is that our problems with COVID-19 will continue after the last patient is discharged from an ICU.
In my closing few seconds, I wish to sound a note of hope. I would suggest that there are thoughtful and practical things that can be done and that are being done. Regarding burnout, a rich literature has developed over the last decade or two, suggesting steps that can be taken.
I think about some of the excellence at my own hospital and some of the work done by people like Drs. Wilkie and Tajirian, who are setting up a peer support group that's been highly effective for doctors. Of course, the treatment of mental health disorders, my goodness, that's my life's work. Never have we been able to do more for people who have mental health disorders. The key, of course, is to recognize these problems and then to take the appropriate actions.
Thank you.