Telemedicine and Depression: A Possible Link

Experts agree that work-life balance is important for physicians to avoid depression.

When it comes to stress, healthcare professionals used to find their medical school studies and post-graduate training especially trying because of the hours demanded. A study in the Annals of Internal Medicine found that nearly 50 percent of students experienced burnout among the more than 2,000 medical student respondents across seven schools.

Thanks to an update of a three-year study evaluating burnout and work-life balance, it seems American physicians may be worse off today than just three years ago. Burn-out has increased among physicians in all specialties. That includes doctors involved in telemedicine, who must deal with work-related stress, isolation, and EHRs.

During a panel discussion at an Arizona Telemedicine Program last week, Bart Demaerschalk, MD, MSc, FRCP(C), touched on the topic of isolation depression. It came up when moderator Ronald Weinstein, MD asked panelists to discuss the recruitment of telemedicine physicians for their programs.

Demaerschalk, who is Professor of Neurology and Medical Director, Telemedicine, for the Mayo Center for Connected Care, said that Mayo is devising and structuring its clinical programs so providers can engage in telemedicine practice without neglecting their face-to-face practice. To be a superb telemedicine doctor, one must be a superb face-to-face doctor, Demaerschalk said in a follow-up email.

Preventing Depression in Telemedicine Providers

Social isolation and loneliness are risk factors for the onset of major depression. Doctors who spend their professional work day seeing patients remotely via telemedicine can be closeted in a room by themselves, staring at several monitors for hours on end. The physical detachment from other people for an extended time can take its toll.

Demaerschalk noted some Mayo providers experienced this while developing telestroke programs in Arizona, Florida and Minnesota. Today Mayo has designed clinical practice initiatives that help clinicians achieve balance in their professional duties and prevent professional isolation and burn-out.

Another suggestion came from Hargobind S. Khurana, MD, Senior Medical Director for Health Management at Banner Health. He oversees the largest tele-ICU program in the country, covering 550 beds in 28 hospitals. One doctor is on duty during the day, but at night five physicians and two nurse practitioners monitor the ICUs.

These providers keep tabs on patients with video cameras and answer requests for help, proactively managing care when the situation requires it. Because they work with a larger team, Khurana said it was much less isolating compared to a telestroke provider working alone at home.

Khurana also noted that working too many busy shifts in a row can also be difficult, for both in-person care and virtual care. As with so many other aspects of maintaining a healthy provider workstyle, a good telemedicine practice will need to involve consistent work-life balance.