Telemedicine and Depression: A Possible Link

Experts agree that work-life balance is important for physicians to avoid depression, even those who see patients remotely.

Medical school studies and post-graduate training used to be the most trying periods of time for those who wish to practice medicine because of the number of 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. A heavy study load can be exhausting and isolate students. Thanks to an updateof a three-year study evaluating burnout and work-life balance, we know that American physicians are worse off today than just three years ago. Burnout has increased among physicians in all specialties, even those involved in telemedicine, who must deal with work-related stress, feelings of detachment toward patients, and EHRs.

During a panel discussion at an Arizona Telemedicine Program at Flagstaff Medical Center last week, Bart Demaerschalk, MD, MSc, FRCP(C), touched on the topic of isolation depression. It came up when moderator Ronald Weinstein, MD the founding director of the ATP - 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, both real and virtual, in such a manner that the clinicians are engaged in telemedicine practice, but not to the exclusion of 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.

It has been known for some time that 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 are often 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 said Mayo has had experience with this problem while developing its telestroke programs in Arizona, Florida and Minnesota. The clinical practice initiatives that Mayo has designed assist clinicians with achieving balance in their professional duties and to help prevent telemedicine practicing doctors from developing feelings of professional isolation and burnout.

Also present for the ATP event was Hargobind S. Khurana, MD, an intensivist - a specialist who takes care of patients in a hospitals intensive care unit. As 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.

Tele-ICU intensivists keep tabs on patients from afar using video cameras and respond to requests for help, proactively managing care when the situation requires it. Khurana says that he and his fellow intensivists generally work with a larger team which makes it much less isolating when compared to a tele-stroke provider who may be working alone at home. However, he did say in a follow-up email that working a bunch of busy shifts, night or day, in a row can be hard, tele, or not.

As with so many other aspects of medicine, isolation depression among some telemedicine physicians warrants further study.

UPDATE: Dr. John Noseworthy, CEO of the Mayo Clinic, was interviewed recently by WTTW-TV in Chicago and said that patients should fire their doctors if they suspect physician burnout. A Mayo study two years ago found the burnout rate for its physicians was 40%. You can watch the video here - the key part is about 8:10 in. You can read a transcript of the key parts here.

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