University of Michigan House Officer Program Teaches Self-Care

Physician burnout has become the subject of the moment, but in fact physician suicide and physician dropout have been a cause of concern for generations. A landmark follow-up study of physicians who had been medical students at Johns Hopkins University School of Medicine, published in Suicide and Life-Threatening Behavior in June 1991, showed that suicide was far more likely in physicians who had difficulty handling stress as medical students. Suicide was also more likely in those who regarded themselves as “help deniers”—those who felt they had to solve issues of depression, lack of confidence, and failures on their own.

In 1997, following the suicide of a promising resident at the University of Michigan, the chair of that resident’s department and two psychiatrists, Elaine Pitt, M.D., and Tamara Gay, M.D., established what would become known as the House Officer Mental Health Program.

There were three primary components to this plan:

• Resident visits were completely confidential, with no record made in the resident’s medical chart.

• Treatment was limited to five visits, with a formal referral made after that if needed. There was no charge to the resident or the resident’s insurance.

• The program was promoted to all residency training directors and to the House Officer Association.

Psychiatrists regularly communicated with program directors and department chairs, as well as with residents during orientation each year, about the availability of the program and its accessibility, with a reminder in each instance of the confidentiality of the program. That is, no program director or chair could request information about a resident from this program without the resident’s consent, even including whether a resident had accessed the program.

Over the years, workshops were presented on a variety of topics, including the identification of depression, healthy sleep habits, meditation techniques, dealing with the disruptive resident, recognition of substance abuse and depression, and the distinction between destructive feedback and helpful feedback to residents.

I inherited the program in its fifth year and ran it for the next 10 years, seeing over 500 house officers for an average of three visits each. Residents who might otherwise feel that it was too difficult to see a psychiatrist because of the time away from the hospital could drop by my office discretely during the day and on very brief notice. Rarely did a resident require more than five sessions; our residents are a pretty resilient group, and there are many other supports in place for them.

I believe the benefits of this program persist long beyond whatever acute emergency may have brought a resident to seek help. For instance, residents from specialties that might not ordinarily consider referring their patients to a psychiatrist had an opportunity to see that it could be quite helpful. Program directors accepted my recommendations in terms of whether a resident was “fit for service” or needed a day or more off, and they were quite willing to modify call schedules when I suggested that their expectations were physiologically impossible (such as when residents were scheduled for night shift for five days, followed by a weekend off and then day shifts.) Program directors respected the confidentiality, and residents appreciated the ease of access.

We had frequent communication about stresses in different departments. For instance, following the tragic plane crash of one of our fixed wing survival flights—in which a resident and several transplant technicians were lost—virtually the whole hospital mourned, and hospital chaplains as well as the surgery department consulted with me around a response. The program was widely accepted and viewed positively.

Because of the House Officer Mental Health Program, residents at our institution have been encouraged from the first day of orientation to take care of themselves and to ask for help when they need to. They are able to see that colleagues and program directors are supportive and want them to succeed, and their exposure to this brief therapy enables them to see how helpful it can be, both for themselves and for their future patients. ■