Work Stress and Mental Health

By Judge David Langham

Stanford Medicine’s Scope Blog recently reported on Causes of Physician Burnout and ways to Address it. It begins with a staggering description of an epidemic in medical care: “more than 50 percent of physicians experience symptoms of burnout, and significant shares report depression and suicidal thoughts.” Half of physicians, a statistic that at least one physician says is a “national health emergency.” The article questions why such a pervasive impact is not seen as a crisis, contending such volumes would be so viewed in other industries. 

Coincidentally, CBS News reported on a discussion panel in Australia addressing Malaysian Air 870’s disappearance in 2014. This panel of experts has opined that flight was intentionally diverted from its planned path, and crashed by a pilot that “was killing himself.” Fox News’coverage of this Australian analysis noted two other similar incidents. One in which an EgyptAir flight crashed near Massachusetts, and another in which a Germanwings pilot crashed a flight into the French Alps. Both determined to be “suicide-by-pilot.” 

The British Broadcasting Company (BBC) recently reported a broader concern about How your Workplace is Killing you. In a nutshell, the conclusion is that our workplaces are capable of either causing or contributing to “dangerous levels of stress on employees.” One BBC sourcecontends that the effects of this stress are detrimental on both employees and on business, and accuses that “governments are ignoring an emerging public health crisis.”

Stress is thus identified from three perspectives, specific to two example professions and in a general context. Though stress is an underlying similarity of the three, the reader is left to wonder whether stress is more prevalent today. Has the workplace changed, are we more readily discussing stress that has long existed, or is today’s news produced by some combination of both increased prevalence and attention?

The prevalence is compelling. The BBC story includes anecdotal examples of stress, medical ailments, and suicide. Each is allegedly related in some part to work.  To broaden the perspective, the author reports that half a billion work days are “lost annually from absenteeism” that is “stress related.” And, the story notes that a vast assortment of studies support a conclusion that “harmful workplace practices were as bad for mortality,” as “second-hand smoke.” The existence of stress, and its impact seem established. 

Those “harmful workplace practices” are said to include

(1) long working hours, (2) work-family conflict, (3) economic insecurity arising from job losses and not having regular or predictable work hours, (4) an absence of job control and, (5) in the US, not having health insurance. 

The BBC notes that this stress epidemic is leading to an aggravation of the previously discussed medical care cost inflation. Medical inflation is outpacing inflation generally, and has been for decades, discussed in The Conundrum of Medical Inflation. Perhaps the impact of stress is multifaceted. Medical professionals are busy, stress results, then absence. The “supply” of caredecreases. When supply decreases, that will generally result in increased cost. Coincidentally, provider absence may also simply increase the stress on the providers that remain at work and thus starting the cycle anew.

The underlying theme of all three articles is obviously stress, but more so the apparent unwillingness to discuss solutions. Some who experience stress may be too proud to concede its effects. Some may eschew treatment due to time demands, others due to cost. Some may experience symptoms, but not perceive the potential for a relating them to stress. But, a more important theme of these articles seems to be our societal reluctance to discuss the prevalence of stress and our ability to recognize and address it.  

Reading these articles, I was reminded of the recent focus on mental health evidenced by The Florida Bar. In January it published Recognizing we have a Problem. The bar is leading us to a recognition of symptoms and a search for solutions. The bar statistics for attorney stress and mental health are alarming, including high stress, work/family balance, career dissatisfaction, suicide, alcoholism, and more. The Bar’s effort is important, not because it can eradicate stress or eliminate health challenges. The effort is important because it evidences an effort at recognizing and discussing, which is seemingly struggling for traction in other professions. The Bar is reacting with recognition and discussion. That may not cure anyone or solve anything, but the attention is a start. 

Perhaps the world is more stressful today. There are those who contend that life is moving faster, that things are increasingly complex, and that populations are more concentrated. Technology that has made us more productive may be positive or negative. Does our technology ease our effort and facilitate our lives, or does it merely overload us with inputs and make life more frantic?

As an example, a lawyer lamented to me years ago that she longed for the time before facsimile machines. In “the old days,” she counseled, communications from other lawyers came around the same time daily, when the mail delivery arrived. Incoming information was less convenient for senders, but more predictable and measured for recipients, Then came facsimiles, and communications became more convenient, unpredictable, or even frantic. That lawyer found convenience in technology, but noted its affects were both positive and negative. Perhaps the same is true of smartphones, email, texts, social media and more?

The analysis provided in Physician Burnout identifies what doctors perceive as increasing their stress. Obviously, knowing we are stressed is a fair beginning, but understanding the cause and effect would likely assist us in addressing stress. If we do not recognize and understand cause, we cannot alleviate or ameliorate cause. While I thus applaud the physician approach, that discussion of cause needs to be both deeper and broader. 

Physician Burnout suggests that physician “burnout” is attributable to 

excessive workloads 

regulatory burdens, 

lack of control, and 

lack of satisfaction

Would anyone argue that these are specifically physician problems? At least from my professional perspective, I can identify with each of these. Perhaps we all can? And, despite identifying with these, perhaps there are other factors with which we could all identify, or with which some profession or industry could? Maybe the doctors have not spotted all the issues. 

It is encouraging that physicians have begun to discuss their perceived stressors. It is encouraging that lawyers have begun to discuss stress and mental health. However, these glimmers of progress must be recognized only for what they are, a beginning. The discussions need to not only continue, but to broaden. More professions must be similarly introspective. Antagonists must be defined and identified (“excessive workloads”), but the analysis must alsobe deeper. 

Our understanding has to include what is stressing us, why those issues are stressing us, and how we can alleviate or ameliorate those root issues. The analysis has begun with recognition, but much work lies ahead in building better work/life balance, defining personal and professional boundaries, and learning how to better communicate our perspectives. Most critical though, we must learn to effectively cope with our emotional responses in healthy and positive ways. 

The analysis has begun, but we have by no means arrived. I would argue that we have yet to even clearly identify our destination. There is much work to do in recognizing where we are, analyzing our objectives, enunciating our destination, and planning our path. It will require focus, acceptance, and attention from us all. Or, we can just keep soaking up the stress, burning-out, and suffering the personal, family, and professional consequences. You choose.