McFarland Daniel C, Hlubocky Fay, Susaimanickam Bibiana, O'Hanlon Robin, Riba Michelle
1 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY.
2 Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago, Chicago, IL.
Am Soc Clin Oncol Educ Book. 2019 Jan;39:590-598. doi: 10.1200/EDBK_239087. Epub 2019 May 17.
The best practice of oncology relies heavily on a mentally and physically healthy oncology clinician workforce. Historically, the mental health of physicians and clinicians has largely been ignored, perhaps in the spirit of a collective collusion to maintain the illusion of Oslerian equanimity. With exceedingly high and unacceptable rates of burnout and suicide in the practice of medicine and oncology in particular, a tacit disavowal of the problem is no longer acceptable. The practice of oncology presents several unique work-related issues that challenge the mental health of its clinicians and contribute to burnout, depression, and suicide. Oncologists work with patients at or nearing the end of life and face administrative and insurance hurdles to obtain needed anticancer medications, heavy workloads, paperwork and electronic medical record demands, and keeping up with expanding pertinent oncologic knowledge for practice and public relations issues. Although oncologists exhibit higher rates of depression with longer work hours than many other internal medicine colleagues, they have higher job satisfaction ratings. This article will (1) review the mental health of professionals in oncology, (2) explore similarities and differences between depression and burnout, (3) describe the unique nature of the oncology work environment, (4) examine suicide and its implications for oncology, and (5) review the evidence for interventions to prevent burnout and suicide. Although individual and system-level strategic approaches to the problem of burnout and its consequences are effective, combinatorial approaches offer the most hope for affecting the most long-lasting change and lessening burnout, depression, and suicide in oncology.
肿瘤学的最佳实践在很大程度上依赖于身心健康的肿瘤学临床医生队伍。从历史上看，医生和临床医生的心理健康在很大程度上被忽视了，这或许是出于一种集体共谋的心态，以维持奥斯勒式镇定自若的假象。鉴于医学实践尤其是肿瘤学领域中倦怠和自杀率极高且令人无法接受，对该问题的默认否认已不再可行。肿瘤学实践存在几个独特的与工作相关的问题，这些问题对临床医生的心理健康构成挑战，并导致倦怠、抑郁和自杀。肿瘤学家与处于生命末期或接近生命末期的患者打交道，在获取所需抗癌药物时面临行政和保险方面的障碍，工作量繁重，有文书工作和电子病历方面的要求，还要跟上不断扩展的与肿瘤学实践及公共关系问题相关的知识。尽管与许多其他内科同事相比，工作时间较长的肿瘤学家抑郁发生率更高，但他们的工作满意度评分也更高。本文将（1）回顾肿瘤学专业人员的心理健康状况，（2）探讨抑郁和倦怠之间的异同，（3）描述肿瘤学工作环境的独特性质，（4）审视自杀及其对肿瘤学的影响，（5）回顾预防倦怠和自杀干预措施的证据。尽管针对倦怠问题及其后果的个人层面和系统层面的战略方法是有效的，但组合方法为实现最持久的改变以及减轻肿瘤学领域的倦怠、抑郁和自杀带来了最大希望。
