First Posted at Common Sense Family Doctor on 11/14/2012
Kenny Lin, MD, The Common Sense Family Doctor
Although they probably came as little surprise to physicians who practice primary care, the results of a national survey of physician burnout in the Archives of Internal Medicine earlier this year made headlines in The New York Times and The Atlantic. This study found that 1) physicians are more likely to experience symptoms of burnout than similarly educated workers in the U.S. general population; and 2) physicians on the front lines of care access - family physicians, general internists, and emergency medicine physicians – had the highest rates of burnout.
A Curbside Consultation in the November 1st issue of American Family Physician discussed the distinct but closely related problem of demoralization in a family physician who serves as the part-time medical director for a financially troubled clinic for children with developmental disorders. This physician was forced to accept layoffs of several key staff members without a corresponding decrease in workload:
She recognized the great need of these children and families, and had talked with other staff and administration about additional programs she wanted to develop. She now would have to say good-bye to coworkers and abandon her hopes for a larger and more robust program. She realized that the remaining staff, herself included, would have to work harder, and that she would have less time to spend with patients, the part of the work she found most fulfilling. Patients who needed the most help would, in fact, get less help. … Over the next week, she became dejected and sad.
Demoralization is a state of hopelessness and helplessness that is akin to, but separable from, depression. It is associated with a sense of subjective incompetence, the belief that a person is unable to express his or her values and achieve his or her goals. Demoralization has an existential dimension that is associated with the affected person’s experienced losses. … Moving past demoralization involves remoralization, or the renewal of one’s personal values and the activities that stem from these values. … However, if not addressed, persistent feelings of demoralization are likely to result in or contribute to burnout.
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Thanks for posting this Dr. Lin. Any discussion of physician burnout is of tremendous value. I work with over stressed physicians as an executive coach … in some cases because a colleagues suicide prompted them to ask for help.
Burnout is a pervasive and invisible problem in medicine. It is the elephant in the room whenever 4 or more physicians get together. Here is why.
The lead author of the burnout survey you reference above – Tait Shanafelt MD – has said in a previous article that “Numerous global studies involving nearly every medical and surgical specialty indicate that approximately 1 of every 3 physicians is experiencing burnout at any given time”. That is an average … I have seen surveys with prevalence rates of 87%.
Burnout’s effects on the physician’s quality of care and quality of life are profoundly negative. By all rights, burnout prevention and physician and staff wellness should be a front burner item for any healthcare organization anywhere, all the time. It mystifies me how attention to this epidemic can be reduced to an “8 Things you can do to prevent burnout” throwaway article.
In my experience there are a number of things that can provide immediate relief from stress for most doctors
Breathing based mindfulness and stress relief programs
Take a break/sabbatical and cut back on work hours
Exercise any control you can over the kinds of patients and diagnoses you see
Become an expert in your documentation method – rather than demonizing it
Become a better team leader and start delegating more effectively
Recognized you are programmed by your training to be a workaholic, superhero, emotion free, lone ranger and begin to notice when these habits start to take you down the road to more stress
Get a peer, colleague, coach, therapist to be a second pair of eyes and accountability partner for you … since much of what is causing burnout is invisible to the individual doctor.
The research is solid on what works to prevent burnout … it is WAY past time for organized action to tackle it head on.
Dike
Dike Drummond MD
http://www.thehappymd.com