BURNOUT - Yesterday, Today and Tomorrow A Realistic Perspective G. J. Heymach, MD, PhD, FACP Associate Medical Director

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BURNOUT - Yesterday, Today and Tomorrow A Realistic Perspective  G. J. Heymach, MD, PhD, FACP Associate Medical Director

Physicians have always had burnout problems, it’s inherent in their personalities and the occupation they have chosen. T. Jock Murray, MD, the director of the medical humanities program at Dalhousie University in Halifax was quoted3 in a 2001 article as having said, “We want people who are driven, who are compulsive, who can excel at anything that they do. What do they do when they get into practice? They try to do everything, and they have this complex which also says they must succeed at everything.”

An article in 19951, bemoaned the burnout in pediatric intensive care units1 where 50% of pediatric intensivists were at risk or burned out. Respondents classified as burned out were significantly more likely than respondents who were classified as not burned out to feel that their work was not valued by others.

The earlier article2, from 1994, now 18 years old spoke to a 58% burnout among HMO physicians, primarily General Internists and FPs, even then a surprisingly high value.

In August 2012, Tait D. Shanafelt, MD, a professor of medicine in the Dept. of Internal Medicine at Mayo Clinic in Rochester, Minn. found that 45.8 percent of doctors have experienced at least one symptom of burnout.3 Their findings are based on a survey of 7,288 doctors, and 3,442 non-doctor working adults in the U.S. These findings are not so different from earlier studies but remain very concerning.

Dr. Colin West,3 at the Mayo Clinic's divisions of general internal medicine and biomedical statistics, agreed that "efforts to promote physician well-being are critically important. This is relevant to patients and doctors alike, because physician burnout and dissatisfaction have been linked to poorer patient outcomes, medical errors, patient dissatisfaction and serious physician issues such as suicidality," West said. "Also, with health care reform and anticipated increased demand for front-line care providers, the severity of distress among these physicians is particularly concerning."

Linda Clever, MD4, founding chair of the department of occupational health at California Pacific Medical Center in San Francisco, remarked, “Exhaustion is pretty common in all walks of life, whether it’s executives, attorneys, clergy, or teachers, and particularly where people care. If you don’t care, you won’t get exhausted.” Clever also pointed out that the changing climate in medicine—is affecting the way physicians work and could make them more prone to burnout and exhaustion.

Poor life-work balance, a characteristic seen in the 50+ year-old physician is perhaps changing, as the employment environment of physicians change. Presently, in the US almost 50% of physicians are employees and the trend upward is clear. Physicians in these positions will no longer worry about staffing the office, managing the billing people, dealing with disgruntled colleagues or even the accounts receivable. All of that will be managed by “the company” and physicians will be obligated, as an employee to show up do their job, document the care and respond to patient needs during their working hours.

The paradigm appears to be changing; but, fear not, “the company” has no intention of rewarding you without utilizing the time freed up from administrative tasks. Initially, RVU’s (Relative Value Units, an opaque and secret way to count productivity) will be used but the changes in health care will drive all care to be measured by outcomes. Similar to the metrics that are used now to see how many post-op MIs get beta-blockers, ACE inhibitors, ASA and statins. In the future, an in-house and post--care provider (likely an RN) will be certain that protocols are followed by all physicians for the 70-90% of care that can be placed in a protocol. This sounds like a horrible idea at first but in fact, utilizing Best Practices data, we should be able to see patient respond quicker, have fewer complications and not bounce-back within 30 days. (An event, that will not in the near future (if it is for the same diagnosis) be reimbursed to the hospital by Medicare.)

So now that we are feeling despondent--- Is there an answer? What is the answer, or at least is there an option? An article entitled “Changing the Conversation From Burnout to Wellness” in the Journal of Graduate Education in December 2009 suggests the following “Toolbox ” for Residents BUT the same Toolbox with some tweaks could easily be placed in many hospitals.

TIPS FROM THE WELLNESS TOOLBOX

• Designate a faculty member (ed. Staff Member) who owns wellness and has time to champion it. Then enlist the help of the chief residents (ed. Chief of Staff). These individuals (ed. The Wellness Committee) can develop a plan based on the program's needs.

• Define wellness.

• Administer a burnout tool, such as the Maslach Burnout Inventory, twice a year to both faculty members and residents (Staff Members). Provide individual and group feedback (ed. Confidentially).

• Schedule "difficult patient" panels twice a year (ed. Quarterly) to discuss as a group how to manage difficult situations and interactions.

• Schedule class meetings every other month (ed. quarterly) with faculty mentors (ed. Psychiatrists, Psychologists on the Staff) who model the human side of medicine.

• Assign wellness partners (ed. mentors- confidentially) to faculty members and residents and set goals. Send quarterly reminders.

• Schedule a yearly retreat with team-building and self-awareness exercises.

• Assign office staff to encourage fun social events for the entire office. (ed. Medical Staff)

• Take time to publicly celebrate accomplishments and hand out appreciation lists. (ed. Even for small things)

• Change the culture over time. Create an environment that does not focus on pathology.

We all, as caregivers, want to be appreciated and have a sense of satisfaction and appreciation. Often, that does not come from patients.

We MUST be keenly in touch with our colleagues and sensitive to the same cues that patients give us —but in our colleagues. If there is a concern –even a slight concern---CONFIDENTIALLY contact the Wellness committee or the Missouri Physicians Health Program, which costs nothing, is an arm of your medical society, and is available to help discuss your concerns—you lose nothing and get the “monkey” off your back. Use your “Tools” to make Burnout of yourself OR others no longer a burden.


 

1 CCM 23(8) 1425 (1995)

2 Med Care 32(7) 745 (1994)

3 AIM, Aug. 20, 2012

4 AIM 135 (2) 145, (2001)

Reprinted from the Greene County Medical Society Journal, November, 2012

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