The rising tide of burnout – a major threat to our healthcare system?

Physician burnout 2

http://catalyst.nejm.org/videos/physician-burnout-stop-blaming-the-individual/

The above is a link to a brilliant talk by the program director for Physician Wellbeing from the Mayo Clinic, Tait Shanafelt, illustrating how physician burnout is a “system issue”.

“We tell physicians to get more sleep, eat more granola, do yoga, and take better care of yourself. These efforts are well intentioned,” says Shanafelt. “The message to physicians, however, is that you are the problem, and you need to toughen up.”

Shanafelt goes on to describe how the six drivers of burnout amongst physicians are largely derived from the characteristics in the work environment.

These drivers are stated as;-

1) Excessive workload

2) Inefficiency and undue clerical burden

3) Loss of flexibility and control over work

4) Problems with work-life integration

5) Loss of meaning in work

6) Organisational objectives that conflict with the altruistic values of the profession

He also states that promoting professional wellbeing is the shared responsibility of individual physicians and healthcare organisations.

Whilst this talk comes from the US setting, I believe the themes that are discussed are becoming increasingly relevant to the Australasian healthcare. My own observations from working in a number of busy tertiary and secondary hospitals across Australia and New Zealand is that we have developed highly efficient systems of delivering essential medical “management”, however, heartfelt “care” appears to have become optional extra.

Hearts in Healthcare

An increasing number of doctors, and doctors in training, have experienced disillusionment the conditions of medical training, and practice, and at the consequential neglected dimension of “care”. I have had countless conversations with caring physicians over the past 5-10 years, at all levels, which has led me to believe that there is a deeply “broken” element to the current healthcare system. Some have felt strongly about the issue of restoring humanity, and the heart, back into medicine that they have also made it their life’s work.

For example, Dr Robin Youngsen, who is a NZ Anaesthetist, has highlighted the importance of creating “time to care” in his first book, which takes on this very title. He also furthered this message his recent TED talk “perfectly broken and ready to heal”, and has set up an organisation dedicating to rehumanising healthcare, called “hearts in healthcare”.

The power of humanity in health care

Looking both forward and backwards in time, isn’t it “humanity” that is at the what is special and important in healthcare?

It seems to me that through a greater understanding, and appreciation, of the benefits of the “human side” of medicine, it is still possible to steer the evolving culture of healthcare in a better direction.

The opening story in Tait Shanfelt’s talk perhaps conveys this better than any, where he recalls how one particular doctor took a deeper interest in his son on a personal level, when he was a patient in hospital. Despite the all round exceptional treatment his son received in hospital, it was this one persons humane interactions that stood out, and also meant so much to him.

Which future shall we steer towards : physician burnout, or, physician wellbeing?

I am a big believer of the notion that often the question is more important than the specific answers.

We now know that burnout exists in high proportions than ever before , but the question remains, how do we respond to this rising tide? Perhaps one strategy can be rather than reacting to the negative effects of burnout, we can proactively create more wellbeing?

But how do we apply this vision in local physician settings settings? Perhaps a start is by asking the question “what can we be doing to improve physcian wellbeing?”.

What am I doing to improve my wellbeing?

What is happening within my hospital or training organisation?

…and

How can I help this ever-growing movement?

What are your reflections on preventing physcian burnout, and promoting a culture of physician wellbeing? I would love to know your views.

I’m just putting this out to further the coversation, between the ever-growing, increasingly diverse network of caring physicians who have a vision of healthcare that values the wellbeing of all, starting with the one who cares.

Physician burnout editorial

Ref: http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)30940-6.pdf

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Interesting interview from the “Godfather of Emergency Medicine”

I was just about to go to sleep at 5am after doing my research when I check the Life in the Fast lane’s list of recommended medical blogs. I clicked on a blog called “residing in the ER” and ended up watching a 3 minute video clip which was an interview with Peter Rosen, known for being the chief editor of one of the most highly recommended text books of Emergency Medicine (“Emergency Medicine: Concepts and Clinical Practice). The truncated interview that follows is taken from an in-progress documentary called “Heal Thyself”, and from what I can gather from this clip, explores a physicians struggle through the realities of modern medical practice that perhaps lead to “burn out”. 

The inteview illustrates this physician’s passion for treating patients, with care, and his inspiration of knowing “what to do” in the delivery of acute care. One of the things that moved me perhaps the most was the wise message given as a strategy to avoid burn out – which was  to “revitalise your ideals” and to connect with the “gift of affection”. However, as I watched this video I couldn’t help wondering “have the current systems of medical care changed so much that it is having effects on even the most passionate within the profession?”

I think the answer to this question is “maybe” as the pressures in hospital medicne and particularly emergency medicine are high, and increasing. Why is this? I think it is to do with the mismatch between the expectations of society, the legal system, hospital manangement, and what the doctors themself expect should constiute health care. 

I have had a special interest in burn out for many years now becuase I have always considered myself to be quite an enthusiastic and caring doctor, and, I am very keen that these qualities do not “burn out” – yet although the challenge is worthy, I feel the road is rocky, in todays high pressured hospital environment, and consequently today’s ‘training’ enviroment. Reading what is out there on the blogosphere I started to realise that I was not alone, and now seeing this clip from Peter Rosen it appears that this sentiment perhaps could be in association with esteemed company.

It has been of great interest to me to try and find tools to avoid burn out, and to maintaining the passion whilst walking the difficult path of training and medical practice. In my view the solution lies in “taking care of oneself” – and for me that involves, ensuring rest and satisfying the soul, through the journey of training. But I guess everyone’s path is different? Nevertheless, the concept of “Healing Thyself”, the proposed title of this documentary (from which the above video clip was taken), is of paramount importance if we are to be able to heal others, and this is something I certainly teach or mentor to those more junior than I whenever possible.

Perhaps those of us who are in medical education are familiar with the CanMEDS principles which are thought to strategically address some of these challenging situations created by modern health care – thorugh a more well rounded training of doctors. I think this is a very noble cause, one that I am very enthusiastic about – and the You Tube clip below shows some of these goals nicely played out with acting and music:-

However, whilst I’m optimist by this framework of training, I believe that at the same time there needs to be the development of “collaborative” common-sense expectations of health care delivery, that involve the ‘entire’ society, as a whole, if we are to avoid the mismatch from persisiting.  

 

Physician Heal Thyself


Physician Heal thyself,

Or you will feel like you are stranded on the shelf,

There is pain you seek to heal, 

But try not to deny what you feel,

 

How can it not affect me,

When it was ‘feeling’ that taught me to see?

How can it not deject me,

When suffering lives on the other side?

 

The change of tide is arriving,

Integration is thriving,

For a new age of understanding,

Is collaboratively re-expanding. 

 

Well there’s my poem for the night – Good night 🙂