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David Baxter

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Is Your Doctor Burned Out?
by Peter Jaret, Berkeley Wellness
February 23, 2018

A family physician and palliative care expert at the University of Rochester Medical Center, Ronald Epstein, MD, has long warned about the growing phenomenon of physician burnout. In 2000, Epstein co-founded the Mindful Practice program, which offers workshops to help doctors handle the increasing pressures of the profession. He is also author of the book Attending: Medicine, Mindfulness, and Humanity (Scribner, 2017). Epstein spoke with us about why physician burnout is a growing problem, and why we should all be concerned.

What are the signs and symptoms of physician burnout?
There are various definitions of burnout, but one of the most widely used has three components: emotional exhaustion, depersonalization (treating other people as objects), and feeling inadequate and powerless. When doctors become burned out, they begin to lose their ability to attend to patients, to listen, to diagnose and treat them effectively. Many end up leaving the profession prematurely, which puts strain on the health care system.

How serious is the problem?
Very serious. According to one of the most common measures used, called the Maslach Burnout Inventory, 56 percent of physicians are experiencing burnout. There are other measures that estimate a lower percentage, around 30 percent. But even that’s a very large number. By any measure, burnout affects a sizeable portion of the medical community. :acrobat: And it’s not just doctors. It’s nurses and other health care professionals as well. And it’s getting worse. Between 2011 and 2014, burnout measured by the Maslach Inventory increased by 11 percent. Among the specialties at highest risk are emergency physicians, OB/GYNs, family doctors, and internal medicine physicians. But burnout is a serious problem in almost all areas of medicine.

Why is burnout on the rise?
There are several reasons. First, the administrative burdens on doctors have increased significantly. There are more for forms to fill out, more boxes to check, and a deluge of digital information. All of that means extra work that limits the amount of time doctors can spend with patients. The burden is compounded by the fact that we have a very dysfunctional electronic medical record system that not only demands too much of a physician’s time and attention but also doesn’t provide the benefits it was supposed to provide.

Another factor is the rise of health quality metrics. Measuring quality of care is important, of course. But if doctors pay too much attention to what’s being measured, they may ignore things that are most relevant to patients. Doctors increasingly find themselves having to answer to two masters — administrators who are measuring specific productivity and quality metrics, and patients, who often have ill-defined human needs that don’t fit into the metrics. All of these things demand more and more of a doctor’s time and attention, and keep them from doing what they do best, caring for patients.

You offer workshops to help physicians deal with burnout. What do you hear from them?
Most doctors go into medicine because they enjoy the challenges and they want to help people. Increasingly they’re finding that their day-to-day work is further and further from what they went into medicine for. They are overwhelmed by too much information coming at them that they don’t have time to fully process. Physicians have always had limited time. But because of the growing administrative demands, they have less and less time to relate to patients. Too often, patients feel as if doctors are treating them as just another number. Doctors feel like factory workers meeting a quota rather than engaging in the deeply important human enterprise of medicine.

What are the consequences in terms of medical diagnosis and treatment?
When doctors experience burnout, they are more likely to come to what we call “premature closure.” They gather data about the patient, come up with their best hunch, and that’s the end of it. They lose their ability to keep an open mind, to consider other possibilities. And that’s not the way to practice medicine. Medicine is an art. You have to keep an open mind. Your initial impression may not be correct.

Some doctors begin to shut down. It’s a self-protective mechanism, but it ends up making them feel even more isolated and exacerbates the problem. When physicians become burned out, they lose their sense of curiosity. Patients become widgets, things that need to be processed as opposed to human beings to relate to. That impoverishes the relationship on both sides, and it jeopardizes a patient’s health and safety.

What’s being done within the profession to address burnout?
There is a growing awareness that burnout is a serious problem, which is an essential first step. There are mandates from more and more professional organizations and medical schools to address burnout in the health care workforce in a meaningful way. Some organizations have been really visionary in their approach, finding the points of pain and stress in the delivery of health care and addressing them directly, by improving the electronic health record systems, for example, and easing administrative burdens on health care professionals. Many institutions have begun to offer workshops in mindfulness, conflict resolution, and stress management. Some now use the well-being of health care professionals as a quality metric. One health care organization, for example, has tied its CEO’s bonus to the well-being of the workforce.

Is there anything we as patients can do?
Patients aren’t responsible for physician burnout, of course, but they can do a lot to help doctors provide the best care. When you come in for an appointment, be prepared. Have a clear sense of what’s motivating your visit and what you hope to get out of it. Most patients come in with a list of several complaints or concerns. They have a rash. They’ve been getting headaches. Oh yes, and they’ve been having chest pain. For a variety of reasons, patients tend to bring up the thing they’re most concerned about last, often just at the end of a visit. Talk to your doctor first about what worries you the most. Be explicit. Tell your doctor why you’re so concerned about a specific symptom. That way, your doctor can give it his or her full attention.

If you have questions or concerns about a treatment or suggestion your doctor offers, say so. We know that between one-quarter and one-third of patients don’t take prescriptions or follow the advice they’ve been given. If you’ve tried a treatment before and it didn’t work, your doctor should know that. If you’re worried about the side effects because of something a neighbor said or you’ve read online, bring it up with your doctor.

And if you have concerns that can’t be covered in a single visit, be willing to schedule another appointment. You can’t go in with a list of 20 things and expect your doctor to cover them in a 20-minute appointment.

Ideally, your relationship with your doctor should be a relationship of sharing — sharing information, sharing thought processes, sharing decisions. I use the term “shared minds.” You and your doctor may not necessarily agree on everything. But you understand each other and speak the same language. Fostering a relationship that’s open and flexible, a relationship of mutual respect, is one of the best things we can do to counter burnout and restore the essential aspect of human caring to medical practice.
 

Daniel

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Why Health Professionals Should Cultivate Gratitude
by Leif Hass, M.D.

...Burnout is characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. I’ll admit that I’ve been in that downward spiral.

What gratitude offers is a positive cycle. Upon receiving a gift, one feels a surge of positive emotion and a desire to give back, which can motivate us to “pay it forward” by helping someone else. Feelings of gratitude make us more likely to help a stranger. In one study, health care providers who twice weekly wrote down things for which they were grateful reported less stress and depression. Those who wrote down things that bothered them at work only became more frustrated...
 

GaryQ

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Good thought provoking post.
I see my GP on the 28th. Would be a good time to let him know how much I appreciate everything he has done for me over the years many times above and beyond his medical obligations. He also has the added pressure of being the clinic’s medical director
 

Daniel

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doctor-burn-out-inforgraphic.png
 

David Baxter

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Fortunately, I'm not seeing any of that in any of my doctors or in the nurses I interact with regularly. I am exceedingly luck with the medical team I have. They are all extremely knowledgeable and competent and compassionate and patient. And probably the main reason I am no longer willing to even consider moving at this point.

I don't know how they do it, really. This past year has been crazy for all frontline health care workers but they somehow still manage to keep going and with a smile and a positive attitude.
 

Daniel

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January 6, 2021

...Initially, some physicians found a great sense of purpose in assisting in the pandemic, and having a strong sense of purpose is vital for resilience. However, as time continued, the same system challenges exist, but new threats were imposed to individual and family safety, finances, and job security. Everyone’s regular routines – physicians and others – were disrupted in a significant and prolonged way. Routines at home and work were disrupted and that caused chaos for some families, especially for those with dual physician-led homes and younger kids...

On the organizational level, people need to feel valued, appreciated, and supported. All leaders should tell their teams – and teams should tell each other – how much they are valued and give encouragement. Find the stressful points in the day or system that can be improved to make the days efficient and easier to allow physicians to focus on what they love most, such as caring for patients, conducting their research, and engaging in educational activities.

I have a quote from the Harvard Leaders in Education Program in which the late Clay Christianson said during a presentation, “Make the right thing to do be the easiest thing to do.” It has become one of my mottos because everything required of the physician should be easy to do. Leaders should get them training if they need skill, use examples and models that are easy, and keep processes simple. Supporting their long work hours by providing snacks and beverages and schedules that give the physician downtime is critical.
 
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Daniel

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2020 Sep-Oct

...At this point, large data sets regarding the impact of COVID-19 on physician mental health and suicide are not available. However, the stories published in the press regarding suicide by health professionals paints a grim picture. The story of Dr. Laura Breen, and ER physician who contracted COVID-19 and then later died by suicide18 illustrates not only the physical toll of this pandemic, but the intense emotional toll to those who are working on the frontlines. There are also stories of paramedics, nurses, techs, and other workers in the medical field who have died by suicide during this incredibly difficult time. These few stories which reach the press are likely only a small fraction of the true loss of life during this time as much of the airtime is devoted to those dying from the infection itself rather than the emotional and mental consequences of fighting it...

All of us are working long hours, picking up extra shifts, and putting our own self-care last during this pandemic which will have dire consequences if gone unchecked. We know from previous research that physicians are a vulnerable group for depression and suicide and hesitant to seek care in the best of circumstances. With these new demands and shifts in work responsibilities we must not lose sight of these underlying facts. This is a marathon, not a sprint; we must continue to take care of our physicians so that they can continue to care for those who need them most.
 

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Resources for healthcare workers in the US:



In Canada (also see next post below):


Screenshot_2021-02-20 Wellness Together Canada Home(2).png
 
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Daniel

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Screenshot_2021-02-20 GoFundMe for Toronto nurse who died by suicide raises more than 5 times ...png
In remembering her, the Ontario Nurses' Association has provided a list of mental health resources for those who are struggling more than they feel they can handle right now, including Wellness Together Canada, the Canadian Mental Health Association, the Centre for Addiction and Mental Health, and various online services.
 
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Daniel

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Although vicarious trauma and overwork are taxing to physicians in training, what drives physicians to insurmountable despair is chronic disrespect and emotional violence from their own peers.
 

Daniel

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I thought when this pandemic began that we were all in this fight together, engaged in a war against a common enemy. Now, I painfully realize: Perhaps we were never on the same side and we never had a common enemy. Perhaps the war has been among ourselves all along. We have won many battles but unvaccinated America is choosing to let COVID win the war.
 

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