“Things sometimes go our way and sometimes they don’t. All we can do is apply ourselves to our profession, giving our very best effort but emotionally letting go of the outcome. Why? Because if we obsess about an outcome, we cannot possibly honour the present moment.” ~ Christopher Dines, Mindfulness Burnout Prevention: An 8-Week Course for Professionals
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This past week, I came upon a few great physician burnout resources including an interview on the New England Journal of Medicine (NEJM) Catalyst site from the Mayo Clinic Despite Burnout, There’s Still Joy in Medicine; also from the same site, a series of 3 videos from Dr. Tait Shanafelt on physician burnout; and a post titled Avoiding Burnout in Medicine: Tips for Success by Dr. Kevin Campbell. Professional burnout remains a significant concern of mine on many levels so I am once again inspired to talk more about it today.
Prior to a few years ago, I am not sure how much the term burnout truly registered with me. Although it was not an uncommon term in the medical world, it did not hold the magnitude it does for me today. I have told the story before, how I turned my interest in physician wellness into a passion, when I actually saw my husband Colin experiencing burnout. It was an epiphany of sorts, watching the words associated with physician burnout, transform into true physical and emotional symptoms and signs before my eyes.
What are the symptoms & signs of burnout?
Dr. Tait Shanafelt, the director of the Mayo Clinic Department of Medicine Program on Physician Well-being, is well known for his work on physician burnout. Two definitions of physician burnout from his work include the following:
“A syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a low sense of personal accomplishment”.
Shanafelt et al. – Arch Intern Med (2012)
“Burnout is a syndrome of emotional exhaustion, loss of meaning in work, feelings of ineffectiveness, and a tendency to view people as objects rather than human beings.”
Shanafelt et al. – Mayo Clinic Proc (2015)
The symptoms and signs of burnout are insidious – they progress slowly and it can be very difficult to categorize both what the person feels and/or what other people see. When it became apparent to me that Colin was experiencing burnout, I was shocked by how it crept up on him over time. Exhaustion, loss of enjoyment and meaning in work, cynicism about medicine and withdrawal from any social interaction at work, were just some of the things we noticed and started to piece together.
What are some of the causes of physician burnout?
Rightfully so, some of the causes of physician burnout relate to the system they work in, not to the physicians themselves. In the interview mentioned above, Despite Burnout, There’s Still Joy in Medicine, they discuss some of the causes that begin in medical training and continue into clinical practice. Unfortunately, stressors are the culprit at every level. Some of the specific causes they mention include workload, debt, autonomy, uncertainty of future and Electronic Medical Records (EMRs). Overall, they point to both the learning and work environments.
EMRs play a major factor in our digital era and are a stressful reality for practicing physicians. Although there are certainly upsides to EMRs, they are not without significant downsides. According to a recent Forbes article What’s Causing Physician Burnout?, “No study existed or exists today that demonstrates that EMR decreases errors, increases efficiency, or lowers costs. Studies do show, however, that it has demoralized doctors and nurses and is a major component of job dissatisfaction and angst about where medicine is heading.”
In Colin’s case, two major work environment factors that he would point to as causes of his burnout are: 1) lack of control over his day-to-day workflow and volume and 2) constant interruptions. Although these factors are not unique to a Radiologist’s practice, they definitely tend to be more pronounced than in other areas of medicine.
What are the potential implications of physician burnout?
The implications are far reaching on a personal, social and system level. Physician burnout can be a warning sign of depression, suicide, substance misuse, broken relationships and medical errors. As Dr. Campbell eludes to in his post mentioned above, unless something changes in their work environment or on a system level, one major implication is that physicians will leave the practice of medicine. Although resiliency factors and self-care can help physicians cope under overwhelming stress, they are not necessarily targeting the root offending cause(s).
Some other thoughts on areas to target potential changes, that we will delve into at a later date, include the following:
- Teach stress management and self-awareness strategies in medical training/practice
- Use community building strategies such as social media
- Improve EMRs and record keeping
- Change the culture of medicine
- Find meaning in medicine
- Develop mentorship programs
What are your thoughts on physician burnout?