The Daily Dose • Monday, April 30

Curing Physician Burnout

By Dr. Nawal Ragheb-Mueller, from the IARS 2018 Annual Meeting*

Despite feeling under the weather, Professor Santhanam Suresh moderated Sunday’s panel on physician burnout and wellness, a headline topic in medicine and the popular press.

Dr. Gregory Hammer diagnosed the disorder and outlined a cure for the audience. The problem of burnout inevitably evolves from complete physical and mental exhaustion. A combination of exposures to environmental factors, inadequate coping skills and personal stressors may lead to burnout. Increasingly cynical, we depersonalize and then check out. The tank is empty.

What are the pressures that are most detrimental? Excessive metrics, increased clerical burdens, pressure for increased productivity as bundled payments and reimbursement drop – these are familiar to most of us. Couple these with a feeling of loss of control over work – we all know what that feels like – and you have the perfect storm. Cases are switched around in the OR all the time, we face inefficiencies in the practice environment, staffing is inadequate, and the implementation of electronic medical records can be a headache.

Performance metrics are on the rise and changing all the time – quality, cost, OR turnover time, PONV rates, patient satisfaction surveys – also contribute to the frustration and lead us to feel that instead of caring optimally for patients, we are focused on metrics we had little input in developing.

The toll can be enormous. Some doctors leave their practices and some abandon medicine altogether. Institutional costs to replace physicians are significant. Costs to society are high when 400+ physicians commit suicide annually. This translates into a million patients a year losing their doctors, says Hammer.

The quality of care goes down as physician burnout increases. Research suggests there are increases in surgical and medication errors as physician wellness diminishes. Ultimately, patients suffer.

Dr. Hammer contends that amongst the many quality metrics in play in medicine today, the missing link is the quality indicator for physician wellness. Achieving our mission for high quality patient care won’t happen without addressing the drivers responsible for burnout.

So how do we turn the tide? Many organizations engage in lots of presentations and less action. Stanford, however, has implemented an ongoing effort to combat this with its program to promote a culture of wellness, efficiency of practice and personal resilience.

Dr. Jeffery Vender took on the role of culture in promoting and sustaining a healthy practice. He contends that rather than emphasize patient satisfaction, the engagement of employees is what predicts the patient experience. Employee satisfaction misses the mark as well, he noted. Rather, engagement at work – a culture of engagement, if you will – has a common purpose and engaged employees perform above the bar.

Leadership is missing in many hospitals and medical centers. Influencing people in a positive way, rather than via authority, and doing it with emotional intelligence will build cultures of engagement and promote wellness across the institution. Leadership that listens to its constituency and implements change based on a good sense of group ethos is leadership that will thrive.

Dr. Vender added that if practice efficiency is poor, wellness suffers. “Hire enough OR nurses, enough anesthesia technicians – commit resources to improve practice efficiencies!”

Dr. Vender noted that each of us should have realistic expectations about our work roles. He urged us to prioritize, build relationships with our colleagues and engage with family and friends. High performance teams are built when there are clear, committed goals and metrics, coupled with a deep sense of purpose based on clarity, transparency and a culture of collaboration and care.

That is a tall order. But it can be done and it starts from within. The panel concluded with remarks from Dr. Hammer on personal resilience. Each of us must have a program in our own lives to promote a sense of happiness – based on mindfulness, peace, and rest. We see human suffering daily but we are blessed to be able to help. We may occasionally feel overwhelmed, but we are better off spending as much time as possible in the present moment.

How can we learn to be present? Be non-judgmental. See things as they are. Remind yourself that you are not expected to know all the answers nor are you able to change everything. Forgive others as well as yourself. If you need help getting started on practicing being present in the moment, Dr. Hammer recommended taking a look at the YouTube videos of Jack Kornfield or dipping into the work of Jon Kabat-Zinn.

The panelists wisely concluded responsibility for our own wellbeing lies within, yet physician and staff wellness needs to be as much of a priority as turnover time and improved patient outcomes.

*Coverage of the Panel, Physician Wellness in Hospital Medicine: Thriving, Not Simply Surviving