In these days of decreased reimbursement, increased workload, and non user-friendly EMRs, physician burn-out rates can be quite high. Stress, depression, and overwhelming fatigue associated with burn-out can interfere with our ability to care for our patients. If we, as providers, are not emotionally healthy, we are not able to provide the very best of ourselves to our patients. When we allow ourselves to become over extended and over committed without adequate recharge time, we may not be able to respond to a sick patients and their families with much-needed empathy and compassion. Moreover, our congitive skills and our diagnostic abilites may not be as sharp. This can lead to less than our best care. Physician burnout may be the cause of medical errors. These errors can then in turn result in worsening of the burnout…a vicious cycle. Family life may suffer as well. Stresses at work are often transported home in the briefcase and can result in negative interactions with spouse and children–further compounding the pressures that lead to burn out. Several studies on physician burnout have been published and two of the most notable articles are found in Annals of Internal Medicine and in JAMA both in 2002.
How can we identify burnout?
Burnout is defined as emotional, physical and mental exhaustion due to overwhelming prolonged periods of stress. It has been said by Dr Glen Gabbard that physician burnout is the “erosion of the soul”. It is a condition most common in middle age physicians but research has shown that younger MDs are at the greatest risk. Physicians and other health care providers are frequently overloaded with caring for the sickest patients with fewer resources and mounting economic challenges.
As physicians, we are trained to put our own needs aside in the care of our patients, our colleagues and our institutions. From the time we begin our training in Medical School and continue through Internship, Residency, and Fellowship, we are embedded in a culture of selflessness. This makes for great patient care and great partnerships with colleagues but is not a recipe for good care of one’s self. In the medical education culture, overwork and tireless labor is seen as a sign of success or “being a good doctor”. The skewed Life-work balance begins early, at the inception of our medical careers. We tend to push aside our own physical and emotional needs in favor of a compulsive need to work and over-work. These maladaptive behaviors (while excellent for making exceptional grades in medical school and receiving superior reviews in training) can have a detrimental effect on ones professional, personal and family lives.
The first step in dealing with unhealthy life-work balance is to perform an honest self assessment. As physicians, we are taught in training to routinely assess our own clinical perfomances but rarely are we asked to determine how we balance our personal life with our practice of medicine. Ask a few simple questions: Are you happy and fufilled? Have your patient satisfaction ratings remained the same? Do you have a shorter fuse than normal? Are there conflicts arising at home? Has the way in which your partners perceive you changed? Do you take time to laugh? Are you overly obsessed with work and work related issues?
Physicians must come to understand the risks for burn out and talk frankly with their spouse and colleagues and practice administrators about achieving balance. Frank discussions with trusted advisors and family can lead to identification of the early signs of burnout. Just as in medical practice, when we identify an issue or risk factor early we can take actions focused at prevention of the burnout and improve outcome.
How can we prevent burnout?
Just as with preventative medicine we can take action to avoid burnout in our own careers. Work to identify things that promote well being on a physical, emotional, psychological and spiritual level. As I reflecton my own career thus far, I have employed several of these strategies over the years (sometimes without even realizing it). Strategies below are adapted from JAMA 2002: 288; 12, 1447-1450.
1. Identify personal and professional values. Do some soul searching. What brings joy to your life both inside and outside of work? Focus on how to find more of these things and weave them into your daily routines.
2.Engage in religious or other spiritual activities
3. Pay attention to your personal life. Find things that give meaning to life outside of work. Strive for a calmness and sense of wellbeing. Schedule TIME OFF.
4. Spend time with family, friends and engage a supportive partner or spouse. See above Schedule TIME OFF.
5. Exercise regularly. MAKE time to care for your own physical health.
1. Analyse your practice situation and attempt to restructure things in a way that makes you feel empowered and ready for success.
2. Find meaning in your work and set limits.
3. Identify and routinely spend time with a mentor
4. Develop adequate administrative support systems.
In addition to working to identify and prevent burnout in our own lives, we have a responsibility to ensure that our trainees and future MDs do not suffer burnout. Early mentorship programs in medical school and residency are essential. I believe that the concept of burnout should be discussed regularly with trainees so that all can be proactive in prevention.
Always at Risk!
As Physicians, our workloads remain daunting. We will always be at risk for burnout. The key is to strive for the holy grail of the proper Life-Work balance. This balance is individualized for each person and can change over time. We must constantly re-evaluate and routinely self-assess. Prevention is critical. If I am honest, I have certainly flirted with burnout many times during my career. Luckily, I have a supportive spouse who routinely keeps me in check. February tends to be a tough month for many of us. Its cold, dark and often the weather is quite bad. For me, my strategy is to go somewhere warm, rejuvenate, relax and come back to my practice once again inspired and excited to be at work.
On that note, I’ll not be blogging next week. In fact, no tweets, no Facebook , no email. I’ll be sitting under a palm tree, reading a book, getting a tan (wearing SPF 50 of course). BUT, the week after that a new, fresh and more inspired blog entry will likely appear.