This article is more than 5 years old. Information may no longer be current.
Is fostering resilience and wellness to reduce physician burnout a personal responsibility?
Click Here to Manage Email Alerts
Click here to read the Cover Story, “Burnout levels reach ‘tipping point’ among oncologists’.”
Yes.
As a clinical oncologist, I take full responsibility for cultivating my clinical skills. This includes staying up to date with scientific discoveries and clinical practice guidelines needed for delivering the best possible care informed by evidence.
I also take responsibility for nurturing and cultivating the relational skills that shape my clinical “presence.” I pay as much attention to the conversations with patients and family caregivers as I do to formulating treatment plans and knowing the impact of a good dose of timely reassurance, support and guidance. There is potential for healing in solid therapeutic relationships. This can only happen if the physician is attuned to the needs of the patient, and it is less likely to happen if he or she is stressed or feels emotionally exhausted.
It falls to the physician to stay emotionally well, and it is essential to deliver the best possible performance. Being emotionally healthy allows one to enjoy clinical practice, and to appreciate the rewards of close connections and bonds with patients and families. These relationships and friendships form the rich stories of our professional lives and give meaning to our work.
Staying well requires a consistent effort and commitment to preserving balance between the competing tasks and interests that make demands on our time. Although it sounds straightforward, it is often difficult to get to the gym, read fiction or listen to music. And let us not forget the need for time and space to process complex emotions and make sense of challenging situations. Some physicians are good at compartmentalizing their emotions, whereas others find themselves vulnerable to grief and need to develop their own mechanisms for dealing with loss and sorrow.
Physicians need to take responsibility for controlling their stress and preserving a calm and engaged demeanor in their practice and high degree of professionalism. But they cannot do it alone. In a large practice or hospital, the institutional culture matters, too, and its leadership needs to be respectful and responsive to the needs of its professional staff.
Lidia Schapira, MD, FASCO, is associate professor of medicine at Stanford University School of Medicine and director of cancer survivorship at Stanford Comprehensive Cancer Institute of Stanford Health Care. She can be reached at schapira@stanford.edu. Disclosure: Schapira reports no relevant financial disclosures.
Wellness is a system responsibility.
Patient-centered care is becoming the norm in health care systems across the country. Patient satisfaction scores have risen dramatically in our own system, where 44% of University of Utah providers are now in the top 10% nationally, and 24% are in the top 1%. Although providers and their teams have been going above and beyond in caring for patients, their own satisfaction and well-being seems to be taking a hit. Burnout among U.S. physicians is reported to be 50% or higher, and satisfaction with work–life balance is low. The personal and professional consequences of burnout are significant, and they lead to increased medical errors and higher costs. The epidemic of poor wellness and its consequences has led to calls for the addition of health care worker wellness as a fourth component of the “Triple Aim,” which consists of enhancing patient experience, improving population health and reducing costs.
Provider wellness is a complex problem that requires a multifaceted solution with a strong focus on prevention that does not simply deal with the consequences of the unwell provider. We have turned our efforts to understanding the institutional factors related to provider burnout. Negative risk factors include increasing requirements for documentation, increasing productivity pressure, work hours, perceived lack of appreciation, sense of loss of control or autonomy, poor sleep and physical activity level. Mindfulness programs and resiliency training — both evidence-based approaches to address burnout — might focus on the wrong things, suggesting to providers that they need to better deal with the stresses of medicine. Promoting self-care strategies is important but — as noted by Susan A. Terry, MD, a physician leader in our own system — we must find a way to get physicians off the “hamster wheel.” Promoting a culture of wellness from an institutional perspective — including improving clinic efficiency, team members practicing at top of license, and electronic health records optimization — will improve the health care visit and get doctors home for dinner. According to Robert C. Pendleton, MD, BSc (Hons), FACP, the institutional solution requires we get providers to a place where they are energized with medicine’s challenges, and engaged and aligned with their workplaces.
References:
Bodenheimer T and Sinksy C. Ann Fam Med. 2014;doi:10.1370/afm.1713.
Keeton K, et al. Obstet Gynecol. 2007;109:949-955.
Shanafelt TD, et al. Mayo Clin Proc. 2015;doi:10.1016/j.mayocp.2015.08.023.
Robin L. Marcus, PT, PhD, is associate professor of physical therapy at University of Utah College of Health and chief wellness officer at University of Utah Health Sciences. She can be reached at robin.marcus@hsc.utah.edu. Disclosure: Marcus reports no relevant financial disclosures.
Brad Poss, MD, MMM, is professor of pediatrics and associate dean for graduate medical education at University of Utah School of Medicine. He can be reached at brad.poss@hsc.utah.edu. Disclosure: Poss reports no relevant financial disclosures.