Burnout is a popular topic of discussion among health care professionals, but preventing it often eludes us. While burnout is common in many professions, it is particularly present in health care. It is estimated that about half of all physicians in the United States suffer from burnout with numbers rising rapidly. Burnout is associated with detachment from those around us and feelings of isolation. Burnout can lead physicians to lose their ability to empathize with patients and colleagues. Medical errors increase. Their own health, as well as the health of the patients they care for, suffers.
No one argues that burnout is a problem or that we would like to see it reduced. I think what is frequently missing from discussions about burnout is the solution. Additionally, if burnout is on one end of the spectrum, what is on the other?
Resilience is defined as the capacity to respond to stress in a way such that goals are achieved at minimal psychological and physical cost; resilient individuals “bounce back” after challenges while also growing stronger. By building resilience we push back against burnout and create the capacity to address the other component of wellness: the environment that we live and work in that creates stressors that challenge us. We can’t change the fact that this work is challenging and that those in health care will face stressful situations on a daily basis. What we can impact is the excitement and joy of meeting the challenge head on. We can do this, in part, by building resilience.
Building resilience can take many forms. It can be as simple as taking care of ourselves the way we recommend that patients do so for themselves: eat fruits and vegetables and real foods; be physically active, sleep enough, develop strong connections with others, and find ways to manage stress that work for us as individuals. People, physician or not, often feel that they must put others first. Unfortunately, this frequently means that it is even harder to care for others. Delayed gratification can be great when it comes to saving money or getting work done, but it is not ideal for dealing with health. It is important to accept that taking your own health seriously is not a luxury, something to consider when finished with one training program or another. Health is something that must be a primary focus from childhood through old age. In the long term, maintaining health and preventing burnout, requires ongoing vigilance. Balance between many competing demands can be struck by regular consideration of priorities.
Another technique that can build resilience is mindfulness. Mindfulness is defined as bringing non-judgmental awareness to the present moment. This ability is an important asset to patient care and teaching encounters. Physicians with skills in mindfulness are found to have a more patient-centered communication style and their patients are more likely to highly rate not only their communication skills but also their medical care. In addition to the effects on mental health, such as depression and anxiety, mindfulness interventions have been shown to decrease burnout among physicians. Programs in mindfulness can increase a patient-centered approach to care, impacting the ability to listen and respond to patients.
By teaching our trainees and junior faculty how to be in the moment with patients and difficult situations we give them a sense of control, which is essential to wellness. We can also give them the skills they need to feel confident in their ability to handle these situations by teaching them how to effectively communicate when things go wrong. We can further help physicians by training them to be able to recognize when a peer is struggling and needs help.
Some say that we can be too resilient, leading us to take on a never-ending steam of tasks that make us even more burned out. I would say that on the flip side, we are increasing resilience so that we can approach the problems of health care and our day to day jobs head on, figuring out the best way to problem solve and create our own solutions.
Medicine as a profession is changing, and physicians’ roles are changing with it. In order to address physician wellness and prevent burnout, we will need to focus on both the resilience of physicians and the environment that promotes a culture of burnout. Changing the environmental impacts on physician burnout such as workspace and the demands of click boxes and menial tasks can be just as challenging. Because of the nature of physicians (always trying to fix things and be helpful), we are quick to step up when tasks need to be done. This isn’t always the most sustainable solution.
It is time to focus our energy on building a workforce of resilient physicians who feel a sense of power and optimism to create the health care system of the future, one in which physicians work with patients to help design optimal care that meets the needs not only of the patient but of the physician as well.
AMY LOCKE MD/PHYSICIAN NOVEMBER 7 2016