Medicine
Although they probably came as little surprise to physicians who practice primary care, the results of a national survey of physician burnout in the Archives of Internal Medicine earlier this year made headlines in The New York Times and The Atlantic. This study found that 1) physicians are more likely to experience symptoms of burnout than similarly educated workers in the U.S. general population; and 2) physicians on the front lines of care access - family physicians, general internists, and emergency medicine physicians - had the highest rates of burnout.
A Curbside Consultation in the November 1st issue of American Family Physician discussed the distinct but closely related problem of demoralization in a family physician who serves as the part-time medical director for a financially troubled clinic for children with developmental disorders. This physician was forced to accept layoffs of several key staff members without a corresponding decrease in workload:
She recognized the great need of these children and families, and had talked with other staff and administration about additional programs she wanted to develop. She now would have to say good-bye to coworkers and abandon her hopes for a larger and more robust program. She realized that the remaining staff, herself included, would have to work harder, and that she would have less time to spend with patients, the part of the work she found most fulfilling. Patients who needed the most help would, in fact, get less help. ... Over the next week, she became dejected and sad.
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Medicine
Strategies for preventing physician burnout
Although they probably came as little surprise to physicians who practice primary care, the results of a national survey of physician burnout in the Archives of Internal Medicine earlier this year made headlines in The New York Times and The Atlantic. This study found that 1) physicians are more likely to experience symptoms of burnout than similarly educated workers in the U.S. general population; and 2) physicians on the front lines of care access - family physicians, general internists, and emergency medicine physicians - had the highest rates of burnout.
A Curbside Consultation in the November 1st issue of American Family Physician discussed the distinct but closely related problem of demoralization in a family physician who serves as the part-time medical director for a financially troubled clinic for children with developmental disorders. This physician was forced to accept layoffs of several key staff members without a corresponding decrease in workload:
She recognized the great need of these children and families, and had talked with other staff and administration about additional programs she wanted to develop. She now would have to say good-bye to coworkers and abandon her hopes for a larger and more robust program. She realized that the remaining staff, herself included, would have to work harder, and that she would have less time to spend with patients, the part of the work she found most fulfilling. Patients who needed the most help would, in fact, get less help. ... Over the next week, she became dejected and sad.
In the accompanying commentary, Dr. Stewart Gabel connected the often temporary state of demoralization to the more serious and persistent state of burnout:
Demoralization is a state of hopelessness and helplessness that is akin to, but separable from, depression. It is associated with a sense of subjective incompetence, the belief that a person is unable to express his or her values and achieve his or her goals. Demoralization has an existential dimension that is associated with the affected person's experienced losses. ... Moving past demoralization involves remoralization, or the renewal of one's personal values and the activities that stem from these values. ... However, if not addressed, persistent feelings of demoralization are likely to result in or contribute to burnout.
Demoralization is a state of hopelessness and helplessness that is akin to, but separable from, depression. It is associated with a sense of subjective incompetence, the belief that a person is unable to express his or her values and achieve his or her goals. Demoralization has an existential dimension that is associated with the affected person's experienced losses. ... Moving past demoralization involves remoralization, or the renewal of one's personal values and the activities that stem from these values. ... However, if not addressed, persistent feelings of demoralization are likely to result in or contribute to burnout.
How can physicians prevent the demands of practicing present-day medicine from leading them down the road to burnout? An article in Family Practice Management suggested eight ideas, including joining a physician support group; strengthening interpersonal communication skills; and making it a priority to address the spiritual needs of patients and themselves.
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The above post first appeared on the AFP Community Blog.
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The above post first appeared on the AFP Community Blog.
- Helping Primary Care Help The Health Of All Of Us
I recently described how primary care can improve the health of our population – proven by dozens of studies – as well as save significant money. Recently, the distinguished family physician George Rust, MD, co-director of the National Center...
- Can Mindful Communication Protect Physicians From Burnout?
Are mindful clinicians happier clinicians, and do they communicate better with patients? A pair of studies published in 2013 in Annals of Family Medicine aimed to answer one or the other of these questions. Mindfulness, defined as "purposeful...
- The Best Recent Posts You May Have Missed
Every other month or so, I post a list of my top 5 favorite posts since the preceding "best of" list on this blog, for those of you who have only recently started reading Common Sense Family Doctor or don't read it regularly. Here are my favorites...
- Do Practice Culture And Clinician Stress Affect Patient Safety In Primary Care?
Initiatives to reduce medical errors in inpatient settings have found that sustained improvements in safety cannot be achieved by simply exhorting health professionals to “try harder” or making evidence-based care protocols widely available (1, 2)....
- Physician Burnout: Is There Anything That We Can Do?
A recent post by Pauline Chen, MD on the New York Times Wellblogspeaks about the nation-wide epidemic of physician burnout. She quotes a recent study published in the Archives of Internal Medicine by Shanafelt, et al (2) that measured the symptoms of...