Physicians benefit from support from peers to keep burnout at bay
There is a plethora of writings on physician burnout. The words “physician burnout” have been well disseminated across the health care system. Studies reveal physician burnout could be affecting approximately half of US physicians. Physician burnout is a well-known, albeit, tragic reality in the practice of medicine today.
Four hundred physicians die by suicide every year. A sobering statistic. Many believe the number could be substantially higher. Why would this nation’s brightest and most gifted individuals decide to make an early exit from life? There are as many answers to this question as there are suffering physicians. Each physician, becoming so desperate as to hurt themselves, is a unique individual with a complex and special set of circumstances. For lack of a better term, these physicians cannot be “lumped” together as if all fell victim to the identical malady. We can, however, look at how physician burnout is defined and described and consider that doctors when experiencing burnout may be vulnerable to significant depression. All too often, depressed thoughts seem to travel with suicidal thinking. With treatment of the depression, the suicidal thinking should diminish. Which brings forth the question, are physicians receiving needed treatment?
How has physician burnout been described? Frequently, there is a particularly striking absence of energy, nearly everything an enormous effort. Joy is replaced with sadness. Meaningfulness becomes meaninglessness. Love and passion for the practice of medicine slipping away. Patients begin to be viewed as objects - their human qualities no longer center stage but rather seem redundant, remote, and dissolving. Clinically, physicians often describe a perplexing situation: being at once present when caring for their patients while concurrently feeling removed from the experience. The Maslach Burnout Inventory or MBI is a valid tool used to measure degree of burnout. The more emotional exhaustion, depersonalization and low personal accomplishment present, the higher the degree of physician burnout. The slippery slope from burnout to depression is evident.
Changes to the profession of medicine have occurred at rapid speed. Managed care, the EHR, newly created healthcare provider roles, identity change from “physician” to “provider”, the ACA, diminishing revenue, shrinking private practices, increased hospital employed physicians, loss of autonomy, working in silos, increased isolation, fears of and facing litigation, and regulatory rulings that once understood seem to change – are just a few of the stressors affecting physicians. With the enormity of changes physicians are enduring, a sad commentary has emerged. Physicians are describing feeling objectified or depersonalized by the very individuals that once held them in high esteem: hospital administrators, practice administrators, nurses, NPs, PAs, ancillary staff and to an extreme, litigators.
What are the consequences of physicians being objectified? According to Immanuel Kant’s system of ethics, the practical imperative affirms that people should always “act in such a way as to treat humanity, whether in your own person or in that of anyone else, always as an end and never merely as a means.” Looking through the lens of Kant’s practical imperative, let us now consider the ramifications of treating physicians merely as a means. While most people would agree that treating physicians merely as a means for financial reasons may not be entirely ethical, physicians are commonly treated merely as means to provide patient care. Many well-intentioned people, physicians included, may be inclined to agree that physicians are merely means for improving the health of patients. Kant, however, was clear that it is never morally appropriate to treat anyone merely as a means. Doing so would deprive them of their dignity. One reason why Kant felt so strongly about this point is that, unlike inanimate objects which have only instrumental value, humans, as rational and willful beings, are themselves universally good and, are therefore, are always ends in themselves. By treating humans merely as means deprives them of rationality and will and thus, diminishes their capacity to act as moral agents. It is an ironic reality, therefore, that treating physicians merely as means to improve patient health deprives physicians of their own moral agency and thereby makes them less likely to treat their patients as ends in themselves. After all, if physicians are being depersonalized is it not going to be more likely that they will depersonalize in kind? No one would deny that it is every physician’s responsibility and goal to direct their efforts to care for their patients. The point is that if those managing healthcare systems and other institutions start treating physicians (and all employees for that matter) as ends as well as means we may begin to see that we will get the best of both worlds – high quality care from physicians who are also treated with human dignity.
As it stands, however, many physicians feel trapped in a system that does not care about them. Fortunately, concern for this nation’s physicians is getting the wakeup call long overdue. Burnout has now been recognized at being at epidemic proportions. Government and state-wide organizations are openly discussing and exploring solutions to the burnout crisis. The World Health Organization release of the ICD-11 recognizes burnout as a syndrome related to workplace stress and limits the phenomenon to specifically the occupational environment.
What has been long understood is the need for physicians to have outlets for the often-unbearable stress they handle daily. Physicians receive the greatest relief from their suffering by talking with other physicians. The understanding that occurs between doctor to doctor is exceptional. No one knows better than another physician what it is to bring life into the world and to be there when a patient takes the last breath. When physicians speak with each other, the often-disabling sense of isolation, rapidly diminishes. Exhaustion decreases. Joy begins to return and replace sadness. Meaninglessness fades and soon the meaningfulness of life returns. The patient becomes center stage again and the heart of the doctor once again embraces the life of the patient.
In closing, physicians are fortunate to be insured at the company we work for, Physicians’ Reciprocal Insurers. PRI has long been out front in promoting physician wellness. Decades ago, PRI began integrating the devastating impact of medical malpractice litigation upon doctors into their Physician Education Program. Seven years ago, we created a Physician Peer Support Program under the tutelage of Jo Shapiro, MD from Brigham and Women’s Hospital, the internationally renowned hospital of excellence and a major teaching hospital for Harvard Medical School. Why did we turn to Dr. Jo Shapiro? Because we wanted our physicians to be supported in their time of need by the very best help available in the profession. We invite you to view this video of Dr. Shapiro:
https://www.pri.com/education/pri-interviews-dr-jo-shapiro-on-the-impact-of-physicianpeer-support