Your Doctor Has Feelings Too: Why We Should Care About Physician Burnout

This article is part of LinkedIn's?Hard?Cases?series, where healthcare professionals share their stories working on the frontlines of the COVID-19 pandemic. You can see more articles?by following hashtag #HardCases.

There is nothing quite as humbling or emotional as assisting in the delivery of a child for first-time parents. But the line between joy and despair is narrow. Some experiences as a physician stick with you throughout your career—and this was one of them for me.

The young parents whose delivery I was attending were a delight. The first hours of labor were filled with happy conversations and nervous excitement. I relished getting to know the young couple, learning about how they met and their plans for their new life as a family. Like clouds passing in front of the sun, our joyful delivery room turned dreadfully serious and quiet as the midwife and I began navigating unexpected complications. Time stood still as we tried every possible intervention and followed delivery protocol, yet we were unable to save the child. Reflecting on that day, more than twenty years later, I can feel the anguish as though it occurred yesterday.

Watching these young parents, with whom I connected personally, experience a life-altering tragedy left me feeling devastated. Despite doing everything we could medically, I felt responsible for the stillbirth and withdrew from everyone around me. For days, I missed obligations and turned away a well-intentioned mentor who showed up at my home to check on me. In my grief, I learned that the parents would be hosting a memorial service for their child. As someone who felt emotionally connected to the family, I wanted to attend the service and pay my respects; yet as a physician, my colleagues advised me to remain professional and let my patients grieve in private. I didn’t end up attending the memorial service; rather, time and the support of family and friends helped me recover from this traumatic case. The pain of this experience is hard to forget, and those feelings of guilt, misplaced as they surely are, are seared into my brain.

In retrospect, this tragic incident had substantial impact on me because it exacerbated already accumulating burnout—an occupational syndrome characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment at work. [1] Physicians are especially susceptible to experiencing burnout due to the nature of our work environments. On a regular basis, we must make high-stake decisions that can significantly alter the course of someone’s life. Most physicians have incredibly demanding schedules filled with constant emotionally complex interpersonal interactions, frequent on-call duties, excessive workloads, and administrative burdens such as managing electronic medical records, ordering labs, prescribing medications, and navigating bureaucratic obstacles. Physicians, including myself, often become emotionally invested in the welfare of our patients—we care deeply and are affected deeply, especially if a procedure or treatment is unsuccessful.

If left unaddressed, burnout can have truly terrible consequences. Studies suggest that physician burnout can contribute to broken relationships, problematic alcohol or drug use, and suicidal ideation. [2,3,4] Additional research shows that the number of physician suicides is more than twice that of the general population, and particularly high among females. [5] Some 300 physicians are lost to suicide each year—every one of those a preventable tragedy. [6] Burnout may also negatively impact the quality of patient care. When physicians are feeling burned out, they are more prone to making medical errors and receive low patient-physician satisfaction scores. [7,8] Burned out professionals can contribute to a difficult work environment for others around them. Physicians may even quit the profession altogether or retire early as a result of burnout—and our society misses out on the contributions of these highly skilled and often compassionate people.?

So what can be done when physicians, dedicated to alleviating suffering, are suffering from their work? As a starting point, it’s important to remember that burnout is not a personal or professional weakness or a physician’s “fault.” Burnout is a syndrome caused by the work environment—rather than blame the worker, we must instead reevaluate the conditions of the workplace and the work. A discussion paper from the National Academy of Medicine suggests that building resilient organizations is an important step in supporting physician wellbeing. A resilient organization will provide resources that meet the demands of the job, offer a connecting and supportive culture, and commit to physician wellbeing as an organizational priority. [9] Resiliency is expected of our physicians and should also be expected of our healthcare institutions.??

Continuing medical education (CME) has an important role in building resilient organizations and supporting physician wellbeing, which has become increasingly relevant throughout the COVID-19 pandemic. CME offers learning environments and experiences where physicians can discuss difficult cases, learn new techniques, and share feedback, support and advice. The intellectual growth physicians gain from engaging in professional development can be a sustaining force that can help prevent several of the elements of burnout.

CME can also bring people together with their peers and with their teams. Collaborating as a clinical team helps to foster a sense of community and mutual respect—a team that learns together is resilient together, resulting in higher quality patient care. As president and CEO of the Accreditation Council for Continuing Medical Education (ACCME), I have had the privilege of witnessing firsthand the convening power of education to support caring and compassionate healthcare teams. CME can help illuminate the signs and symptoms of burnout and encourage teams to look out for and support one another, before it’s too late.

The COVID-19 pandemic has prompted many to wonder what the future of healthcare will look like. More than ever, physicians need resilient work environments and collaborative learning opportunities that offer connection and professional growth. Twenty years ago, I was traumatized by a stillbirth that almost led me to leave the profession entirely. My hope is that the next generation of physicians will be welcomed into healthcare organizations that value and invest in them and their wellbeing—our lives may literally depend on it.

# # #

References

[1] Maslach?C, Jackson?S, Leiter?M.?Maslach Burnout Inventory Manual.?3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996

[2]????Shanafelt?TD, Sloan?JA, Habermann?TM.?The well-being of physicians.??Am J Med.?2003;114(6):513-51912727590

[3]????Oreskovich?MR, Kaups?KL, Balch?CM, et al.??Prevalence of alcohol use disorders among American surgeons.??Arch Surg.?2012;147(2):168-17422351913

[4]????Shanafelt?TD, Balch?CM, Dyrbye?LN, et al.??Special report: suicidal ideation among American surgeons.??Arch Surg.?2011;146(1):54-6221242446

[5]????American Psychiatric Association (APA) 2018. Abstract 1-227, presented May 5, 2018.

[6]????Center, C., Davis, M., Detre, T., Ford, D. E., Hansbrough, W., Hendin, H., Laszlo, J., Litts, D.A., Mann, J., Mansky, P.A., Michels, R., Miles, S.H., Proujansky, R., Reynolds, C.F. 3rd, Silverman, M. M. (2003). Confronting Depression and Suicide in Physicians. JAMA, 289(23), 3161. doi:10.1001/jama.289.23.3161

[7]????Moss M., Good V.S., Gozal D., Kleinpell R., Sessler C.N. An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health Care Professionals: A Call for Action. Am. J. Crit. Care. 2016;25:368–376. doi: 10.4037/ajcc2016133.

[8]????Wright A.A., Katz I.T. Beyond Burnout—Redesigning Care to Restore Meaning and Sanity for Physicians. N. Engl. J. Med. 2018;378:309–311. doi: 10.1056/NEJMp1716845.

[9]????Sinsky, C. A., L. Daugherty Biddison, A. Mallick, A. Legreid Dopp, J. Perlo, L, Lynn, and C. D. Smith. 2020. Organizational Evidence-Based and Promising Practices for Improving Clinician Well-Being.?NAM Perspectives.?Discussion Paper, National Academy of Medicine, Washington, DC.?https://doi.org/10.31478/202011a