In the United States, burnout is a huge issue for everyone. It affects 28% of the general working population, according to a recent Mayo Clinic report. Even worse, burnout affects 44% to 54% of physicians. This is a scary statistic, since this puts all of our health at risk. “Doctors who report burnout symptoms are twice as likely to commit a medical error.”(Forbes.com)
Even though doctors are battered, bruised, and begging for help, there has been very little noticeable improvement in the physician “burnout crisis”. Dr. Robert Pearl, contributor to Forbes says he has done a good bit of research to try to get to the bottom of what is causing this “burnout crisis” among physicians.
“The American Academy of Family Physicians describes burnout as a condition shaped by exhaustion, lack of effectiveness and compassion or emotional energy.”(PostandCourier.com)
Although most doctors think burnout is caused by a broken healthcare system, burnout actually seems to have three distinct causes, which need attention and action from doctors:
- The Healthcare System
Most physicians, when asked, will say burnout is caused solely by a broken healthcare system, and that the solutions to that problem are beyond their control. They point “to a number of systemic obstacles standing in their way: cumbersome computers, vexing regulations, endless paperwork and long hours at the office.”
Dr. Rex Morgan, an internal medicine physician with East Cooper Coastal Family Physicians, in Mt. Pleasant says that doctors do not like spending hours on a computer; they would rather be taking care of patients. He said sometimes doctors are even working on the computer during a patient’s appointment.
Dr. Pete Zwerner, chief medical officer for the physician’s group at the Medical University of South Carolina said all this imputing data for health insurers and making sure billing codes are correct “take time away from doctors who want to spend more time with patients.”
Insurers say all this required paperwork is supposed to save healthcare dollars by preventing ineffective and unnecessary services.
- Moral Injury
Moral Injury is “a term first used to describe the psychological distress of combat soldiers.”
Doctors experience moral injury when the healthcare system inflicts harm on patients.
An example of moral injury to a physician:
A person starts experiencing dizzy spells. He goes to his doctor, who diagnoses him with vertigo and orders a CT scan. The CT scan comes back inconclusive, so the doctor then orders an MRI. Two weeks go by, and the insurance company still hasn’t approved the MRI. Most of us have experienced similar insurance delays, as a patient.
The patient is highly anxious and unable to concentrate because of the long wait. The doctor feels highly frustrated and helpless because there’s nothing else he can do at this point to provide medical care for his patient.
Now imagine this same type of scenario happening to multiple patients at the same time. This can cause hopelessness, disengagement and depression for the doctor.
- Medical Culture
Dr. Pearl says,
“For the overwhelming majority of medical history, [the medical] culture was constructive. The desire to heal, combined with a righteous sense of mission, guided every clinical decision, even when there was little doctors could do to help patients. For centuries, doctors relied on their experience, wisdom and intuition as the best defenses against disease, injury and illness. Their kindness, empathy and compassion sustained the doctor-patient relationship through history’s most difficult moments. Even today, much of what calls doctors to the profession is rooted in these ancient cultural precepts.”
A doctor was supposed to “always [be] on call, never say no to any request, make your job your priority, and accede to every demand.” In those times, a doctor had to basically be a Superman or Superwoman. Saying no was a sign of weakness and a betrayal of the profession. (kevinmd.com)
However, the medical profession today seems far-removed from this original culture of 2,500 years ago. Transformations in science and society are turning everything upside-down for doctors. Everything is changing quickly, with the invention of the internet, evidence-based medicine and clinical checklists. The “clash between the values physicians were taught and their new reality is producing some of the telltale symptoms we associate with burnout, including disillusionment and despair.”
Examples of these changes:
- Patients are now treated like “consumers” and doctors are being labeled “providers”.
- Patients can now use the internet for medical advice.
- Insurers challenge doctors’ requests for tests and procedures.
Doctors are increasingly resisting these changes in science and society, but are getting nowhere. A mere 40% of physicians today would recommend their career to others.
“Medical culture must evolve in order to address healthcare’s runaway spending and lagging quality.”
Physician burnout has always been a reality, but it was always dismissed; doctors were just forced to deal with it. Now that we know the horrible damages burnout can cause, dismissing is no longer viable.
“In today’s economic climate, any burnout solution that costs more money won’t happen”, says Dr. Pearl. But something has to be done to stop physician burnout.
Some Possible Solutions:
Roper St. Francis Healthcare in Charleston, SC is developing a wellness program for staff members. They suggest doctors find activities like exercising to relieve stress, and that physicians not take paperwork home.
The Medical University of South Carolina Wellness Center in Charleston has opened classes for physicians and students to help with burnout. One of the classes offered is water aerobics.
Dr. Morgan hopes that in the future physicians will be able to delegate paperwork and data entry to administrative staff.
Health care systems across the country are adopting policies to create more responsive, less rigid workplaces for physicians. This will help doctors maintain a healthy balance of work and personal life.
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