Physician offers Rx to peers on avoiding burnout at work
Nearly half of physicians report they have experienced at least one symptom of "burnout" during their career. Work hours are long, difficult and emotionally draining. Primary care, emergency room and critical-care physicians report the highest rates of burnout, but exhaustion is reported by medical students and residents, too.
Dr. Christina Surawicz, a UW Medicine gastroenterologist and University of Washington professor of medicine was invited to discuss burnout at the annual meeting of the American College of Gastroenterology, an organization she led as president in 1998-1999. She subsequently spoke about the issue with writer Michael McCarthy.
Q. What is burnout?
A. The term “burnout” was coined by the psychologist Herbert Freudenburger in the 1970s. He defined it as a “state of mental exhaustion caused by one’s professional life.” The paradox is that the people who are the most prone to burnout have the traits that you want to see in a healthcare provider: idealistic, dedicated and hardworking. They push themselves hard, they put their patients first, but they also often fail to take care of themselves.
Burnout has three components: first, emotional exhaustion, a feeling being overextended and overworked; second, a decreased sense of personal satisfaction; and, third, depersonalization, a tendency to become unfeeling and callous toward your patients and co-workers, to think of them as objects rather than individual human beings. For example, you might catch yourself saying, “I have one more ‘colon’ to do” instead of “I have to see my patient who needs a colonoscopy.” Now, doctors often use the name of a procedure as a kind of shorthand, but when we stop thinking of our patients as people and start thinking of them as diagnoses and procedures, then we have a problem.
Q. What causes burnout?
A. A survey of surgeons found that two major factors associated with burnout are long hours and more nights on-call. That survey found that the more hours a surgeon worked per week, the greater the risk of burnout. Conflicts between a physician’s home life and work obligations are also associated with burnout, particularly when work obligations win out over the physician’s family obligations. Surprisingly, burnout is more common during the early years of practice, perhaps because after all those years of training you find you’re not happy with the life you're living. Physicians who burn out are more likely to develop problems with depression, substance abuse and they may be more prone to medical errors. They may also become more difficult to work with, they often receive lower patient satisfactions scores, and many leave the profession early.
Q. What can be done to prevent burnout?
A. Tait Shanafelt, who directs the Mayo Clinic's Department of Medicine Program on Physician Well-being, recommends three steps:
- Identify and balance your personal and professional goals.
- Actively shape your career to emphasize what is meaningful to you and to reduce stressors.
- Take steps to promote your own wellness.
The first step is perhaps most important. You have to step back and take stock of your life. What are your personal and professional goals? What’s most important to you in your personal and work life? Are they in balance or do they conflict?
Once you’ve identified your goals, identify where they conflict. Often it’s a question of time. Long hours at work are a major factor in burnout and common cause of work-home conflicts. So ask yourself: Are you spending too much time at work and not enough time with your family or doing the things you enjoy?
It’s important to take control of your schedule, to work reasonable hours and to take a day off when you need to. Work with your co-workers to make the hours you work more flexible. Set up a backup plan so someone can cover for you when your child has a dance recital. Senior physicians may need to step up and offer to cover for younger physicians who have young children or other important needs. In some cases, the answer may be just to decide to work fewer hours, even if it means less income. Sometimes the answer may be a change in career.
Finally, people should adopt wellness strategies. Nurture your relationships, and take care of yourself: Get enough sleep, exercise and take your vacations. Another option can be practicing mindfulness techniques. These techniques help you be in the moment and not be distracted by what just happened or what might happen next. It can be as simple as stopping at the door before you go in to see the next patient and taking a deep breath to clear your mind. Then when you go into the exam room, you’re not thinking about the patient you just saw or the patient you'll see next but the patient you are seeing now. Several studies have shown that mindfulness training has improved both patient and physician satisfaction.