Today I am writing about an under-appreciated problem in medicine that may impact the health care received by any of us: professional “burnout.”
This condition affects the quality of care by causing medical errors and poor communication in patient-physician relationships. Early retirement of health care professionals, affecting the availability of care, also results. Recent surveys show that over half of physicians and nurses now report symptoms of burnout,1,2
compared to the rate of 28% in the general working adult population. What is burnout, why is it increasing, and what can we do to help?
In the health profession, burnout is commonly defined as distress related to one or more of 3 conditions: exhaustion, depersonalization, and lack of a sense of personal achievement.3
Exhaustion includes being emotionally drained by work as well as physical fatigue, making one feel that work is just too hard. Depersonalization means lack of empathy, compassion exhaustion, or looking at patients as if they are objects. Professionals without a sense of personal achievement no longer feel they are accomplishing anything worthwhile at work. (To take a self-test on professional burnout, go here
Surveys of health professionals point to several causes of burnout. Younger physicians cite the conflict between work hours and personal and family life as a major factor, as well as financial stresses from large medical school loans. Mid-career and older physicians may blame their anxiety and loss of professional fulfillment on the many changes occurring in the medical system. These stressors include less personal control of practice due to increasing corporate, hospital, and insurance interference, which often emphasizes productivity over quality, leading to less time with patients, and impersonal care. Some electronic medical records and reporting requirements, geared to improving payments rather than quality of care, also take time away from patient visits. As for nurses, three-quarters report that stress and overwork from long hours and insufficient staffing is their top personal health concern.2
Burnout is garnering needed attention of late, and both medical institutions and individuals involved with educating and certifying professionals are searching for solutions. The culture of an institution may need to change to help the mental health of its staff; engaging professionals in leadership, rewarding successes instead of just punishing errors, and curbing stigma when help is requested are examples of essential changes. Medical and nursing schools are beginning to teach students preventative strategies before they reach the burnout phase. And recently, the powerful Accreditation Council for Graduate Medical Education held an important symposium, to create a plan of action for all U.S. residency programs, that will foster physician well-being.4
Research shows that training to promote the mind-body connection is a useful strategy to reverse and prevent burnout. But many medical professionals, by virtue of self-selection and Western education, may be awkward mind-body students. We are predisposed to concentrating our minds outside of our bodies, living in a mind-body disconnect, and this perspective is reinforced by the hardships of training. Busy practice also seems to require this focus, so that we can ignore the complaining sensations in our bodies when we are busy or in the operating room for a long case. Even our specialties have traditionally separated the mind from the physical body, like psychiatry and internal medicine.
We also tend to devote our minds to the future instead of the here and now. When I was a resident, I admired one of the senior surgeons. He told me that on his daily morning walks to the hospital, he spent the time reviewing in his mind the surgery planned for the day, everything that could go wrong, and how to handle complications. I quickly made this my own ingrained habit, even if my plans for the coming day did not really require such analysis. One morning a coworker asked how the weather was outside, and I realized I hadn’t noticed, since my mind was only in the future! I think the difficulty of staying connected to our bodies in the present contributes to the high rate of burnout we are experiencing.
In my case, although I saw my chronic pain patients improving with mind-body therapies, I did not think I needed to apply the principles to myself, and besides, I was too busy while in practice, or so I thought. I also imagined that I was immune to burnout, when in reality I had been exhausted for years. It wasn't until I developed an aggressive cancer that I realized I needed to reconnect with my body. The cancer followed the death of my mother after a slew of other family stresses, and my natural self-healing, self-repairing system became overwhelmed. Body and Brain Yoga was the perfect solution for me.
Other antidotes for burnout are simple but key: making time for sleeping, healthy eating, and activities that support self-value and purpose. Dr. Kathi Kemper studies the benefit of self-compassion and mindfulness for medical professionals,5
and has created an on-line course to learn these skills.6
Her new book, Authentic Healing: A Practical Guide For Caregivers
, is a must read for professionals and lay people who want to bring comfort and relieve suffering, but avoid burnout.
Remember the mantra of my 4th article: “Self-care is not selfish, an empty vessel cannot serve.” Please take good care of yourselves!
Alliance for Pelvic Pain Retreat in May 20-22, 2016
I would like to announce that the pelvic pain weekend retreat is this month! It is open to health care professionals, such as MDs. RNs. PTs, and psychologists who take care of people with chronic pain, in addition to patients. Come and de-stress while you learn to care for your patients and yourself, in beautiful peaceful surroundings, with people of like mind. A breakout session will be designed especially for you. Some spots still available!
- Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clin Proc. 2015;90:1600-13.
- Kemper KJ, Mo X, Khayat R. Are Mindfulness and Self-Compassion Associated with Sleep and Resilience in Health Professionals? The Journal Of Alternative And Complementary Medicine. 2015; 21:1-8.