Burnout in Physicians _ ______________________________________________________________________
Many physicians do not seek help for stress or burnout because of the belief that these conditions are normal for the profes- sion, an attitude that begins in medical school, with students being advised to push through stress [20; 86]. This attitude leads physicians to believe that if they just work longer hours, the situation will resolve, but working longer hours only exacerbates stress and accelerates the burnout process. In addi- tion, not dealing with stress appropriately may lead to factors associated with stress, such as alcohol abuse, depression, and suicide ideation. Despite the high rates of these conditions, studies have shown that 33% to 60% of medical students and physicians are reluctant to seek help [27; 43; 77]. The reasons for the reluctance are concerns about their medical license, discrimination in hospital privileges and professional advance- ment, perceived stigma, and an inability to take time off from work [27; 43; 45; 87]. To help overcome these barriers, the Joint Commission issued guidelines mandating that medical staff “implement a process to identify and manage matters of individual health for licensed independent practitioners that is separate from actions taken for disciplinary purposes” [88]. The concept of self-care is emphasized in every book or article on preventing job stress and burnout across occupations. Self- care warrants particular emphasis for physicians, as they have been trained to put the care of others ahead of themselves and are not typically good at caring for themselves [89]. Self-care is essential for energizing, restoring, and maintaining the physical and emotional stamina to manage stress and helps increase job satisfaction [6; 44; 90].
The following strategies to prevent stress and burnout are recommended on the basis of studies of interventions as well as guidance from burnout experts and physicians who have successfully prevented stress and burnout. The strategies address changes in personal and professional lifestyle habits. PERSONAL AND PROFESSIONAL LIFESTYLE STRATEGIES Enhance Well-Being The most important first step in preventing stress and burnout is to enhance well-being. Self-care, improving work-life balance, and mindfulness training and other structured interventions are key elements for maintaining physical and emotional well- being ( Table 8 ) [19; 65; 90; 91; 92; 93; 94]. Enhancing physi- cians’ well-being is vital not only to address the consequences of stress and burnout but also to improve patient outcomes. The relationship between physician well-being and patient outcomes is understudied, but a systematic review (18 studies) showed that well-being was associated positively with patient satisfaction, patient adherence to treatment, and interpersonal aspects of patient care [95]. The authors of the review noted that most of the studies were observational and of average quality.
STRATEGIES FOR MANAGING STRESS AND AVOIDING BURNOUT
Strategy Classification
Specific Strategies
Personal lifestyle
Obtain adequate sleep Ensure proper nutrition Participate in regular physical activity
Identify and maintain priorities Schedule adequate vacation time Participate in hobbies and/or volunteer activities Maintain sense of humor Recognize limitations Seek emotional support and practical assistance from family Maintain network of friends
Professional lifestyle
Eliminate chaos in the office or practice Review and redesign workflow Make documentation a team effort Take time away (short breaks) Seek support from colleagues Promote a healthy work environment Become an advocate
Organizational level
Create a healthy work environment Encourage and maintain strong leadership style Engage in participatory decision making, especially with respect to direct patient care Foster good interpersonal relationships among all healthcare professionals Encourage and provide access to training targeted to physician well-being
Source: Compiled by Author
Table 8
77
MDPA2326
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