________________________________________________________________________ Burnout in Physicians
Make Self-Care a Priority Self-care involves several universal lifestyle measures, such as healthy eating habits, exercise, sleep, and regular health care. The results of studies and surveys have shown that physicians who maintain a healthy diet and follow the Centers for Disease Control and Prevention guidelines for exercise are less likely to be burned out [31; 92; 96]. Physicians who have successfully avoided burnout recommend self-care as a strategy, with physi- cal well-being ranked as the most common strategy (60%) in a small study of hospice and palliative care physicians [93; 94]. Attention to self-care should begin in medical training, and one program was developed to help second-year medical students focus better on personal behaviors, such as exercise, eating habits, sleep, and emotional health. The students were asked to target a specific area for change, set a goal, track their prog- ress toward the goal, and assess their success [97]. Although approximately 50% of the students had not reached their goal by the end of the program, 80% said they were healthier because of the program and 82% said they would use the program again. Such programs during medical training can
Engage in Mindfulness Training Mindfulness is defined as purposeful and nonjudgmental attention to one’s own experience, thoughts, and feelings [101]. Interventions to enhance mindfulness in primary care physicians have led to short-term and sustained improvements in well-being, reductions in indicators of stress and depression, and lower scores on the emotional exhaustion and deperson- alization scales of the MBI [102; 103]. A nine-month interven- tion that involved facilitated physician discussion groups that integrated elements of mindfulness with reflection, shared experience, and small-group learning significantly decreased scores on the depersonalization subscale that was sustained 12 months after the end of the program [104]. Scores on the emotional exhaustion subscale and overall burnout scores also decreased substantially. The intervention improved physicians’ sense of meaning in their work but did not lead to significant differences in stress, symptoms of depression, or job satisfaction [104]. Mindfulness has also been associated with more patient- centered communication and an increase in the number of satisfied patients [101]. Explore Other Interventions Cognitive-behavioral training, physical relaxation (e.g., massage), and mental relaxation (e.g., mediation) may have limited benefit, according to a meta-analysis of interventions to reduce work-related stress in healthcare workers. The study demonstrated low-quality evidence that cognitive-behavioral training, with or without relaxation, reduced stress compared with no intervention, but only after the more than one month of follow-up [105]. Similarly, physical relaxation was most effec- tive one to six months after the intervention. Little evidence supported mental relaxation as a way to reduce work-related stress after up to six months [105]. Develop Efficient Practice Habits As discussed, use of EHRs is a leading source of physicians’ stress and dissatisfaction, and approximately 61% of physi- cians have reported that other staff could perform functions in EHRs [37]. Thus, making documentation a team effort can help alleviate physicians’ electronic burden. In addition, experts recommend that physicians ask colleagues for help in using EHRs more efficiently and that they create templates as a way to semiautomate documentation [98; 106]. Given that a chaotic work environment is associated with high rates of stress, job dissatisfaction, and burnout, eliminating chaos can help prevent stress and burnout [65]. Redesigning work flow can also help; this strategy was associated with sig- nificant reductions in the burnout rate in a study of primary care clinicians working at 34 clinics [107]. Physicians can work more efficiently by standardizing workflows and processes whenever possible, minimizing interruptions by batching nonurgent tasks, and creating patient resources or delegating patient education [98]. Taking mini-breaks during the day gives physicians time to recharge and refocus [108].
help foster self-care as a priority. Improve Work-Life Balance
As noted, work-life balance and work-life conflicts are sig- nificantly associated with job satisfaction and burnout. One challenge in achieving an appropriate work-life balance is that physicians often search for a single solution to solve the prob- lem. Drummond, who coaches physicians on how to avoid burnout, notes that burnout is more of a dilemma and so requires ongoing strategies to ensure finding and maintaining an appropriate balance [98]. Physicians who participate regularly in hobbies, personal interests, and meaningful volunteerism are at lower risk of burnout and are more likely to have higher quality of life [92; 96]. Experts recommend scheduling time each week to pursue hobbies and participate in activities of interest [92; 99; 100]. Participating in hobbies was reported by 40% of physicians as a way they avoid burnout [94]. Other strategies include setting strict boundaries between work and home, making time for friends and family, taking regular vacations, and remaining clear about priorities [65; 93; 94; 99]. Personal relationships and personal boundaries were reported by 37% (each) of physicians as a way to avoid burn- out. As practical advice, Drummond suggests that physicians work with their families to develop a master “life calendar” that includes not only social events such as having coffee with a friend, reading, and exercise, but also all family members’ schedules and special events [100]. Physicians should keep an electronic calendar or take a picture of the calendar with their cell phone, check the calendar when a potential work commitment arises, and learn to say no to colleagues’ requests when necessary.
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