American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Burn Bright II: Reflections on Solutions to Burnout (Part Two of a Two-Part Series)

 

There have been many published studies describing the current epidemic of burnout among physicians, but there are far fewer with solutions to the problem. Different approaches have been tried, but few have shown a significant impact on burnout or improved wellness among physicians. Nevertheless, the few published studies of solutions present some promising strategies for addressing the problem. The most effective interventions include leadership or system-wide changes. A systematic review and metanalysis showed that interventions directed at individuals reaped small benefits that were often increased in the setting of system-wide organizational approaches.1 In order to make meaningful change in the culture of medicine, toward a profession where burnout is a rarity and not an epidemic, a comprehensive approach that effects change at all levels of the system is required.

Bohman et al2 describe the 3 interwoven areas of well-being: personal resiliency, clinical efficiency, and a culture of wellness. This model recognizes the interconnection between our capacity to weather stress, our clinical work, and the impact of our work environment on overall well-being. In this second article on burnout and well-being, we will describe actions that can be taken at the personal, occupational, and organizational level to reduce burnout and increase resiliency, engagement, and satisfaction.

Personal

The mantra of “physician heal thyself” has never been more relevant than it is in the context of today’s burnout crisis. In order to optimally care for others, we must be in our best state of health. This includes taking care of our basic health needs: seeing our own personal physician, getting physical exercise, eating nutritious food, getting proper rest, enjoying healthy relationships within our families and community, and last but not least, nurturing a sense of meaning in our lives. Getting rest is one of the hardest to employ. As physicians, our culture values hard work, even at the expense of our own rest. We each have different needs for sleep and rest, but after intense periods of work, we need to rest and restore our physical, mental, emotional, and spiritual selves. Some of this rest is in the form of adequate quality and quantity of sleep, yet it also encompasses the need to reconnect with what we enjoy and makes us feel re-energized. This is often difficult, as many aspects of our nonwork life can be equally demanding: caring for family members, our own health issues, and challenges in personal relationships, just to name a few.

Resiliency is the amount of “give” we have in our reserves. When a tree is blown by a fierce wind, a resilient tree is more likely to bend and bounce back to its original position, rather than snap. Medicine is one of the most stressful and demanding professions; it often involves a series of intense experiences. We work with patients in their most vulnerable and emotionally intense moments of illness, deal with matters of life and death and hold space for others’ suffering. Simply trying to reduce or remove the stress is not possible or realistic, given the inherent nature of the profession. The goal is to remove any unnecessary added stressors and to meet the stress with as much resiliency as we are capable of. Our resiliency in a given moment varies depending on the number and nature of other stressors acting upon us. However, there are skills, behaviors, and practices that can enhance our ability to “spring back” rather than “snap” in response to stress. Several studies have described practices that we can employ to increase our own resiliency.

Connecting to purpose and meaning in one’s work has been shown to increase resiliency and reduce burnout. Jager et al3 found that physicians who did not perceive their work as meaningful had higher rates of professional burnout. Strategies for maintaining connection to purpose include keeping nearby a daily reminder of that which brought you to medicine or reflecting on your most meaningful patient experiences when you are questioning your calling as a physician. This can be practiced individually, incorporated within small groups in the workplace (ie, prior to clinical rounds, noon meetings, or the end of a clinic day), or both.

Other evidence-based techniques to decrease burnout include practicing mindfulness or stress management and participating in small group discussions.4 The Mayo Clinic facilitated small group monthly meetings over a 1-year period that improved the sense of meaning and engagement in work and reduced one area of burnout, depersonalization.5 Such small groups, in addition to providing a safe and supportive space to process the challenges inherent tophysicians’ work, also create a stronger sense of community.

As the medical profession has evolved over the past century, the culture of medicine and our interactions with colleagues have also changed, with a significant impact on how we relate to each other. Gone are most physician lounges where colleagues would mingle at lunch, share stories, and hear about each other’s lives and families. Physicians are disconnected from each other in huge buildings, with electronic health records and texting capacity so we don’t need to walk around the hospital to read notes in the chart or even pick up the phone to reach out to the specialist who is consulting on our patient. Having frequent interactions that allow for sharing and connecting can make a significant difference in our sense of resiliency. Creating community and connection in large and small practice settings allows for sharing and can make a significant difference in our sense of well-being.

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-Mari Ricker, MDa, Noshene Ranjbar, MDb

-This article originally appeared in the April issue of The American Journal of Medicine.

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