Physician Heal Thyself First

The demands on physicians keep growing—they are not only responsible for assessment, diagnosis, and treatment, they are subject to all manner of related administrative and practice responsibilities. It’s no wonder that they are too busy to step back and periodically assess themselves and what they are doing. They disregard signs of stress and have an apparent lack of concern about their own well-being; eventually some succumb to burnout.

As Director of the Wellness Program at the University of New Mexico School of Medicine in Albuquerque, Gregory Franchini, MD, may have some insight into the reasons for this. In his presentation, Physician Well-Being—Who Cares? at this year’s US Psychiatric and Mental Health Congress, he discussed how a physician’s distress affects his or her patients, the reasons why doctors might become distressed, and what they can do to avoid burnout.

In their book, The Physician as Patient: A Clinical Handbook for Mental Health Professionals, Myers and Gabbard¹ suggest that medical students are, in many ways, a unique group of individuals. They often share personality traits such as discipline, endurance, inquisitiveness, perfectionism, and perseverance. These are all good qualities, but as these high achievers go through medical school and residency, these “good” characteristics may become excessive, resulting in excessive devotion to work, heightened preoccupation with details, and increased perfectionism. One study found that 20% of participating physicians met criteria for obsessive compulsive disorder.²

Stressors come from a myriad of sources: the environment, our body, our thoughts; most are psychosocial and are the result of demands we place on ourselves. It is understandable then, why physicians are at increased risk for stress and its consequences, eg, suppression of the immune system, increased risk of health problems, clinical depression, and burnout.

Galen (130-200 AD) said, “The physician will hardly be thought very careful of the health of his patients if he neglects his own.” A physician’s well-being is strongly linked to patient satisfaction. It affects the patient’s perception of his health care, and promotes patient confidence in treatment and thus enhances treatment adherence.

Until we [physicians] cure ourselves, we cannot hope to cure others.

First, however, we need to understand how to assess burnout and to determine who is most affected by it. The most commonly used validated measure of emotional exhaustion is the Maslach Burnout Inventory (MBI). This screening tool uses 22 questions to identify 3 stages of burnout: emotional exhaustion, depersonalization, and feelings of low personal achievement. Shanafelt and colleagues³ from the Mayo Clinic used the MBI in the first national survey of physician burnout. Their findings may surprise you.

The researchers compared 7288 doctors with matched samples of other professionals; almost 46% the doctors reported at least 1 symptom of burnout. Moreover, the doctors were more dissatisfied with work-life balance than the other professionals (40.2% vs 23.2%). The researchers also looked at burnout by medical specialty. Psychiatrists did relatively well: in the findings for percentage of burnout in 25 specialties, psychiatry came in at #17; and for satisfaction with work-life balance, psychiatry came in at #8.

The results of this survey were sobering because physician burnout can have serious personal repercussions and undermine quality of patient care. The survey showed that the prevalence of physician burnout is disturbingly high and significantly higher than burnout in the other professionals.

What can be done to reduce these high numbers of burnout among physicians?

Most approaches for reducing burnout and promoting well-being focus on stress reduction and organizational changes that include supporting physician autonomy, providing adequate support services, and a collegial work environment, reducing work-home interference, and encouraging a better work-life balance. Unfortunately, these methods are often ineffective, largely because they focus on the symptoms of burnout rather than on its root causes: personality plays a major role in burnout among physicians.

Before something can be done to reduce the high numbers of burnout, the “runaway train” that is the driven physician needs to be stopped. Physicians need to slow down to be able to evaluate what they are doing and to develop a work-life balance. In combination with the well-doctor checkup,⁴ exercise, and a well-balanced diet, meditation—specifically mindfulness—improves concentration and helps the individual recognize that which is most fulfilling and satisfying and will ultimately bring better balance to life. As physicians, you must first care enough about yourself so that you can care for your patients, and mindfulness might just be the means to bring you well-being.

References
1. Myers MG, Gabbard GO. The Physician as Patient: A Clinical Handbook for Mental Health Professionals. Arlington, VA: American Psychiatric Publishing Inc; 2008.
2. Krakowski AJ. Medicine and physicians. Psychiatria Fennica. 1985;16:73-83.
3. Shanafelt TD, Boone S Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;20:1-9.
http://www.ncbi.nlm.nih.gov/pubmed/22911330
4. Franchini G. The Well-Doctor Check-Up: A Ten Point Assessment of Well-Being. Presented at the Osler Symposium; May 14-20, 2011; Albuquerque, NM.