Burnout, Patient Care and What Matters in the End

 

Medical burnout is a contentious yet common topic among medical schools, employee human resource departments, and hospital settings across the country. Many graduate programs in higher education have seminars, or potentially even entire courses dedicated to provider wellness and avoidance of burnout.

The topic has careened into the spotlight after years of being pushed under the rug by our entire profession. Traditionally, the role of the health care provider has been to delay our own personal gratification to the benefit of others. To become a provider is a daunting task ; years of schooling, student debt, and innumerable hours of studying, rehearsing, and preparing ourselves to care for patients certainly can take a noticeable toll on us.

The role of burnout was rarely questioned until over the past few years, when our profession started to wake up. We have begun to realize that the stories of overworked surgeons hurling scalpels across the room or berating a medical student for an incorrect answer is not normal, nor is it acceptable.

We have realized that working hundreds of hours per month is not healthy for our physical, emotional, psychological needs, nor does it provide good patient care. As a result, schools have aimed to better prepare their students for a life as a clinician and employers have realized that provider wellness benefits everyone, including patients.

 

What is Burnout?

Our profession continues to struggle to find a way to combat this “burnout”, primarily because we still have difficulty even defining the term.

What is burnout?

What is normal for a clinician to feel when the long weeks blend together?

What do we tell our students who, wide eyed and listening, ask us for guidance when the journey becomes difficult?

Many institutions categorize burnout as a physical, emotional, or spiritual exhaustion that is manifested by a lack of job satisfaction and a loss of sense of purpose. It is estimated that one in three health care providers is suffering from burnout at any given time (Shanafelt 2009). The risk factors for burnout are multifactorial, vary with specialty, but are deeply rooted in our profession’s rigor.

As students, we are expected to absorb insane amounts of information, with each test a chance to fail. As we graduate through didactic into supervised patient care, not only are we still responsible for our medical information, but now applying it to living, breathing patients.

The risk and burden of responsibility is terrifying and overwhelming. Our eyes see horrific things such as traumatic injuries, dying patients, things our loved ones could never imagine.

Many times for students and young clinicians, there is no outlet. After running a code or pronouncing a patient dead, we soldier on into the next room because there is always another patient to be seen. This type of repetitive trauma causes us eventually to detach from reality, depersonalize our patient care, and lose job satisfaction.

 

My Personal Experience with Burnout...

Recently, I had an experience with burnout I would like to share with you. In December, I traveled across the country to Los Angeles to help Andrew with our newest endeavor, a comprehensive board review course aimed to help clinicians and students pass the PANCE.

For me, education is a way for me to decompress and fight burnout. I obtain great personal satisfaction from helping students and the academic portion of medicine.

As I returned after a long flight, I came into my apartment and began preparing for the next clinic day. I had sworn to do no clinical work on this trip, but I knew that going back to work after a few days away, there would be plenty to do.

Patients’ medications would need filled, calls for sinus infections not getting better would need advice, etc.

I swore to myself, I would only do 30 minutes of work.

Even before opening my computer, I received a call from our local emergency room on my cell phone. One of my patients had died suddenly and I would need to fill out the death certificate.

Although technically still on vacation, I felt absolutely overwhelmed. The next day, I arrived to work earlier to catch up on work, prepare for the day, and try to find time in my schedule to squeeze in a few more patients.

It was one of those weeks where I continually felt beat down.

I never truly got caught up on my work. Patients complained to me that I was gone for a few days and they could not see me. Insurance companies declined my prescriptions. I ran low on sleep and a 40 hour week turning into much more.

Patients seemed to blur together. I felt guilty for wanting the day to end and I found myself worrying about all the work I had to do while patients told me about their concerns.

Toward the end of the week, I found myself completely overwhelmed. Leaving my desk to go see another patient, one of our receptionists approached me.

What now?

“I’m sorry. One of your patients is out in the waiting room. She says she needs a minute of your time.”

Upon hearing the name, my heart ached. It was the wife of the patient who had just passed. Dutifully, I walked out to the waiting room.

She smiled a kind yet restrictive smile. She introduced me to her daughter, who was in town for the funeral. She had traveled across the country and was soon leaving the area.

“I wanted you to meet our daughter. She came up for the funeral and heard so much about you. We had to come in so that she could meet you.”

“Thank you for everything you did for Dad, he loved coming in to see you”.

In that moment, it all seemed to fade away. The stress was gone; my feeling of burnout disappeared.

In that touching moment, I was reminded why I am in medicine. To improve lives, prolong lives as best as I can, and provide compassionate care to my patients.

After a few short minutes reminiscing about memories from office visits, they left our waiting room and I went back to my desk. Being a little behind no longer seemed to matter. Having a ton of messages to answer no longer felt overwhelming.

Moving on to the next patient, feeling refreshed, I stood up, knocked on the next exam room door, “Hi, I’m Dan one of the PAs, how can I help today”, realizing that my patient who passed had done more for me than I had ever done for him.

 

Burnout is Tricky...

...because it manifests in different ways depending on the clinician.

For me, I am able to fight burnout by writing these articles, working out, and taking little trips to decompress. Occasionally, medicine overtakes me and on my evening run, I still think of all the work I have left to do, or reflect too much on a patient encounter that could have gone better.

A few times per year, a situation such as the above presents itself and completely recharges me. A patient or family encounter that is so deeply rooted in compassion, appreciation, and human emotion that it washes over all the negatives of medicine. I live for these. They are unbelievably gratifying and remind me why I am in medicine.

What’s your burnout story?

If you are a student, how do you combat the endless hours of studying? If you are a new or experienced clinician, what do you do each day to fight burnout?

What are the experiences, values, etc that make you feel fullfilled?

E-mail us to start a discussion and remember, someone is always listening.

We’re here to help.

Shanafelt, Tait (2009). A Prescription for Preventing Burnout and Promoting Patient Centered Care. JAMA, 302 (12): 1338-1340.