I was born in Québec, the last of a family of six. My father was a family physician in a small community, and his office was in our house. I remember that the practice was busy, with lots of kids crying at night. At the hospital, he would perform minor surgery, like an appendectomy. And he and the health care team enjoyed their work. There was no EMR, data was easy to capture, the ER was never overwhelmed, and patients were very satisfied with their care. There was no such thing as physician burnout. Growing up in this atmosphere, my three siblings and I chose medicine as our future life. Now fast forward to our current day. What is the matter with all of us? Surveys vary but state that around 50 percent of physicians have at least one symptom of burnout. We are exhausted — but from what? We’re exhausted from a system that is continually adding more technology and more advanced medical knowledge. We’re exhausted by perfectionism and lack of self-care. (Ha! Self-care: Such a simple notion that surrounds us and keeps our body and mind healthy.) This accumulation of data, information, and stress sometimes becomes the personal narrative that drives us to burnout and mental disease. This could potentially all be preventable by simply allowing the mind to share this long-term accumulation of thoughts with a thinking partner — in other words, a coach. We accept that athletes have coaches — someone who takes someone from where they are to where they want to be. Why is it that we think we don’t need help to do our best? It seems that once you decide to take the path of medicine, there is no need for a coach. But having one might prevent burnout and help you focus on self-care. But if you only coach one individual in a team, will it really produce the optimal result? You must coach the entire health care system to have an impact. In 2007 the Institute for Health care Improvement (IHI) established the triple aim of: improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care. A great concept, yet the population continues to be unhealthy, and we continue to feel the burden of this deeply. Some suggest that two important elements are missing from this triple aim: preventing physician burnout individual patient engagement These should be considered the fourth and fifth goals. Physician burnout is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment. Physicians often develop burnout incrementally due to chronic increases in stress, inefficiency and excessive workload. Physician burnout creates an unsafe environment and can be contagious among team members. Increased productivity requirements and expectations contribute to burnout. And the most frightening fact is: Approximately one physician commits suicide each day in the United States. We discuss/write/evaluate the problem substantially, yet the action is not there. We attempt to define what or who is responsible. But is this all there is? Let’s talk about patient engagement. Is it possible that the health care system could be overwhelmed because of our unhealthy behaviors putting extreme pressure on the system and the providers? If this was a team effort where the patient is incentivized to take care of their health, then the provider would see them when there is true sickness? Let’s be real, a day in a primary care office today is mostly filled with patients that have a chronic disease. Let me emphasize that 80 percent of chronic disease is related to our lifestyle and therefore has no reason to exist. Chronic diseases are preventable and reversible. As a society, we are paying a substantial amount of money for our health and have no motivation in an engagement model. I pay my insurance and the health care system takes care of me. Why would I make an effort? The smoker with diabetes type II and HTA pays the same premium as the individual that has paid attention all their life to health. In that sense, the value-based model will never encounter success, and we will continue to put excessive pressure on the system fueling burnout. In this scenario, the health care system is taking care of a significantly unhealthier population than when my father was in practice. We, as physicians and leaders, are trying to figure out how we can work on this together. Yet we both have not signed on to this contract. This business is much bigger than we can deal with at present. If we want to impact our health care system, we need to rebuild it with all the stakeholders. Health leaders, including providers, need to align their effort to build a system of well-being, not sickness. It is in our power to change our health, and with that understanding, we can build a system of collaboration of leaders/practitioners/patients/clients. This is where leadership and well-being intersect: Leading toward an ecosystem of the collective impact of leadership and well-being for the administrators/physicians/providers and patients. This is the impact we could make by coaching the health care system to health for the collective good. Elisabeth Fontaine is an obstetrician-gynecologist. Jill Berry Bowen is a hospital executive. Source
