This should be a no-brainer: you don't want your doctor to feel burnt out, fatigued, or depressed. Otherwise, he or she is more likely to make mistakes, as a study just published in the Mayo Clinic Proceedings found. What is also a no-brainer, meaning that no brains are being used, is why our health care system, including the medical profession, and society are not doing much more about this growing problem. After all, wouldn't you be alarmed if the person who is flying your airplane or handling a large amount of uranium started muttering about being just too tired to function or wanting to end it all? The recently published study involved surveying physicians from August 28, 2014, to October 6, 2014, about burnout, fatigue, suicidal ideation, the safety of their work units, and recent medical errors. A team from Stanford University (Daniel S. Tawfik, MD, MS, Daniel S. Tawfik, Jochen Profit, MD, MPH, PhD, and Tait D. Shanafelt, MD), the American Medical Association (Christine A. Sinsky, MD, and Liselotte N. Dyrbye, MD), and the Mayo Clinic (Timothy I. Morgenthaler, MD, Daniel V. Satele, MS, , MHPE, Michael A. Tutty, PhD, and Colin P. West, MD) conducted the study. The results were depressing. Of the 6586 physicians who responded and provided enough information, a majority (3574 or 54.3%) reported burnout symptoms, nearly a third (2163 or 32.8%) reported excessive fatigue, and several hundred (427 or 6.5%) reported thoughts of suicide recently. This was not good for potential patients, like you, as 691 (10.5%) reported a major medical error in the prior 3 months. Those who reported errors were significantly more likely to have symptoms of burnout (77.6% vs 51.5%), fatigue (46.6% vs 31.2%), and recent thoughts of suicide (12.7% vs 5.8%). Combining all of these, physicians reporting making errors were over twice as likely to have reported burnout and 38% more likely to have reported excessive fatigue. Sure the study had limitations. It relied on physicians reporting about themselves without verifying information and surveyed only a sample of physicians and not all physicians. But quibbling about the limitations of this study would be like arguing with the deck chairs on the Titanic and missing the bigger picture. The findings make sense. For nearly every job, performance depends on health, unless your job is to get sick. In fact, the study probably underestimates the number of medical errors and the feelings of fatigue and burnout. After all, how many people are willing to admit, "I screwed up really badly," especially when a lawsuit may be a sneeze in the wrong direction away. Moreover, many physicians can be remarkably self-unaware, working themselves into the ground before saying, "a little help here please." Moreover, since the 1990's, there's been news about increasing physician dissatisfaction, burnout, and suicide. For example, four years ago, in 2014, my former business school classmate Daniela Drake, MD MBA, wrote a piece for the Daily Beast entitled, "How Being a Doctor Became the Most Miserable Profession," which included the statistics that "9 of 10 doctors discourage others from joining the profession, and 300 physicians commit suicide every year." Pam Wible, MD has been an advocate for bringing more attention to the concerning number of physician suicides and has written that the problem is not only being ignored but covered up, such as a piece on the website KevinMD entitled: "A physician suicide: covered up with a tarp and silence." Here is a TEDMED talk from Wible: Why then hasn't more been done to address this problem? Why isn't this being tackled with more urgency? Maybe you think that it doesn't affect you. But if you do, you are wrong, potentially dead wrong. As this Mayo Clinic Proceedings study suggests, your doctor's well-being can significantly affect the quality of your care. To paraphrase what one of my friends says, someone who doesn't have a life preserver himself or herself may not be well equipped to rescue you from drowning. Moreover, disgruntled doctors may be more likely to leave a practice, making it more likely for you to have to play doctor roulette every time you need care. And I just wrote for Forbesabout the importance of continuity of care. What should be done? Well, you can blame the victims, which would be like yelling at animals when they are trapped in an oil spill, or just hold wellness lectures and distribute wellness pamphlets. But blaming the victim only works when you don't want to solve a problem and to my knowledge pamphlets alone have never solved any major problems unless your problem happens to be having excess paper. Therefore, the only real solution is to address the broken systems that are causing these problems. How do we address these systems? Here are some possibilities with an emphasis on the word some: Review and improve management: People, including doctors, are smart and perceptive. They can tell when the leaders of an organization, department, or other unit of the organization do not have genuine interest in them as people or knowledge of what they actually do. An effective leader needs to have management abilities, a real understanding of medicine and patient care, and genuine concern for employees. Increase diversity in leadership: Leadership should reflect the diversity in medical schools, training programs, and the health care work force. Otherwise, leadership may not be able to relate to the perspectives that people from different backgrounds have. For example, you may not be able to understand discrimination and harassment (and how to best address them) if you haven't experienced them yourself. Identify and eliminate tactics that create poor mental health environments: This includes bullying, harassment, intimidation, rumor spreading, and other such tactics. We see how quickly people may try to label their political adversaries as "unhinged", "crazy", or "nuts", which may seem like a great way of discrediting adversaries in a vague, unverifiable way. However, using mental health as a weapon simply increases the stigma of mental health issues and makes it harder for physicians who really need help to actually seek it. Clean up the environment: Here environment isn't referring to the rivers, air, and forests around us, although they need cleaning as well. Rather it's referring to the working environment, including the cleanliness, Feng Shui, and physical layout of clinics and hospitals. Include physician satisfaction and well-being as quality of care measures: In a piece on the KevinMD website that serves as a blog for doctors who want to speak their minds (or at least write their minds), Joshua Sonkiss, MD, a psychiatrist, raised an interesting point. Nowadays, the Centers for Medicare and Medicaid Services (CMS) and other regulator bodies require hospitals to report on various measures such as those on patient satisfaction and patient safety issues (which of course is good) but not about physician well-being such as physician satisfaction, turnover, and complaints. This makes absolutely no sense or cents. Imagine a football team paying attention to other things but not how the players and the coaches are doing and feeling. Change reimbursement models to account for physician well being: Cyndi Lauper once sang, "Money Changes Everything." For many years, there has been too much emphasis on physicians' procedural and technical skills as reflected by the direction of insurance reimbursement compared to their other skills and abilities. Identify, alleviate, or even eliminate things that are causing physicians stress: Too much paperwork. Having to see too many patients. Fifteen minutes is too short a time to interview and examine a patient. Too little time off. Patient care is too much like being on assembly line. Too many "too's" may be making clinical medicine too unpleasant for too many doctors. Re-design medical education, training, and workplaces to encourage and support mental well-being: The culture of medical training and practice in many places need to change. Encourage physicians to complain more: Not vague, grand, general nonconstructive complaints such as "this stinks," "don't go into medicine," "we need a single payer system," or "should have been a park ranger instead." But rather much more specific complaints that can help the general public. Patients will want to know if physician turnover has been over 50% in a clinic or if a majority of doctors are dissatisfied with a particular hospital. They should know if doctors are forced to spend only 10 minutes per patient because the clinic wants to make more money. It is important to convey that the physician work room has not been cleaned in a month or no allowance for continuing medical education is provided. Again these are just a few possibilities. It is important to remember that doctors are not robots on an assembly line or apps on a smartphone. They can't do it all. To effectively take care of others, they need to first and foremost have the opportunity, support, and means to take care of themselves. Source
