Physician Wellness Beyond Words— Advocating Wellness in Practice

PReRna mewawalla, mD

Physicians serve as the backbone of our communities and are responsible for treating people and helping them feel better every day. However, the immense pressure of treating patients, making life changing decisions, managing heavy workloads, all while trying to balance family life can lead to extreme burnout. The World Health Organization (WHO) defines burnout as a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: (1) feelings of energy depletion or exhaustion; (2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and (3) reduced professional efficacy .

Physicians experiencing burn-out and feeling depleted in their personal and professional lives is not just their individual or family problem. This is a broader societal issue, given that physician burnout is linked to worse patient outcomes. A study published in JAMA Internal Medicine found that burned out clinicians were twice as likely to report a recent medical error compared with those who were not burned out . Burnout has also been linked to a higher risk of medication errors, detachment from patients leading to reduced patient satisfaction, lower productivity, and increased healthcare costs.

Physician burnout is very common across the board. Women physicians are even more likely to experience burnout compared to their male counterparts. 63% of women and 46% of men physicians reported being burnt out in 2022 . Factors such as being a primary caregiver, having more responsibilities on the personal front, gender discrimination in the workplace, pay disparities and disproportionate job demands may contribute to this. Additionally, women physicians may also experience bias and scrutiny related to their appearance, personality, and communication style, which can contribute to feelings of isolation and dissatisfaction with their work. Some physicians may also be subject to unconscious or sub-conscious bias due to their gender, ethnicity, age, sexual orientation, etc. which further creates a negative environment and exacerbates burn-out.

It is imperative to identify factors that fuel burnout among physicians leading to deteriorating well-being and wellness. It is important to not only address the symptoms of burnout but also focus on prevention and addressing the root causes. Burnout is a psychological syndrome that is caused by chronic workplace stress. One of the primary reasons for physician burnout is the excessive workload they face daily. Physicians have to manage large patient populations and they are making life altering decisions every day. Additionally, significant time is also spent on documentation, reviewing patient results, responding to patient messages via EHR, coordinating with other healthcare professionals, and dealing with administrative tasks outside of patient care. Most employers do not give physicians enough time to do all the tasks they need to do aside from seeing patients so they can maximize their billing time. In the current environment, many hospital systems across the nation have experienced financial losses due to increases expenses, lower elective patient volume, etc. This is creating even more pressure on physicians to see additional patients and increase billing revenue.

We often hear of hospitals or employers trying to initiate programs to help physicians who are already burnt out. But organizations do little to take precautionary measures to prevent burnout from occurring in the first place or to at least make meaningful interventions when there are early signs of burnout. So, what can be done to decrease physician burnout? One of the most important resolution areas that always comes up in physician surveys is having work flexibility. Being a physician requires long hours at work, leaving limited time for family or hobbies. Therefore, healthcare institutions can implement flexible working hours, remote working options for telehealth days and provide sufficient autonomy and empowerment for physicians to manage their own schedules, without being constantly micro-managed.

In addition, hospitals should provide adequate support staff. This could entail shifting the focus of administrative staff to nonvalue added activities to supporting physicians in the service of a patient. For instance, providing scribes to decrease the workload of documentation would go a long way. Having support staff to screen all results and bringing only the results which need to be acted upon to the physician’s attention. Adequate time should be allotted during regular working hours for other tasks that physicians need to do and not expect that to be an after-hour commitment. It is important to streamline administrative tasks and paperwork to reduce the burden on physicians. Identifying when one is burnt out and ensuring they can rest and take a break. It is essential to distribute the workload among the workforce, hire additional support staff, and delegate tasks to free up time for physicians to focus on patient care.

It is so important to have an efficient EHR that is easy to use. In the age of the iPhone and tablets, we still have EHRs that look like they are from the Stone Age. It is also vital to demonstrate frequent meaningful recognition and appreciation for physicians and treating them with respect.

In conclusion, physician wellness is a multi-faceted problem that needs addressing through a holistic approach. It is crucial to create a positive and supportive work environment that values compassion, empathy, and open communication. By promoting self-care practices, work-life balance, cultural change, and sharing the workload, healthcare institutions can reduce the risk of burnout amongst medical professionals. Ensuring physician wellness is critical not only for the physicians themselves but also for the patients’ safety and quality of care. Therefore, it is essential to prioritize the well-being of medical professionals to ensure a healthy and sustainable healthcare industry.

References

i https://www.who.int/news/item/2805-2019-burn-out-an-occupationalphenomenon-internationalclassification-of-diseases ii Panagioti, M., Geraghty, K., Johnson, J., Zhou, A., Panagopoulou, E., Chew-Graham, C., ... & Esmail, A. (2018). Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis. JAMA internal medicine, 178(10), 1317-1331. iii https://www.forbes.com/sites/ corinnepost/2023/02/09/womenphysicians-face-burnout-crisisamid-lack-of-support-fromstaff/?sh=7bfa3e5b5d99

RiChaRD h. DaFFneR, mD, FaCR

Mary was a pleasant 82-year old woman, who, in the autumn of 1967, became a patient of mine in the Medical Clinic of the old E.J. Meyer Memorial Hospital (now Erie County Medical Center) in Buffalo during my internship. Mary had a history of severe abdominal pain radiating to her back for several years, and her frequent visits to the hospital had generated several pounds and multiple volumes of medical records. Repeated physical examinations as well as abdominal x-rays, upper GI exams, barium enemas, and intravenous urograms were all reported as being normal. She was labeled a “crock”. In March of 1968, she was admitted to my ward, after being found unresponsive at home by her daughter. The presumptive diagnosis was a stroke. A few hours after admission, she died. Fortunately (for us), her daughter consented to a post-mortem examination.

The autopsy revealed the cause of death, as well as the cause of her years of abdominal pain that had not only plagued her, but also had led to her being labeled a “crock”. Surprisingly, Mary had not suffered a stroke, nor a terminal cardiac event. Examination of the abdominal cavity revealed a large, non-calcified abdominal aortic aneurysm that was eroding into her third lumbar vertebra.