Avoiding Physician Burnout

Burnout. Webster’s online dictionary defines it as “fatigue, frustration, or apathy resulting from prolonged stress, overwork or intense activity.”

Curt Reisinger, PhD, director of the Employee Assistance Program at New York’s North Shore-Long Island Jewish Health System, agrees with that definition. And, where physicians are concerned, he includes “a cynicism about the practice and what you’re doing that’s also accompanied by a sense of a decrease in personal accomplishment.”

Depression is not an isolated condition; it can lead to other problems that exacerbate the condition, such as substance abuse and divorce. And in the medical community, burnout can lead to problems that interfere with the care of patients and result in medical errors. Recognizing the signs of burnout, accepting that it’s real, and then addressing the problem as early as possible are the keys to combating the condition.

Recognize the causes

Burnout has many sources, both internal and external to the physician. According to Joseph Weiner, MD, PhD, president of the Joseph Weiner Corp., a New York-based consulting service for physicians, the causes include the emotional distress inherent in being a doctor; the temptation to ignore self-care through overwork; relationship challenges due to lack of availability to loved ones; financial strain due to medical school loans and diminishing reimbursement; and diminished opportunity for personal gratification.

“Most physicians went into medicine to help people and to have a good life,” Weiner says. “But as one general internist said to me, ‘It’s getting harder to help people and to have a good life.’”

Elizabeth Frates, MD, assistant director of medical education, Institute of Lifestyle Medicine at Harvard Medical School, agrees that there are many causes to physician burnout. She believes the key element is the lack of prioritizing self-care for physicians. Like the shoemaker who walks around with holes in his shoes, physicians spend hours caring for other people, but only minutes caring for themselves.

“Physicians really need to understand that it’s okay to take time for themselves,” Frates says. “This is not something that is discussed or emphasized at all in medical school. We are constantly learning about disease, pathology, patients, and treatments. But if we are to survive the stresses of caring for others, we really need to take the time to care for ourselves.”

Convincing physicians to take that time, says Reisinger, is not an easy task. “Starting in medical school, physicians are taught not to complain. They should just ‘tough it out.’ And that continues through residency and some fellowships. They just push themselves relentlessly until they have no more to give.”

Understanding the cures

One of the barriers that prevents physicians from seeking help from burnout is the embarrassment or sense of humiliation they sometimes feel. “I know of a medical student who called for a psychiatric consultation from a payphone in the street so none of his student colleagues could potentially overhear his phone call from the dormitory he lived in,” says Weiner. As such, some health systems, including North Shore-LIJ, have physician resource networks that provide anonymous mental health services.

Many physicians, especially established, older, physicians, are often in denial, says Frates, who is also a wellness coach. To offer help, Frates and the Institute of Lifestyle Medicine are planning a CME in November 2009 in which physicians will learn about the importance of caring for themselves by way of caring for their patients.

“By learning about exercise, weight management and nutrition so that they can help their patients, they’re learning about these things for themselves as well,” Frates says. “It’s all about making them aware that there are people out there who will take the time to help them care for themselves; help them make a plan for behavior change so they can incorporate exercise, proper eating and stress management into their daily lives.”

Frates explains that studies have proven that exercise is an antidepressant. Therefore, as a wellness coach, the first thing she does is ask physicians to look back at their lives and find a time when they were physically active.

“Let’s find that one thing that each physician can relate to, find time for, and get enthusiastic about,” Frates says. “The fascinating thing about behavior change is that when you start with one and you get a little success, successes build on themselves. It’s all about small steps, small successes. Physicians have to go through a process of behavior change. And the behavior change is taking the time to take care of themselves.”

Ed Rabinowitz is a veteran healthcare reporter and writer. He welcomes comments at edwardr@frontiernet.net.