Monday, April 22, 2013

Provider/Physician Burnout: Taking The Battle to the Brain

Our Coach+Leader blog helps you have a greater impact on improving care. It offers healthcare leaders sound perspective, road-tested tips and tools that remove unneeded complexities... allowing leaders to focus on what matters most to patients. Every so often we hear about exceptional people doing exceptional things and believe it is important to share these stories with our community. Our friend and physician wellness expert, Randall Levin, MD, F.A.C.E.P. shares our passion about making sure physicians and clinical leaders are well prepared to serve their patients. Dr. Levin and I are equally concerned about the current state of physician satisfaction, engagement and more importantly wellness. As these symptoms worsen due to reform and other contributing factors, it has become more apparent that we as an industry must make physician wellness a priority if we expect to see safety and quality improve. Dr. Levin practiced emergency medicine for 28 years, was a director of an emergency department, and is ACEP's physician wellness editor. Dr. Levin is an expert on physician wellness and we are lucky to have him as a contributor at the Coach+Leader. Please share his insights and solutions with your colleagues.

Brian Wong, MD

Provider/Physician Burnout: Taking The Battle to the Brain

Using Positive Psychology to Improve Engagment and, Ultimately, Patient Care

We all know something has to change. Debates on the direction of the healthcare system and competing approaches to patient care are flying fast and furious around us. Now is the time when we, the people who know patients best, need to be at the top of our game. This will allow us to be participating partners with our physician leaders in helping re-create the patient focus medical environment. A sense of well-being and decreasing burnout goes hand in hand with much needed change. Refocusing from provider survival mode to a role as a facilitator for patient outcomes can not easily occur without the element of wellness among providers and other healthcare team members. However, a recent Medscape survey indicates many of us are not at the top of our game.

of responding physicians reported they are burned out
A recent Medscape survey ( found 39.8% of all responding physicians were suffering from burnout. The numbers are even more daunting when drilling own in to specialties with Emergency Medicine and Critical Care physicians reporting burnout rates at or above 50%. All the specialities identified in the survey reported burnout levels exceeding 30%. How can we expect to be open to, or craft creative solutions and offer the very best care to others when we struggle so plainly to care for ourselves?

Burnout and Stress feed each other and we end up chasing out tails

A View of Burnout In Action

Here is a scenario many physicians, especially those in emergency medicine, can no doubt relate to:
It is an overwhelming busy day in the ED. All the rooms are filled with 10 (20, 30, etc) charts of patients who need to be placed into rooms. We are top-bedding admitted patients in our ED, because there are no vacant beds in-house. This top-bedding of patients in the ED, limits freeing beds up for our patients from the waiting room. The waiting room is filled to capacity and we are unable to divert (when an ED is overwhelmed you can divert any further ambulance patients to other open hospitals until the overcrowding resolves) our patients to another hospital due to protocol criteria (if all EDs are diverting then all EDs open up and cannot divert). The staff is overwhelmed and showing signs of stress, being short with colleagues and remaining disconnected from the patients being seen. We cannot "close" to take the pressure off and our lack of resources is causing what systems we had in place to unravel. The next moment I hear the EMS call-in box transmit information concerning a new patient being brought into the department. I think to myself, "Where will I put the patient? How can we safely care for yet another patient?".

I am not the only one wondering as I hear comments from both the medical and nursing staff.
  • "I cannot take on another patient, I am overwhelmed."
  • "I don't have anymore to give, and "they" (administration) can't expect us to stand for this."
  • "If I have to care for another patient, I am going to quit."
These statements, clear implications of stress and burnout, framed our mind state and how we perceived the patient the whole day.
This scenario, while extreme, is all too common and illustrates the real hurdles we need to overcome. Too often though, we focus on the external as the only way we could make this scenario different. "We just need more staff." "A few more rooms will solve our problems." While these changes might indeed help to improve things, what do we until we get additional staff or those new rooms? What do we do if those two changes are not enough to make a hectic day like this better? What do we do? We think differently.

Three Ways To Think Differently

Here are three positive psychology approaches that could help us change the scenario not only for ourselves, but our patients as well.

Be Present (Mindfulness)

The scenario above was already a hectic one when the EMS call came. My focus was on my "survival" and became distracted from the patient. When that happened, I was already jumping three steps ahead imagining negative and defeatist implications. The next time you feel the day spinning out of control, stop, and focus on that one patient in front of you or the one you will be seeing next. Give them your whole attention and effort. Reconnect to your empathy and compassion if you are sensing a disconnect.

Maintain Perspective

In the scenario above, I and all the staff around me were focused on what we were feeling and what we wanted. We had lost sight of the person and purpose we were there to serve. Stop, and review your posture, attitude, and approach. Now imagine you were the patient, scared and frustrated, about to be attended by someone in your current mindset. Putting our concerns in the broader context, can help us to connect with our patients and support mindfullness.

Be Flexible

Too often a response to stress is to default to the familiar. If your familiar is an environment where over 30% (or more) of your colleagues are burned out and disconnected, you may be defaulting to a position that will not provide you or your patient with positive returns. Stop, take a deep breath and ask yourself if you could approach your scenario differently. Take it one step further, ask someone else. Take it one more step, and ask someone you don't normally speak to. Taking a moment to open yourself up to alternative ideas or options, could result in a new successful path, providing you and your patients with a more positive experience.

These suggestions are not a panacea, nor are they the only options available to us. But I can truly state that my mindset was changed and my body language was more of an anticipatory "thank you" for the patient – thank you for allowing me to be there for you and use both my didactic medical knowledge and skills, along with my empathy and compassion. I could again focus on the patient (and not on how was I going to survive). It was not about having to be a "hero", but how to be a human being helping another human being.

I have adapted these ideas from concepts explored by Neil Farber, MD, PhD. His series on Positive Psychology offers an invaluable overview of more techniques and approaches to incorporate positive psychology into your practice and into your life. You can learn more about this series Burnout is real and it's ability to blind us from how we and why we practice medicine is powerful. Using a new way of thinking we can start to take those blinders off and smother the flames of burnout.

Dr. Randall Levin, MD, F.A.C.E.P.

Director for Physician Education - Medical Technology Management Institute, a continuing education division of Herzing University

  • ACEP Wellness Section Newsletter Editor
  • Practiced Emergency Medicine for 28 years
  • Past Director of Emergency Department - Aurora West Allis Medical Center
  • Past Member of Executive Committee - Aurora West Allis Medical Center

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