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Physician Burnout Is Prevalent, But Preventable

Posted on Wed, Oct 26, 2016
Physician Burnout Is Prevalent, But Preventable

This is Part 1 of a 2-part series.

By Ronald Tompkins, MD

When I attended EmCare’s Annual Leadership Conference, I heard several speakers discuss physician burnout, and while the conference covered a variety of topics, the sessions that addressed this topic stuck with me the most. I wanted to share what I learned, and some of my thoughts about burnout and resiliency.

ER docs must learn resilience. The burnout rate is more than 60 percent, the highest of all professions. Doctors in general work many more hours than any other profession. Studies show the number of doctors who often work more than 60 hours per week is seven times more common than any other profession. The intensity of work and new demands makes us try to adapt by working harder and harder. This is initially successful but eventually you hit a wall and can do no more. We all know the super human doctor who is always winning awards for juggling more than anyone else, and it seems they never struggle. They do. They just hide it and suffer in silence, and so do their families and the nurses who have to work with them.

Multitasking is a myth. We’re often praised for our ability to multitask, and the docs who do it best are often considered efficient. What’s really happening is some doctors handle interruptions better than others. We simply go from topic to topic every few seconds, handling only one at a time because our brains can only handle one thought at a time. Studies show that an ER doc is interrupted about 100 times per hour. Our brains get neuronal fatigue and need to recover somehow.

Psychologists who focus on treating physicians state that ER docs work under the most stressful situations of any profession, by far, due to the interruptions and unrealistic expectations. One of the presenters at the conference likened it to standing in the busiest intersection you have ever seen and trying to tell the traffic what to do, knowing you are going to get hit a few times a day. We are smart, controlling people by nature, but we control very little in our environment, leading to exhaustion and burnout. The burnout rate is more than 60 percent at any time, and expectations are growing steadily. They believe we handle approximately five times more material every day than just 20 years ago.

Tips for Recharging Your Resiliency

Adding to the neuronal fatigue is the use of computers and how we spend our free time looking at email and social media and worrying about trivial things. They believe that trivial thinking is nearly as exhausting to the brain as routine work is. The trivial computer and smart phone interactions every day account for the equivalent information intake of watching five full-length movies. They suggest that doctors take multiple short sessions a day to relax the brain, such as listening to music or walking. Of course, this is often impossible, but eliminating unnecessary tasks such as email and Facebook is helpful. Snacking during the day is helpful, too, as the glucose in the brain needs to be replenished. Caffeine, not so much. As the brain fatigues, decision making and performance suffers, making the doctor prone to mistakes. The end of the shift is often the worst. Be willing to offload the patients from the doctor you are replacing, as he is psychologically exhausted.

Offloading the brain of unnecessary material is very helpful. As mentioned above, limit your down time activities, but also make use of handwritten lists. Relying on memory is inaccurate and fatiguing. High performers have made use of external memory (handwritten lists of tasks) for generations, and it’s proven to be of great benefit. I’ve done this for years myself. Also make use of your peers, nurses, etc., to offload some tasks that they can handle. They have skills and we can’t do it all. Delegate duties when appropriate.

Limit information channels. They suggest making others communicate with you the way you communicate best and eliminate the other channels. Voice mail, snail mail, texts and phone calls are all OK and not as intrusive as email. Emails are abused and not very effective as we now get innumerable useless emails. Emails seem to suggest that everything is an emergency and worthy of interrupting you at any time. Most of it isn’t necessary and adds to the daily fatigue of your brain. They suggest telling your peer group of a special emergency way to contact you, but limit who has this contact.

Keep gatekeepers around you to protect you from unnecessary interaction. Create buffers to help create a “stress free zone.”

Change in medicine is inevitable and always has been. What’s different now is the rate of change and the energy and concentration required to keep up. It’s less stressful to accept the change and work with it than to fight it. Remember, do you want to be right or do you want to survive and pay bills?

The age old struggle of work/life balance concerns us all. Life is basically about work and love. Each effects the other. Stress at work equals stress at home and vice versa. There is no definition of life balance. It’s a myth. How much you are gone from the house at work doesn’t effect home happiness nearly as much as your attitude while you are at home. Be fully engaged with the family when with the family. Those who win the struggle of work/life balance have the love and support at work and at home.

Dr. Ronald Tompkins

Ronald Tompkins, MD, is the medical director of the emergency department at Parkridge Medical Center in Chattanooga, Tenn.
 

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Comments
John Marshall, MD
Very well written and timely blog post. We all face issues such as fatigue, burnout, and work-life balance and this post had some good information about the magnitude of the problem, the challenges we face and some good suggestions about how to avoid burnout. Really good job!
10/29/2016 7:34:32 PM