Kindlelife

Insight, Inspiration, Motivation

Burnout: Chinese vs US Physicians


Just read yet another article on Physician Burnout (http://www.medscape.com/viewarticle/803968). This one compared burnout amongst physicians in China and the United States. In order to keep the groups comparable, only the responses of physicians less than 45 years of age were selected – there were 6000 Chinese, and 7500 US physicians. I was specifically intrigued by one of the charts presented, which is reproduced here:

Options Chinese US
It is manageable and I’m not making any changes 36% 25%
It is manageable but I need to make some changes in hours/workload/etc. 52.2% 62%
I am thinking of leaving my current position 7.3% 7%
I am thinking of leaving medicine altogether 4.5% 5%

Forty two percent of US Physicians, and 82 percent of Chinese physicians who took part in the survey reported burnout. Of these, 52% and 62% respectively said they needed to make changes in their working lives. This is very significant in that 3120 Chinese and 4650 US physicians know they should do things differently. It would be interesting to know how many of them are really doing something about it, and how many simply feel stuck, and will sooner or later end up either resentful or leaving their jobs.

What is even more disconcerting is that almost 12% of the responders in both countries were thinking of either leaving their current job, or giving up medicine altogether. This means, 720 physicians in China and 900  in the US – all under 45 years of age). If we consider the entire physician population in both countries, this number would obviously be much higher.

These physicians who report burnout must have put in a lot of time, money, and sacrifices to get to where they are. The government also would have spent a lot of resources, training them.

I wonder, what would it take for these physicians with burnout, to decide to stay? What would it take for them to re-discover their love for the profession that attracted them initially.

Please let me know your thoughts, either through comments on this page or by e-mail: kindlelife7@yahoo.ca.

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June 17, 2013 Posted by | Personal Journey, Psychology, Self Improvement | , , , , , , , , | 2 Comments

Burnout – FAQs


I recently gave a talk at my hospital Grand Rounds, about Burnout, which is one of my favourite topics. There were a few questions asked, which I thought I could try and answer here.

“If I take any time off, what will happen to my patients?”

I would like to clarify that I wasn’t asking people to all take lots of time off, and go away! On the other hand, I suggested that everybody needs rest, and that we should all be sensible about recognizing that need, and taking rest, before we become too fatigued, and forced to rest. If we wait until we have to go, then we will not be able to enjoy such time off. Also, if going away for any length of time is impossible, then make sure that the time that we get every day that we come home after work, be well utilized to recover as completely as possible, from the stresses of the day.

It is very true, especially in community hospitals, that there often is nobody else who shares the care of our patients, normally. We have a great rapport with most of our patients, and the sense of responsibility for their well being is also great. This can lead to a sense of guilt, even at the thought of having to make them wait longer to see us, or worse, having to cancel their appointment, for any reason.

On the other hand, we have a responsibility also to give them our best, when we are with them. If we work ourselves to the point of burnout, then we will surely be unable to feel the compassion that the patients need, and perhaps the good judgment we need in certain situations that call for more involved, critical thinking. This can lead to mistakes, or at the very least, misunderstandings and a loss of trust and that very rapport that we try to maintain, by not missing work!

To look at things from a broader perspective, imagine a freshly dug hole in the ground. At first, the hole will have very sharp banks, but slowly, the soil around it will shift, the edges will look blunt, and eventually, the hole will disappear. How long it takes to fill the hole will depend on how big the hole was, but fill up, it will.

Similarly, if a physician suddenly drops out of the scene – due to illness or (heaven forbid) death, there will be a void at first. The size of that void will depend on how well that physician was thought of. It is probably the physician’s own family who will be the most severely affected – let’s make no mistake about that. However, life will go on. Sooner or later, alternate arrangements will be made, others will move in, and the patients will get taken care of, the work will get done.

It is true that each of us is unique – and nobody will be able to do things exactly as you do it! But people will learn to adjust and even like the way it eventually gets done. That is how they will cope with the change themselves.

So, ultimately, it is in our own interests to not be forced to drop out of our working lives before we are ready to go. Also, we owe it to our patients to give them our best, when we are there, in front of them, giving them our full attention.

I will answer some of the other questions that have been raised, in future posts.

 

 

May 5, 2013 Posted by | Personal Journey, Self Improvement | , , , | Leave a comment

Making Mistakes


I had promised to write on this topic, a while ago, so here goes.

I was shocked to hear, in this day and age, that any medical educator can actually warn students to “never make a mistake!”

I can only hope that they did not mean it literally. I hope they meant to TRY to avoid mistakes. I hope they meant to say that in the business of human life and health, a mistake made by us can actually cost another human being their health, and therefore can be a very bad thing. I hope they meant that mistakes can be costly in many other ways as well. They can lead to litigation, immense stress, burnout, depression, and so on.

All of that would be right. But the fact remains that, despite everything we do, despite our best intentions, mistakes CAN happen.

What is most important to teach students and trainees is – How to avoid them, and how to deal with them, when they do happen.

Avoiding mistakes involves a lot of forward thinking, even play-acting in the initial stages, when setting up office. Work-flow has to be carefully analysed, and possible sources of error have to be eliminated.

For example, every lab report should be seen within a certain period of time, by the physician ordering it, and should only be filed away after it has been acted upon. In order to prevent mistakes in this sequence, it is necessary to make sure that every lab report is seen by the right physician, at the right time; there has to be some sort of code, that the physician puts on the report, that informs the staff of what action is required. there has to be a mechanism for the staff to see this, and then act on it, and follow up on those actions. Finally, the report has to be filed in the appropriate chart. A system has to be put in place, to ascertain that every one of these steps is carried out correctly, if mistakes are to be avoided.

Even after a system is set in place, and things are running smoothly, there have to be regular evaluations of these systems, to try and improve upon them, and make them more efficient.

When a mistake does occur, it can be a very scary thing. Mistakes can sometimes be small and inconsequential, and at other times bigger, and causing either distress or bodily harm of varying severity. It can also be the result of the action of any one person in the whole team of individuals involved in a patient’s care – and that includes clerical staff, as well as other support staff in hospitals. Often, however, the physician in charge has to take responsibility for it, anyway.

Whatever the cause of the mistake, early, full disclosure is always the best policy. It is of course, required by the law in Canada. There are plenty of resources, and workshops put out by the CMPA (Canadian Medical Protective Association), that help physicians understand what this means, and how to go about it. I am sure that such resources exist in other countries as well.

No matter what, the one thing that patients appreciate is a physician who tells them the truth. The majority of cases that go to court have been ones in which the patient felt that they were lied to, or not given answers to their questions in an honest and open manner. There will always be things we cannot explain when something goes wrong, however, and it is alright to say “I don’t know,” about such specifics. But overall, the patients and their families expect to see that the physician cares that something went wrong, and that they are not taking it lightly.

Perhaps the one thing that will be most appreciated when a mistake has been made, is an indication as to how this will be avoided in the future. If we can make it clear that we have identified ways to avoid it in the future, and put necessary mechanisms in place already, that will avoid a lot of conflict.

I do not know any physician who has worked for any length of time who can honestly say that they have not made mistakes. As far as I have seen, the person most affected, is always the physician, who feels guilty, and worries about making the same (or other) mistake again. They often find it hard to forgive themselves, especially when there has been a bad consequence. Over a period of time, however, they do learn to go on.

Ultimately, mistakes make us humble, they help us grow. They teach us forgiveness, and other valuable life lessons. When we do make mistakes, it is important that we try and learn everything there is, to learn from it, before we move on. And pray that we don’t make more!

April 22, 2013 Posted by | Personal Journey, Self Improvement | , , , | Leave a comment

Preventing Burnout


According to Maslach and Jackson, who created the Maslch Burnout Inventory (MBI), the symptoms and signs of burnout can be grouped under three headings:

Emotional Exhaustion,

Depersonalization (or Cynicism), and

Ineffectiveness.

The cost of such a condition, in a physician can be immeasurable – not just for the physician, but for the family, the colleagues, and for the community at large! Unfortunately, when trying to be strong, in the face of repeated stress,  physicians think they are doing the right thing, that has been taught to them, and is expected of them. They believe that everyone around them is looking up to them for strength and support, and any sign of weakness on their part would be harmful to everyone.

This, in reality, is far from the truth. We are doing nobody any favours, if we allow ourselves to suffer to the point of exhaustion, overwhelm and burnout. No patient would want to be served by a physician who is so emotionally depleted that he suffers from ‘compassion fatigue,’  nor would they be very understanding if a mistake was made by a physician who is exhausted, or didn’t really care enough! So, it behooves us to take care of ourselves, so that we can serve those whom we have committed to serve.

How do you prevent Burnout? Here are a few steps you can take, to avoid burnout.

1. Be Aware: Any change starts with self-awareness. We first need acknowledge that this is something we are all susceptible to, and that there is a certain courage in recognising problems and seeking help as required! If we think that we are in some way immune to the stresses, or that we are capable of handling it all on our own, we could be deluding ourselves.

It is important to know and detect the symptoms and signs early, and have an idea of what you are willing to endure, and for how long.

2. Be proactive: Smart people solve problems, by avoiding them in the first place. For example, every physician requests tests, and will receive the results in some form (electronic or paper). Isn’t it the smart thing to do, then, to set up a system, whereby the results will be looked at and acted upon, in a seamless way, least delay? Once this is in place, the chances of missing an important report can be minimised. Similarly, we can have different structures in place to deal with referrals, phone calls, etc. Maintaining a well organized and functioning office is perhaps the best thing one can do, from the professional point of view.

There are many things we can do on the personal level as well, like taking care of minor ailments to avoid major complications, clearing small misunderstandings in relationships to prevent build-up of resentment, and so on.

3. Be very clear of Your Values and Your Mission: You need to know what are the values that are most important to you, as a person, the violation of which will bring you pain. It will also help, if you know what you really hope to accomplish, through those values – in the near, and the distant future.

4. Prioritize: Once you know what is important, you can try to get more of what you want in your life. This includes knowing what is not important, that takes up our time and energy, that you can cut out of your life.  This also means being able to say “No” to things that encroach upon your priorities.

5. Take care of your body, mind and spirit: Eating regularly, eating the right foods, and exercising should not be something relegated to when you have time. It would help to have some activity outside of work, that can help stimulate you in a totally different way, and make you happy. Volunteering is great, not just to balance out the stresses, but also to get some endorphins flowing! A spiritual practice helps to navigate the ocean of life, the currents of which can at times be very turbulent. Make sure you take time for renewal on a regular basis.

6. Build a support system: Have a good team around you. Choose your colleagues carefully, if you are in a position to do so. Make it a point to cultivate good relationships with supportive people, whom you can call upon, when you need help. It also means that you should have trusted people you can delegate all those tasks to, that you don’t really need to do yourself.

7. Learn to be a good team-player: It is important to try and understand that people are different, and that having different people is what makes a team strong. So, when conflicts arise, remember that it is most likely due to a simple difference in mental wiring or a difference in priorities. If you learn to understand the differences, and can learn to negotiate, and to work together – then you can avoid a huge source of stress in your life.

 

I have simply put together a few suggestions, many that have worked for me, and some, that I am still working on.

Please e-mail me with any comments, suggestions or questions.

 

 

 

 

 

 

February 25, 2013 Posted by | Personal Journey, Psychology, Self Improvement | , , , , , | Leave a comment

Why Physicians Burnout – and Why They Don’t Seek Help


In my last blog post, I wrote about the problem of surgeon burnout. Although the particular paper cited was about surgeons, burnout is not a problem of surgeons alone. It is common amongt all physicians, and even among medical students and residents these days. It is becoming more prevalent, as the stresses in life all around us seem to be getting worse.  I have been pondering on the reasons for this, and have come up with the following:

Physicians are High Achievers – Most of them have been high achievers from their school days, and have been consistently working hard, putting in long days and nights, through their medical school and residency, and even afterwards, in most cases.

Delayed Gratification that wasn’t! Many of them chose to “work while their companions played” (a little poetic justice used there), thinking that if they worked hard now, they could have the good life later (trust me, I know. My father promised me that if I worked really hard in the last 2 years before college, and got into med school, I would never have to work so hard again)! They often come out of their residency with huge student loans, that they find themselves working even harder to pay off. If they have a family, or other responsibilities, then it is one thing after another, and before they know it, they hit the middle ages, and feel cheated.

The Ever Changing Health Care System– It is becoming more and more difficult to practise medicine with the diminishing resources, and increasing expectations, that there is a great deal of frustration on a day-to-day basis.

High Expectations – Physicians are seen as knowledgable, and ‘life savers’ by their families and their patients, and when they do not get good results, they often find it difficult to accept. While they enjoy their successes, many take the treatment failures quite badly. They also want to be really good at what they do, and so are their own worst critics.

Sources of Strength – Physicians are the sources of strength for their patients and families, at their most vulnerable times, ie, when they are sick, or have a sick relative. Because they carry out this function really well, most of the time, they are somehow seen as strong people, and so, they try to live up to that image subconsciously, even in the face of their own stress.

Why do they not seek help?

Unfortunately, physicians are their own enemies, in that they are the last to acknowledge their own problems, and even when they do recognise it, are unwilling to seek help. This may be because of two main factors.

Fear of appearing weak – Physicians may not want to seek help because they are afraid to be seen as weak in any way, considering they are the sources of strength at home and in the community.

Lack of Support – There really isn’t much support to the physician at risk of burnout, or who is going through excessive stress. There are physician hotlines for when they have reached a pathological level that they are unable to function, and have either broken down completely, or worse, are considering suicide!

What we really need is coaching to help guide them through troubled waters, and PREVENT suicidal ideation, rather than treatment for it.

Tell me, what do you think might be some other factors in physician burn out, and what you have found helpful in your own experience, to overcome it.

March 10, 2012 Posted by | Personal Journey, Psychology, Self Improvement | , , , , , , , , , | 6 Comments

   

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