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Blame Burnout on System, Not Doc, Says Advisor to Surgeon General

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Physician burnout, which has increased during the COVID-19 pandemic, is primarily a result of systemic workplace factors, not individual factors, said Tina Shah, MD, MPH, a senior advisor to US Surgeon General Vivek Murthy, MD, in a recent webinar on burnout sponsored by the Science & Entertainment Exchange, a program of the National Academies of Sciences, Engineering, and Medicine.

Shah, a pulmonary/critical care specialist, said she has experienced symptoms of burnout on and off since her clinical training. However, she said, treating COVID patients during the pandemic “is the most extreme experience I’ve had as a physician.”

Up to a third of these patients die in the ICU, Shah noted, and their loved ones can’t be present. As a result, she said, physicians may experience “moral distress” when there is a conflict between what they know they should do and what can be done under the circumstances.

Shah cited a case in which a monitor showed a patient’s heart rate was dropping quickly. Along with a nurse practitioner and a nurse, she rushed into his room and found out he’d been critically ill for some time. Despite their best efforts, the patient died within 10 minutes. “We didn’t get a chance to support him or talk to his family.” Then they had to move on to the next patient.

Research has shown that burnout causes brain changes, Shah said. Among these are the ability to focus and make medical decisions and changes in motor control, creativity, stress, and short-term memory.

In addition, she noted, burnout is associated with increased medical errors and patient deaths. Physicians and nurses who burn out may cut back their hours or leave their jobs.

Definition of Burnout

The problem of burnout of course existed long before the pandemic, Shah pointed out. Prior to COVID, about half of doctors and 62% of nurses experienced burnout, she said.

Burnout in medicine can be defined as a mismatch between the demands of clinical work and the available resources, Shah said. Among its symptoms are emotional exhaustion, depersonalization, and a low sense of accomplishment.

What can be done about it? First of all, Shah emphasized, ordinary people can reduce clinicians’ burnout by getting vaccinated and by persuading friends and family to do likewise. Second, if they know frontline healthcare workers, they should check in with them from time to time to make sure they’re all right.

In the hospital, she noted, burnout is contagious. If one person burns out, it affects the whole care team. Some health systems, such as Christiana Care, based out of Delaware, have taken this challenge on at a systems level, she said. They take extra pains to recognize a clinician’s hard work and organize peer support groups, for example.

It can also be helpful to have a psychologist on staff dedicated to helping healthcare workers, she said. However, this will not be beneficial to everyone. Many physicians, for example, avoid seeking help from a therapist because of the stigma. Some medical boards inquire about whether doctors have had mental health care, increasing their aversion to it, she said.

Perfectionist Culture

Certain aspects of physician culture may also increase burnout, she said. Doctors tend to be perfectionists, she noted, and some of them strive to be a kind of superhero. As a result, they may try to keep going despite obvious signs of burnout.

Women clinicians, especially those younger than 55, are prone to burnout, she said, adding that the same is true for minority clinicians and healthcare workers who feel the sting of racism. “How we get to well-being is tied up with health equity.”

Shah also addressed the challenge of using electronic medical records (EMRs) designed for billing rather than clinical work. Some EMR makers are trying to improve their systems, she said, but it still takes too much time to find key data and to document in EMRs, and clinical messaging leaves much to be desired.

Nurses along with physicians spend an inordinate amount of time on documentation rather than patient care. “Can’t some of this be automated?” she asked.

Shah repeatedly returned to her argument that burnout is a systems problem rather than an individual issue such as depression. Asked how to get healthcare executives to address this challenge at a systems level, she advised physician leaders to make a business case for reducing burnout. Even before the pandemic, she said, burnout cost the healthcare system $4.6 billion a year, and healthcare organizations lose $500,000 for every burned-out doctor.

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