Blame burnout on system, not doc, says surgeon general’s advisor

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Physician burnout, which has increased during the COVID-19 pandemic, is primarily the result of systemic factors in the workplace, not individual factors, said Tina Shah, MD, MPH, senior adviser to the surgeon US 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 exhibited symptoms of burnout intermittently since her clinical training. However, she said, treating COVID patients during the pandemic “is the most extreme experience I have had as a doctor.”

Up to a third of those patients die in intensive care, Shah noted, and their loved ones cannot be present. As a result, she said, doctors can 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 that a patient’s heart rate was dropping rapidly. Along with a nurse practitioner and a nurse, she rushed to his room and found he had been seriously ill for some time. Despite their best efforts, the patient died within 10 minutes. “We haven’t had 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 changes in the brain, Shah said. These include the ability to focus and make medical decisions and changes in motor control, creativity, stress, and short-term memory.

Additionally, she noted, burnout is associated with an increase in medical errors and patient deaths. Physicians and nurses who exhaust themselves may reduce their hours or quit their jobs.

Definition of burnout

The problem of burnout, of course, existed long before the pandemic, Shah pointed out. Before COVID, about half of doctors and 62% of nurses were on 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 weak sense of accomplishment.

What can we do about it? First, Shah pointed out, ordinary people can reduce clinician burnout by getting vaccinated and persuading friends and family to do the same. Second, if they know any frontline healthcare workers, they should check in with them every now and then to make sure they’re okay.

In the hospital, she noted, burnout is contagious. If one person becomes exhausted, it affects the entire healthcare team. Some healthcare systems, such as Delaware-based Christiana Care, have responded to this systems-level challenge, she said. They go the extra mile 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 benefit everyone. Many doctors, for example, avoid seeking help from a therapist because of the stigma. Some medical boards ask if doctors have received mental health care, increasing their aversion to it, she said.

Perfectionist culture

There are aspects of physician culture that can increase burnout as well, she said. Doctors tend to be perfectionists, she noted, and some of them strive to be some sort of superhero. As a result, they may try to continue despite clear signs of burnout.

Female clinicians, especially those under the age of 55, are prone to burnout, she said, adding that so are minority clinicians and healthcare workers who feel the sting. racism. “The way we achieve well-being is linked to health equity. “

Shah also rose to 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 long to find key data and document it in EMRs, and clinical messages leave a lot to be desired.

Nurses and physicians spend an enormous amount of time documenting rather than caring for patients. “Can’t some of this be automated?” ” she asked.

Shah has repeatedly gone back to his argument that burnout is a systemic problem rather than an individual problem such as depression. When asked how to get health officials to meet this systems-level challenge, she advised leading physicians to prepare a business case for reducing burnout. Even before the pandemic, she said, burnout cost the health care system $ 4.6 billion per year and health organizations are losing $ 500,000 for every exhausted doctor.

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