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Blog: Halting Clinician Burnout

Halting clinician burnout by increasing resiliency

Burnout and stressLooking for solutions to clinician burnout syndrome

The medical community is paying more attention to the pervasive problem of clinician burnout. Medical providers with hectic practices—those who see one patient after another with few moments to reflect—may find themselves feeling less connected to their patients. Instead, they feel compelled to be constantly vigilant, ready to take on the numerous, unending challenges of patient care.  A physician might ask, “Will this ever get easier? Will I ever go home without feeling exhausted? Why do I feel so alone?” As they get closer to complete burnout, the fatigue and isolation start to overshadow the pleasures of helping patients get well.1

The Maslach Burnout Inventory-Human Services Survey (MBI-HSS), the gold standard in burnout assessment for health care professionals, has been extensively tested for reliability and validity and is designed to measure the three factors associated with burnout: emotional exhaustion, depersonalization, and a sense of low personal accomplishment.2 Burnout in clinicians is characterized by losing enthusiasm for work because of emotional exhaustion, resorting to cynicism and sarcasm as a way to distance themselves from patients (depersonalization), and having a sense that work is no longer meaningful (low personal accomplishment).

Studies have shown that more than 45% of physicians experience burnout—and the number increases to over 50% for internists and 60% for emergency medicine physicians. In fact, one in five nurses intends to leave his or her current job in a year.3 Like other professionals experiencing burnout, nurses continually hope their next job will have less stress, and they feel pressed to move on.

Burnout and its correlation to medical errors

Clinicians may not be motivated to create a change for their own health, but some take their burnout seriously when they see its relationship to medical mistakes.

Medical error is an indicator of physician burnout. A 2010 Mayo Clinic article reported not only that 9% of surgeons were concerned that they had made a major medical error in the past three months, but also that burnout and depression were independent predictors of such errors.4 In a Journal of the American Medical Association article, burnout expert Tait Shanafelt, MD, reported on a study whose outcomes were eye-opening:

In one of the few studies to evaluate the effect of a clinician-based intervention on quality outcomes, a large medical malpractice insurer developed and tested a stress reduction program for hospital employees that focused on individual training in stress management and organizational control of factors that produced stress. A pilot study found a reduction in medication errors after implementation of the program at a single hospital. The investigators subsequently conducted a controlled trial that evaluated the longitudinal effect of the program on malpractice claims at 22 participating hospitals relative to 22 control hospitals matched for size, practice scope, geography, and baseline frequency of malpractice claims. Malpractice claims over the ensuing year were reduced by 70% at intervention hospitals compared with a 3% reduction at control hospitals (P<.01).5

How can stress-management programs make a difference?

A significant body of evidence points to mindfulness and mind-body interventions as effective means for reducing anxiety, depression, and perceived stress while increasing empathy and self-compassion and gaining a greater sense of self-actualization, self-responsibility, and self-directedness.6 William Norcross, executive director of a physician wellness program at the University of California, San Diego, says, “[Burnout] can’t be solved with antidepressants or increasing somebody’s salary.” Instead, he says that physicians can make a significant difference by creating resilience with mindfulness practices.7

How can an already busy health care team find time to make a change?

Implementing small mindfulness moments during the day can help a stressed-out clinician shift from operating in the sympathetic nervous system (fight-or-flight) to the parasympathetic (relaxed state). We find that adding a mindfulness habit onto an existing work habit makes the implementation of these practices very accessible.

Here are some stress-reduction strategies we offer to clinicians, business professionals, and others who work in high-stress careers:

  1. Create a hand-washing ritual. Whenever you wash your hands, say something affirmative and hopeful such as “Help me be present with my potential” or “I am calm. I am ready to listen to my next patient.”
  2. Prior to getting up from your desk for lunch, take two minutes to look out the window and pay attention to what you see.
  3. When you eat something, take one minute to pause, look at your food—three bites, even—and notice the taste and the sensation as you chew. Try it with one piece of chocolate or for the first few sips of coffee. If you can work up to eating your entire lunch mindfully, you could have a transformative experience.
  4. Pause outside your patient’s room and take two deep breaths. Notice the feeling of your feet connecting to the floor. Feel the patient file in your hand. Some physicians will take this moment to think of a supportive word or phrase such as “healing presence” or “The greatest gift I can give is being present.”
  5. Take 5 minutes at the start of your day to do a guided meditation.

What are hospitals around the country doing to help reduce stress and burnout?

Hospitals are increasingly incorporating mindfulness techniques, including yoga, for staff during half-day retreats and weekly classes. In studies of yoga classes at hospitals, the results have been significant.8 Some physicians will say, “I’m not flexible enough to do yoga,” but yoga is not about getting your foot over your head. It’s for real people who want to decrease stress and pain and increase strength and resiliency. An important part of yoga—and some martial arts practices—involves scanning your body for tension and learning to release it.

Because clinicians already have so many demands on their time, these practices, once learned, can continue to support a clinician in the long term. Even providers who practice mindfulness for five minutes a day can notice a difference in their stress and can start on the path to higher job satisfaction and better relationships with patients.

Conclusion

The prevalence of burnout among clinicians has a direct impact on the health care delivery system and patient safety. A growing body of research indicates that the solution for this serious issue can be found in mindfulness practices. This is good news for busy physicians, and these practices, once learned, can be easily implemented into existing habits.

 

1. Michael Kearney, Radhule Weininger, Mary Vachon, Richard Harrison, and Balfour Mount, “Self-care of Physicians Caring for Patients at the End of Life,” Journal of the American Medical Association 301 (2009): 1155-64, doi: 10.1001/jama.2009.352.

2. Christina Maslach, Susan Jackson, and Michael Leiter, Maslach Burnout Inventory Manual, third edition (Palo Alto, CA: Consulting Psychologists Press, 1996).

3. Work Well NW, Reducing Clinician Burnout with Yoga and Mindfulness Training, white paper, https://www.phyins.com/members-only/download-file.php?file=Reducing-Clincian-Burnout-WhitePaper.pdf.

4. Tait Shanafelt, Charles Balch, Gerald Bechamps, Thomas Russell, Lotte Dyrbye, Daniel Satele, Paul Collicott, Paul Novotny, Jeff Sloan, and Julie Freischlag, “Burnout and Medical Errors among American Surgeons,” Annals of Surgery 251 (2010): 995-1000.

5. Tait Shanafelt, “Enhancing Meaning in Work: A Prescription for Preventing Physician Burnout and Promoting Patient-Centered Care,” Journal of the American Medical Association 302 (2009): 1338-1340, doi: 10.1001/jama.2009.1385.

6. Michael Kearney, “Self-care of Physicians Caring for Patients at the End of Life.”

John Jones, Bruce Barge, Brian Steffy, Lisa Fay, Lisa Kunz, and Lisa Wuebker, “Stress and Medical Malpractice: Organizational Risk Assessment and Intervention,” Journal of Applied Psychology 73 (1988): 727-735, doi: 10.1037/0021-9010.73.4.727.

Sarika Arora and Jayashree Bhattacharjee, “Modulation of Immune Response in Stress by Yoga,” International Journal of Yoga 1 (2008): 45-55, doi: 10.4103/0973-6131.43541.

Chase Scheinbaum, “The Many Dangers Posed by Burned-Out Doctors” Bloomberg Businessweek, August 22, 2012, accessed April 15, 2014, www.businessweek.com/articles/2012-08-22/the-many-dangers-of-burned-out-doctors.

Alberto Chiesa and Alessandro Serretti, “Mindfulness-based Stress Reduction for Stress Management in Healthy People: a Review and Meta-analysis,” Journal of Alternative and Complementary Medicine 5 (2009):593-600, doi:10.1089/acm.2008.0495.

Bassam Khoury, Tania Lecomte, Guillaume Fortin, Jarjolaine Masse, Phillip Therien, Vanessa Bouchard, Marie-Andree CHapleau, Karine Pacquin, and Stefan Hofmann, “Mindfulness-based Therapy: A Comprehensive Meta-analysis,” Clinical Psychology Review 33 (2013): 763-771, doi: 10.1016/j.cpr.2013.05.005.

Fadel Zeidan, Susan Johnson, Bruce Diamond, Zhanna David, and Paula Goolkasian, “Mindfulness Meditation Improves Cognition: Evidence of Brief Mental Training,” Consciousness and Cognition 19 (2010): 597-605.

7. Chase Scheinbaum, “The Many Dangers Posed by Burned-Out Doctors.”

8. Andres Asurero, Jenny Queraltó, Enriqueta Pujol-Ribera, Anna Berenguera, Teresa Rodriguez-Blanco, and Ronald Epstein, “Effectiveness of a Mindfulness Education Program in Primary Health Care Professionals: A Pragmatic Controlled Trial,” Journal of Continuing Education in the Health Professions 34 (2014): 4-12, doi: 10.1002/chp.21211.


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