Ways to Avoid Physician Burnout

Ways to Avoid Physician Burnout
Corbis / Getty Images

Employee burnout is generally defined as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. Burnout generally progresses in stages. Often, emotional exhaustion and depersonalization (or cynicisms) are telltale signs of the beginning of employee burnout. Those in certain medical professions are especially susceptible to burnout because of the growing gap between demands and resources in health care.

This imbalance is also often encountered in other occupations that involve “people work” as well because it is hard to get these services to scale. This means as the need for health care continues to increase, one of the only ways to deal with the growing demand is longer work hours.

Burnout Epidemic Among American Doctors

The Medscape Physician Lifestyle Survey 2017, which included over 14,000 doctors from a range of specialties, confirmed that burnout is a serious issue in our healthcare system. According to Medscape’s recent report, the proportion of physicians in the United States who are burned out is around 50 percent. This means only one in two doctors has a healthy relationship with their profession. The condition is present across all specialties and regions of the country. Emergency medicine doctors are topping the chart with 59 percent of participants reporting burnout, followed by obstetricians/gynecologists (56 percent).

Family physicians, internists, and infectious disease doctors came in third at 55 percent. In comparison, the Medscape survey from 2013 showed an overall burnout rate of 40 percent, which signals a concerning upward trend. Other published surveys have come to a similar conclusion regarding the rapid rise in burnout among doctors in the United States.

Health Technology and Burnout: Improving User Friendliness

When physicians included in the Medscape Lifestyle Survey were asked about the main causes of their burnout, many cited bureaucratic tasks and increased computerization of their practice (e.g. EHRs). These two factors were among the top four culprits. Another study, published last year in the Mayo Clinic Proceedings, revealed that clinicians who were using electronic health records (EHRs) and computerized physician order entry (CPOE) reported lower satisfaction with the amount of time spent on clerical tasks. Furthermore, rates of professional burnout and the risk of burnout were higher among these professionals.

These findings indicate that technology might be one of the core stressors for many doctors experiencing work stress. However, it could also suggest that if managed properly, technology has the potential to help turn the situation around.

One way to improve clinician satisfaction is to make EHRs more user-friendly. The annual EHR Satisfaction Survey in 2016 showed that some EHRs are better accepted than others. The highest score in the survey was given to Epic, followed by Meditech and Siemens. Users reported several complaints about the systems currently in use, including “too many clicks,” annoying alerts and poor interoperability.

Considering all this, it is not surprising that many healthcare leaders are planning to retool their use of health technology to improve staff satisfaction as well as to optimize the benefits of EHRs. A study commissioned by Nuance Communications, Inc. found that specific strategies that are planned to boost clinician satisfaction included education and training, enhancement of existing technologies and tools, and programs to increase the adoption of new technologies. Those surveyed said they were planning to invest in mobility tools (44 percent), computer-assisted physician documentation (38 percent), and speech recognition tools (25 percent).

Virtual Reality for Stress Management in Health Care

Virtual reality (VR) has been used to treat post-traumatic stress disorder (PTSD) in both military and civil populations. Prior to deployment, soldiers now often undergo stress inoculation training, which appears to be effective. It has been suggested that similar preventative programs could also be adapted to address physician burnout. Scientists have been working on technology-enhanced protocols for stress prevention and management related to medical care.

One such protocol was tested on a group of nurses in Italy. The approach combined experiential virtual scenarios, real-time monitoring and support, and advanced technologies (e.g. VR, wearable sensors, and smartphone technology). VR used in the study included role-playing a potentially stressful situation, as well as using immersive natural scenarios to learn relaxation techniques. Nurses were also exposed to real-life situations and were then assessed in both worlds using biosensors and behavioral analysis. This approach is called interreality (IR) and has shown to be more effective than standard stress management training, such as cognitive behavioral therapy (CBT). The authors of the experiment, led by Associate Professor Andrea Gaggioli from the Istituto Auxologico Italiano in Milan, Italy, suggested that interreality could become an effective protocol for stress prevention and treatment.

Seven Skills That Can Boost Your Mental Resilience

Experts suggest that burnout is caused by personal characteristics as well as organizational factors. When certain personality traits are coupled with risky demographic characteristics, a person can become more prone to the type of work-related stress that ultimately leads to burnout. For example, a review by Brenda Wiederhold, PhD, and her colleagues from the Virtual Reality Medical Institute in Brussels, Belgium, showed that high neuroticism, low agreeableness, introversion, negative emotions, and poor self-concept can contribute to burnout. On the other hand, certain organizational factors and work circumstances can also have a negative effect (e.g. time pressure, insufficient control, poor quality of communication, low decision-making at work, and insufficient rewards). Therefore, interventions need to be aimed at mitigating risk at both the institutional level and the individual level.

Resilience strategies have also been the focus of burnout research and interventions. In a nutshell, resilience pertains to how we react and cope during tough times. It affects our happiness and fortunately it can be refined and improved upon. Seven skills have been identified that can potentially boost our resilience:

  1. Recognizing the impact of our thoughts and beliefs
  2. Recognizing how we often make errors when we think about things—for instance, when we jump to conclusions
  3. Becoming aware of our thinking patterns and beliefs that impact our emotions and behaviors
  4. Learning how to step back and calm down from tough situations
  5. Learning more effective problem-solving behaviors that involve challenging some of our preexisting beliefs
  6. Learning how to put things into perspective so we can stop the downward spiral of negative thoughts and replace them with more realistic ones
  7. Practicing real-time resilience—this happens in the present and combines all the previous skills mentioned

Apps and Tools to Help You Build Resilience and Avoid Burnout

The Human Performance Resource Center (HPRC), established by the Department of Defense in 2009, offers some evidence-based resources for building mental resilience. These include apps, tools and videos. The T2 Mood Tracker is an example of an application that was initially developed for service members but is now widely used by civilians as well. The app supports self-monitoring of emotions and records the user’s experience of stress, depression, and anxiety. Along with monitoring and measuring, the app can also help build mental strength.

Another mobile app promoted by the HPRC is BioZen, a biofeedback app. This application can be paired with compatible external biosensors. Users can follow live data about their biophysiological functions, including brain, muscle, and heart activity. They can also get an insight into the connection between their thoughts and their body and mind. BioZen comes with a meditation feature and can display different brain wave bands (Alpha, Beta, Theta, Gamma). Users can see how relaxed and peaceful they are by manipulating an image on their smartphone with their mind activity and heart rate. The app gives them feedback about their levels of stress by changing the image on the screen—for example, when your heart rate decreases, more peaceful landscapes appear.

A Gratitude Platform for Thanking Your Healthcare Professional

Studies also show that a good way to improve your resilience and reduce stress is by regularly conveying and openly receiving gratitude. For instance, people who took time to acknowledge a thing they were grateful for on a daily basis have been found to be more satisfied with their lives compared to those who did not.

Studies also show that in health care, there is a significant association between patients’ satisfaction with care and health professionals’ perception of the quality of their work life. Positive relationships with patients can therefore be an important resource that could potentially help mitigate burnout. A study from the Department of Psychology at the University of Turin, Italy, confirmed that when patients expressed gratitude and support, this could potentially reduce burnout among nurses.

DohJe is an innovative mobile platform that connects the science of gratitude with everyday life. It makes it easier for people to express their feelings of gratitude to those who have provided health care, in turn potentially boosting the morale of health-care worker(s) who provided the service. It might not always be possible to express our positive emotions in person and/or to the right person, so DohJe can facilitates this exchange digitally.  DohJe—which means “thank you” in Cantonese—was launched in 2013, on National Nurses Day. It is free to use and can be utilized by patients and also by co-workers wishing to show appreciation for one another.

To send a DohJe, all you need to do is select the facility where you were treated. A list of healthcare workers with their photos helps you find the one you wish to thank. You (or the person who was provided for) can either send a pre-written message or create your own. According to founder Amanda Krantz, “beyond improvements in well-being, increasing gratitude can result in real cost savings for hospitals. In one year, the 600 staff at Delta County Memorial Hospital received 1,700 notes of thanks via DohJe, increasing their overall shared gratitude a thousand-fold. In the same year, employees used 761 fewer hours of sick leave from the year prior."

Sources:

Converso D, Loera B, Viotti S, Martini M. Do positive relations with patients play a protective role for healthcare employees? Effects of patients' gratitude and support on nurses' burnout. Front Psychol. 2015; 6:470.

Gaggioli A, Pallavicini F, Riva G, et al. Experiential Virtual Scenarios with Real-Time Monitoring (Interreality) for the Management of Psychological Stress: A Block Randomized Controlled Trial. J Med Internet Res. 2014; 16(7):54-72.

Jackson R, Watkin C. The resilience inventory: Seven essential skills for overcoming life’s obstacles and determining happiness. Selection & Development Review. 2004; 20(6): 13-17.

Shanafelt T, Dyrbye L, West C, et al. Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction. Mayo Clin Proc. 2016; 91:836-848.

Wiederhold B, Riva G, Gaggioli A, Wiedrehold M. Physician Burnout: Improving Treatment Efficacy with Virtual Reality. Stud Health Technol Inform.2016;220:454-458.

Continue Reading