The Checkup: Taking Care of the Physician

Maybe you should. A growing body of research shows that physician burnout and depression are linked to medical errors and to the kind of depersonalized care that is often both less effective and less palatable.

“It has been shown in some studies that if the physician is exercising, if the physician is taking care of themself, eating well, sleeping better, they have patients who have better clinical outcomes,” said Dr. Hilary McClafferty, a pediatrician who is an associate professor in the department of medicine at the University of Arizona College of Medicine in Tucson. But the problem may be less the individual doctor’s health habits, and more the medical system that is hurting us all.

“It’s not that physicians are burned out and so don’t care, it’s that they care deeply,” said Dr. David Schonfeld, a developmental behavioral pediatrician at Children’s Hospital Los Angeles. “You can’t experience compassion fatigue if you’ve not had compassion.”

Another statistic often cited in the physician wellness conversation is the suicide rate. Physicians are at approximately twice the relative risk of suicide compared to people in other professions, Dr. McClafferty said. “Women physicians especially are at a significantly higher risk of completed suicide than matched female controls in other professions,” she said. An estimated 300 to 400 physicians commit suicide every year.

If this were happening in any other high-profile industry, Dr. McClafferty said, “I can’t imagine people wouldn’t be rallying round, saying this is unacceptable, it has to stop.”

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We place physicians in situations where they are detecting problems, often connected to social conditions or poverty, Dr. Schonfeld said, but then don’t give them the support they need to address those problems. And we don’t adequately teach the skills in medical training that doctors will need to deal with the realities of taking care of patients. “There are more advanced skill sets, how to deal with conflict, how to deal with negotiation, how to deal with the distress of patients,” he said. “We just send trainees in, the training focuses on medications, pathophysiology, genetics, not the skills they need to be able to deal with those broader issues.”

So we might look to changes in the ways we train residents, not just limiting work hours but looking more closely at what the content of those work hours is like, and at the skills we teach, and at what we do and do not discuss.

“Because of organizational structures and competing responsibilities there’s less time, and physicians are really sad about this, and we need to struggle as a society to make it different,” Dr. Serwint said.

“The solution is not to weed out the ones who don’t care, but to support the large number of physicians who are deeply invested and have the capacity to provide excellent care, but lose that capacity over time,” Dr. Schonfeld said. “Physicians enter medical school deeply committed to the field, they come with the desire to be empathic and compassionate, if we just create a system that nurtures what they come with then we will have less burnout and higher quality care.”

It should not be the doctor’s responsibility to feel that “if I’m just more mindful, if I just exercise more or do it better or more consistently, all will be well, and I shouldn’t be feeling burned out or exhausted,” Dr. McClafferty said.

The fact that nearly half of physicians and over 50 percent of trainees experience burnout at some point “shows that it is not predominantly an individual deficit, but an organizational and system problem,” Dr. Schonfeld said

“If you’re my physician,” Dr. McClafferty said, “I want you to be in good shape mentally, physically and emotionally, so you can be really successful at helping me.”

 

November 14, 2017

Sources:` New York Times

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