Check this out. What you will see is a psychiatrist, who specializes in helping physicians and their organizations deal with “complex personal challenges,” asking his colleagues a question. Are they “healers” or are they “widgets.” According to Dr. Adelman, the trend over the last 50 years toward “industrialized medicine,” where doctors’ workflows are controlled by corporations rather than by their own wills, has caused there to be so much “coming at them” that they are like Ethel and Lucy in the chocolate factory. They just can’t keep up. They become unable to do “their best work.”
A powerful quote from Adelman’s post:
Malaise sets in when you realize that you have become an almost inanimate object. This is ‘physician burnout,’ which has been conceptualized by some as a form of moral injury visited upon us by industrialized medicine.
Bottom Line. The move away from being a healer and toward being a widget seems inexorable. This is not likely to get better in coming years.
My question? Then what will “worse” look like in years to come???
Check this out. What you will see is an important reminder of an obvious fact. Here, our friend The Country Doctor explains that it is not hard work, but inappropriate work, that causes physicians to burnout. Why, he asks, are all the non-physician players in healthcare encouraged to work “at the top of their licenses,” while doctors are left to do the grunt work at the bottom of theirs?
Bottom Line. As the doctor reasonably summarizes, “I find the priorities of modern primary care bewildering.” Thinking back to my Ph.D. program in Industrial Psychology, I am very prone to agree with him. If an “efficiency expert” were called in to look at primary care in the US in 2021, what would his reaction be? Dismay?
Here’s a better question. Why hasn’t an efficiency expert been called in???
The gentleman pictured above is Dr. Jimmy Turner, the self-proclaimed “Physician Philosopher”. In this post, he sets out to debunk the title shown above. In doing so, he argues that a physician’s early retirement does not render the slot he occupied in medical school a waste. How many years should a doctor be required to practice in order to make his education worthwhile? 10? 20? Until he dies? Good question!
He also defuses the concept of early retirement contributing to the physician shortage. Here, he argues that too few doctors entering the field, rather than too many doctors leaving medicine, is the actual cause of the doctor shortage. He’s probably right again!
Of course, Dr. Turner has an axe to grind here. He coaches physicians on the principles of FIRE, Financial Independence and Retiring Early.
As I pondered this piece, I thought of the work I do as a Board member at Volunteers In Medicine on Hilton Head Island, SC. We have 10,000 patients who would otherwise be medically underserved. And what lets us care for all of these patients with only a minimal budget? Volunteers. RETIRED volunteer physicians, nurses, dentists, pharmacists, etc., all anxious to continue to put their clinical skills to good use, especially now that they don’t have to worry about running a practice as a business. Many in their 70’s, retired for years, but still going strong.
Bottom Line. So, is it really wrong for a doctor not to work full time practicing medicine until she dies, worried the whole time about finances and burning out?
I am going with a big “No” on that one! How about you???
Check this out. What you will find is a Web site offering seminars, etc. designed to reduce the stress of being a physician. We’ve talked about this before. Physicians walking away from clinical practice and getting into the Zen-like business of helping their colleagues to enjoy life and avoid burnout. There are already a lot of sites like this, and their numbers seem to be growing rapidly.
Bottom Line. As usual, I am left wondering. Wondering how well the physicians who have chosen this career path actually make out financially. And existentially. Wondering what are the marketing strategy and tactics that characterize a successful site.
The final thing I wonder about here? Is there an opportunity for us to step in and apply the vast resources of the pharmaceutical industry and the behavioral sciences to providing these services?
Check out this 4 minute video clip. What you will see is two female Cardiologists, discussants in my On Doctors’ MindsSM project, talking about the reasons that the pandemic is causing them both major stress. Covering for sick colleagues, concern about lack of PPE, worry about bringing the disease home to their families, being forced to treat hospitalized COVID-19 patients even though they are not trained as Intensivists, etc. are all contributory factors here.
Bottom Line. As I talk with these physicians every month, I wonder… I wonder what impact this stress is having on their current treatment of patients. I wonder whether this stress will cause them to burnout, retire, develop mental health problems, commit suicide.
Again, Wolf Blitzer and Lester Holt have done a wonderful job taking us inside the “nation’s busiest ICU’s” and showing us the living hell that the pandemic has made of the lives of Intensivists. BUT. Office-based Primary Care Physicians and other specialties will also likely be suffering the psychological sequelae of the pandemic for years to come!
A few days ago, a colleague asked me whatever happened to all of my blog posts on physician burnout and suicide. I had no immediate answer to the question. Strange. I must have written fifteen or twenty posts on those topics over time, but they had largely dried up over the course of 2020. Like so many newscasters, I had become so tied up with my observations about the pandemic that terms like “physician burnout” and “physician suicide” had largely, make that totally, disappeared from my posts.
I need to correct that here and now. Check this out. What you will see is a fascinating and in depth ABC story of the impact of the pandemic on front line physicians. There are several important things to note.
First, the causes of physician burnout and suicide have changed during the pandemic. In the “good old days,” they were caused by annoying, but relatively benign, things like having too much administrative paperwork to deal with. Not anymore. Now they are caused by:
Amazingly intense and long work weeks. I had a conversation with an Infectious Disease Specialist in December who told me that the day after we talked would be her first day off in 2020.
The unique horror of having to hold the iPad of patients who were saying goodbye to their relatives who weren’t allowed to be with them at the end. Or of holding their hands after the conversations.
The traumatizing experience, typically several times each day, of having to tell someone over the phone that their loved one has just succumbed to COVID-19.
The fear of carrying the infection home to their beloved families.
Yes, physician burnout, anxiety, depression and suicide are indeed on the rise, and changing in their causation and depth, resulting from a year long period of physicians experiencing threat induced hyperarousal without the fight or flight possibilities that are supposed to be available under such circumstances.
Bottom Line. Complicating all of this is physician “stoicism.” The training of physicians that they should not appear to be cracking under pressure. The result? They just crack internally.
The solution? There is none really. But palliation can be obtained through compassionate support. You can see this balm being applied in pictures like the one above. Hugs, yes risky hugs, are about all the compassion that front line physicians (and nurses, and respiratory therapists, and…) have time for during these days of the pandemic.
Check this out. While you will see is a sobering, if not surprising, comment on what is happening to medical residents as the result of the COVID-19 pandemic. Residency has never exactly been a piece of cake, with guidelines in the U.S. being required to limit the doctors-in-training to a “mere” 80 hour a week workload under the best of circumstances. But now they are often being expected to treat corona virus patients for most of their waking hours, and often to cover for their mentors who are conveniently distancing themselves from infected patients.
Absence of personal protection equipment, lack of overtime or hazardous duty pay, and concerns about taking the infection home to family members results in a level of stress that is not surprisingly yielding significantly increased levels of anxiety and depression for the budding doctors.
Bottom Line. What will be the long-term impact of all of this on the affected doctors’ skill levels and mental health?
As most of you know, I spend a lot of my time reading about, thinking about and writing about physician burnout. For those of you who are not up to speed on my thinking as to why physician burnout is so important for professionals in the pharmaceutical industry to understand, you can get a quick (Okay, it’s 45 minutes!) update by going to my recent Intellus presentation on the topic. In this presentation, and in most of what is written on the topic by me and by others, burnout is usually attributed to a physician being employed in a stressful workplace. It’s exogenous. External.
But check this out. What you will see is an interesting blog post by a Radiologist who is also a Certified Daring WayTM Facilitator. In the latter role, she runs workshops that, in a nutshell, are designed to get people to feel better about themselves. And about their imperfections.
Through this lens, Dr. O’Connell believes physician burnout can be managed using a “nifty” trick. She tells her colleagues to spend time thinking about what they would be doing for themselves if they weren’t so busy taking care of others. Like I said, this is a different take on burnout. It’s endogenous. Internal.
Bottom Line. Hopefully you are sitting there thinking that both perspectives are correct. Doubtless, working in a stressful environment is a major contributor to physician burnout. That’s what the doctors themselves tell us.
BUT. Why is it that about 50% of physician burn out and 50% don’t? I’m guessing that it is how the individual processes the external stress that leads to this fork in the roads.
On a practical note, I think Dr. O’Connell’s focus is the appropriate one. Individual physicians can’t change the stress in their environments. What they can do is to work on how they process the stress, and on not letting it diminish their own self-images.
On April 2, I had the opportunity to deliver an Intellus Webinar to 51 participants. If you missed it, it is available here. There we were, all 52 of us each cocooned in our home offices in our sweat pants, discussing physician burnout while the COVID-19 pandemic swirled around us outside. I suggested that the attendees should consider the survey data on burnout that I would be presenting during the webinar as the “before” picture. Much of it was collected in the first few months of 2020, i.e., before all hell broke loose. During recent weeks, we have seen the very nature of physician burnout change. In the good old days, i.e., a few short months ago, doctors were mostly “burned out” by administrative hassle. EMR’s, pre-auth requirements, etc. Now, physicians are being more literally burned out by working long shifts in ER’s and ICU’s, treating patients they know full well might infect them and, by proxy, their families.
During the session, I discussed a great irony in all of this. Dr. Frank Grabin was a two-time cancer survivor, ER physician and the author of the book pictured above. He had made it back from the old-fashioned kind of burnout, and had written a best-selling book telling other physicians about his journey back from the dark side. The irony? He died the day before our Webinar of the new kind of physician burnout. COVID-19.
Bottom Line. As I sit here today, I am slowly but surely coming to the realization that this pandemic will change the psychology of our HCP customers forever. Will the new burnout replace the old? Will it simply layer on top of it, or multiply it? We had best start to spend some time studying these changes and developing a plan to deal with them in the world of the “new normal.”
Check this out. What you will see is pretty much what you would expect during the Covid-19 pandemic. Dr. Hartsock, the physician pictured above, is a Hospitalist. And she is scared to go to the hospital every day. Scared for herself and scared for other healthcare workers. Scared because 10% of the infected patients in Italy, a country which we seem to be mimicking, are healthcare workers. AND. Scared because, for some reason, when people on the frontlines of fighting this pandemic get the COVID-19 virus, they get it BAD! And yes she is asking for donations of PPE (Remember when we didn’t know what that acronym stood for?). Like I said, pretty much what you would expect a physician in this position in March 2020 to be saying.
So why do I refer you to this post if its content is so predictable? Answer? Because it got me to thinking. You see, I have a “stock speech” about physician mental health that I have given several times at conferences, as a Webinar, etc. In it, I cover physician suicide, depression and burnout. Such manifestations of physician mental health issues are of great concern due their frequency and impact on the practitioner AND on patient care.
SO. Against this backdrop, I am pondering the longer-term impact of the COVID-19 pandemic and the practitioner fear it is understandably causing. Will rates of physician suicide, depression and burnout increase significantly? I am thinking PTSD here.
And will rates of “compassion fatigue” increase among the nurses who are working amazingly long hours, afraid of getting sick themselves and having to hold dying patients’ hands since no visitors are permitted? Again, I would think, a resounding yes.
Bottom Line. My prediction? Those of us who deal with health care providers, as professionals and as patients, are going to be dealing with the psychological sequalae of COVID-19 long after the virus itself has been beaten into submission!