It isn’t always easy to detect when a friend or colleague is suffering from burnout, and even if you do, it can be uncomfortable to speak up about it. But while it may be difficult conversation, speaking up can make all the difference for a struggling physician.
In the second of two “AMA Moving Medicine” podcast episodes featuring a panel discussion on burnout, the AMA's team of experts on physician burnout discuss what to do if you think a friend or colleague is dealing with burnout and how the health care system can cultivate physician resiliency. Kathleen Blake, MD, MPH, leads the panel with Marie Brown, MD, Jan Kief, MD, Ryan Ribeira, MD, MPH, and Hunter Pattison, MD.
Dr. Blake: I'm going to just, from a personal anecdote, share the fact that going into residency or into internship, my husband and I made a pact. And it might seem silly, but it worked. And the pact was that during that year that we knew would be incredibly stressful, we were not going to make a baby, we were not going to change religions, and we were not going to know the word divorce.
So, literally, what we did is we just said, "Park it." And like I say, it might seem silly. But I would tend to ruminate. And I could have ruminated myself probably into changing religions, possibly getting a divorce. Probably not making a baby. But it's something where you just say, “Certain things—they can wait.”
I'm going to go to Hunter next and ask our third question, which is, what do you do if you are starting to observe that a friend or colleague and you think they might be about to burnout? Or they're acting in a way that you think they've already reached that stage?
Dr. Pattison: No one is walking around with a low-battery logo above their head. People will experience burnout differently. And you may not always recognize that. A lot of times, the most common ways that people will say residents and medical professionals will burn out will be with patient care or being late to meetings or late to reply on things, big changes in personality and things like that.
If you're starting to see that and starting to recognize that, I think it's important to point it out to the person, because they may not realize what's going on. They may not realize that they are burning out or they're experiencing symptoms of burnout in their system. And the same goes with you as well. You may not realize that you're burning out, but you are being less efficient in your clinical duties and your other duties. Or you're not finding satisfaction in the things that you used to get a lot fulfillment out of. I think trying to be that helping hand and trying to connect people to wellness resources or encourage them to seek out those wellness resources is important.
But again, it puts the blame of burnout on the person in that, when you think about burnout, it's not the person, it's not the fact that they're weak or they aren't able to get through the system or through their training and become the doctor that they're supposed to be. It really is a systems issue. I think the best advice would be to try and realize what's causing that burnout. Whether it's shift scheduling, or whether it's administrative tasks. Or if it’s extremely burdensome with the EHR—things like that. And work with your community and your organization to try and fix that.
Because that's the only way you're going to prevent burnout is by trying to help fix the system that's causing it. I also would definitely put in a plug for state involved organized medicine too, because I think coming to meetings like this and staying involved in your communities and your hospital organizations, state organizations, things like that, that's how you can make a difference. And that's why I think everyone on the panel is still involved, because they feel like they can help make a difference in the system.
Dr. Blake: Jan, Marie, Ryan, anything you'd like to add to that?
Dr. Brown: I think depersonalization, saying something really negative about the patient. They're not Mrs. Jones in room two, they're that train wreck. We know, looking back, depersonalizing the patients and playing silly games where you've got points for certain hits that you got that night: that was depersonalization. We didn't know it at the time, but that was us dealing with burnout. If you see that, and somebody's really angry, there is a script and talking points on STEPS Forward. Because those are hard conversations because you're struggling too—but say something. ...
If you say, "I'm really struggling, I just feel whatever," reflect and then see what comes from that other person. But if you don't feel comfortable, bring it on to the program director or your medical student, the clerkship director, or whoever is a safe person for you. I know when I was in residency during internship, now the CEO of Rush was my chief resident. And one of my colleagues was burned out, my dearest friend, and I didn't know that she was burning out. So, he had the two of us come over for beers and pizza to just have a quiet time.
The people who—I'm afraid some of you are in this room—who say yes to everything, and are the least likely to be considered burning out because you're always happy, you always say “yes,” you're the go-to person, you can go to the AMA, you can run this meeting, you can make everybody else better.
That person, we've seen across the country, without anybody knowing, that perfect medical student, that perfect resident, that perfect doctor, we found out with some horrific event when they just let it go. So, watch out for yourself, if you're the “yes” person, and you know somebody who's always the “yes” person. Say: "We might be adding to that person's burnout because they may be the last person that you think."
Dr. Blake: Thank you. Last question, and we'll start with Ryan to answer this one. How do we cultivate resiliency throughout our medical career? And are there any particularly useful tools—we've heard a bit about some of them already—that you've encountered to enhance—and I'm going to modify the question a little bit—not just your personal resiliency, but the resiliency of the people around you, so that this is a more systems approach?
Dr. Ribeira: Yeah. I'm glad that you said that, because my first response to this question was that I kind of object. Generally speaking, I object to utilizing the term resiliency in these conversations too much. I think it is a worthwhile concept, but always needs to be coupled with the fact that providing tools for resiliency is just to help you get through a system that really needs an overhaul until we can fix it. We talked about cultivating resiliency through your medical career. I think, honestly, currently the way that medical training is structured does a disservice for us, kind of, for the rest of our lives.
And this has really been punctuated for me having recently finished my residency. I talked to my friends who are in other fields and they say, "Oh, how are you doing?" And I say, "Oh, it's pretty good, I'm pretty busy. I usually travel for my business Monday, Tuesday. I do administrative meetings Wednesday, Thursday. I do shifts Friday, Saturday and Sunday. And they're like, "Oh, that sounds like a nightmare." And I'm like, "Oh well, I guess. It's way better than residency." And I really, in my mind, I'm always comparing my life to the 90 hours a week or so that you are doing residency, and this seems way better.
I think by taking people through their very formative years of life, and then for three to nine years making them work 80 to 90 hours a week—and never go to the dentist, and never work out, and eat like garbage, and all these things—how do we expect them then, for the rest of their lives, to reverse all those horrible habits that we have forced upon them and live a normal and mentally healthy life? I think it is the system itself that is ingraining in us those bad habits.
Consequently, I think the solutions that are most appealing to me are solutions that facilitate the development of good habits during training. Some of the things I've seen that have been successful: At Stanford, in our residency program, in lieu of mandatory wellness lectures, once they kind of got the message around, they said, "Well, you know what we're going to do? We're going to give you residency conference credit for doing wellness activities. So instead of going to conference, you can go work out for an hour. And you'll get an hour of conference credit for that."
Or, "You can go to the dentist, or you can go get a massage, or you can go do whatever you want to do for your own personal wellness, and we'll give you conference credit for that as if you were there." That kind of solution I think is excellent. It helps foster those good life habits.
Also at Stanford, the surgery program just started scheduling people for days to meet with their primary care doctor and giving them the day off. They're like, "Hey, we gave you Thursday off. And we also scheduled an appointment with your primary care doctor. You don't have to go if you don't want to. But you know, just to help you out a little bit." Things like that, that help you develop those good habits and those life skills that are going to be important for the rest of your life, I think are some of the more useful interventions.
Dr. Blake: Great. Are there comments from the panel? Jan?
Dr. Kief: I've got a couple of comments. Those are very good, Ryan. You do have to have a very supportive institution. And this issue of burnout, it's lifelong. There are diverse factors. But there are certain things you can do yourself. Then, certain things, like organized medicine, where you can hopefully change the system, or with teams, you can suggest that things at your institution be changed.
One of my dear friends is an astronaut at the International Space Station, Kjell Lindgren. He’s also a physician. The astronauts adhere to this program of self-care, then team care, and then the mission. Self-care: you can't show up being a mess. Tell yourself: Three aspects of gratitude a day. Religiously practice that. My students think that is a huge thing. Always: Three things that you are so grateful for every day. Science has proven that's more effective than SSRIs. Take care of yourself in nutrition, your health. Have a personal physician. All of that stuff, you just have to do. So, self-care, that's No. 1.
Then team care. We really need the efficient, empowered—you have to be able to innovate, that makes you happy—physician-led teams. And that's going to take a lot of the administrative burden off. It's going to make you have fun at your work every day and give you a sense of purpose so that, you look at the three pillars of burnout, it's going to help alleviate those. So self-care, team care, and then the mission will be able to happen. ... There are toolkits out there with all sorts of things you can do in your institution and in your personal life.
Dr. Blake: Other comments?
Dr. Brown: Many of you may be going back, and hopefully your organization is looking to you for some ideas. I had the opportunity to spend a couple of days at Penn State last year and the medical student group had some very good ideas that I'll share with you that'll be posted up on Steps Forward in the not-too-distant future. One was they had the therapy dogs that are there for patients, and they just had them in the student lounge, and it was so popular.
And then, you're also experiencing what the patient might experience or when the patient says, "No, I don't want to do this." She said, "Well, I did it. It really feels good." And the other thing they did as a group, they made teddy bears or sewed some things for the pediatric ward, and they phrased it more as surgical suture technique and sewing. So, there are things you can do on site that are pretty creative.
Dr. Pattison: I'll just make it quick. I know we do talk a lot about like the systemic burnout, but at the end of the day, if you are feeling burned out or if you know someone who is feeling burned out, a lot of it comes down to that person trying to do stuff for their own wellness. Are you taking control and trying to do stuff to make you feel less burned out and give you that life satisfaction, or those things in your life that can bring you that fulfillment?
I remember starting out residency and people were like, "Oh, don't forget to cook food and go to the gym every day or go to gym every week and still enjoy the things that you want to do and take time to do that." And one month in, I was like, "How do people have time to do this?" All I wanted to do was sleep when I got home. And I'm sure that a lot of you feel that same way in medical school too, but it really takes a conscious effort to still maintain those aspects of your outside life that allow you to be the person that you are.
So, I think making that conscious effort to, if you like running, still try and run three times a week. Maybe not every day, or if you like gardening, or if you like reading, or if you like watching Netflix or anything, just taking that time to yourself and taking that little bit of control that back into your own hands, I think will help.