Doctors deal with enormous stress working every day with life and death. How can they balance the priority of the patient with their own needs? If the patient comes first, when does it end?
There’s nothing like talking to a palliative-care and hospice physician to learn about the stress of working every day with life and death. That’s death, as in dead. Dr. David Casarett, whom I spoke with last week, began to open up in an insightful way what it’s like to avoid burnout.
I wanted to know more about the connection between management of the daily work and the clinical models used to get it done, so I checked in with Matthew O’Dell, a health care industry management consultant who works specifically with this question of burnout.
He zeroed right in on a key point: how the clinician can balance the priority of the patient with his or her own needs. “That’s a hot topic,” he says. “Does the patient come first? And if so, how? You have to go in depth on that question: When does it end?”
When does it end, I asked. It seemed to me that clinicians — like clergy — could get caught in an endless loop putting others’ needs before their own, finding that their own burnout hurt their ability to help the person in need.
Keeping the books balanced
O’Dell said it’s an ongoing conversation, but there was a particular take he’d found helpful, and it uses an analogy from the very different field of finance. He’s worked with Dike Drummond, MD, a Mayo-trained physician and author of “Physician Burnout: What to Do When Working Harder Isn’t Working.” Drawing on Drummond, O’Dell identified three inner “bank accounts” that we all have, whatever field we’re in: physical, emotional and spiritual. And when someone carries a negative balance on any one of them, they can expect negative consequences.
“When the physical account is low, you’re tired,” O’Dell explains. “Clinicians are told to soldier on, work long hours, and this can start the early stages of burnout. When there’s no emotional energy, it impacts the ability to empathize and subsequently hurts bedside manner with patients.”
When the spiritual bank account is low, he says, it results in a loss of meaning — clinicians don’t feel that their work matters anymore.
“In this field, many clinicians went in because of a desire to help,” O’Dell says, “but because of the structure and culture [of the medical field], it’s harder to do. So the culture needs to be addressed.” And there’s another part of the downside, he adds. “A low spiritual account is contagious. It affects your team. Your colleagues are likely to provide less-than-optimal care if they see you’ve lost a sense of meaning in your work.”
The overall effect of those low accounts is disturbing. “Burnout has caused high employee turnover, early retirements, mortality rates, contributing to higher costs of care,” O’Dell says. “I think the factors were there before, but because of the tremendous changes the healthcare industry has gone through in the past few years, it has intensified.”
Team-based clinical culture
O’Dell also agreed with Casarett’s observation about younger physicians and a changing medical culture. “There’s a generational gap,” O’Dell says. “The younger generation is demanding more of a work/life balance. They often look to achieve that by working in a team-based model of medicine. Historically the medical education system has taught a more authoritative leadership style. Older physicians may have more stressors as the industry consolidates and moves toward a team model.”
Thinking back to Casarett’s description of his own processes (collegiality at work, downtime for his own creative writing), I asked O’Dell how clinical environments. can accommodate the daily pressures of the work doctors do. Like Casarett, O’Dell reinforced that it is a process for each individual for each organization.
“[The solution] is not ‘one fits all,'” he says. “One example is having working groups for medical professionals who meet to actively address the issues causing burnout. But basically, the overall effort needs to be funded and needs support from top leadership for it to be effective.”
Management needs to make it work
I probed a little further about how leadership can know if their efforts are working. “What does ‘good’ [clinical culture] look like? That’s what the leadership of hospitals need to be asking,,” O’Dell says. “It’s about processes that enable a healthy culture. It’s going to have to be answered in real-life on-the-ground settings. Any changes made toward a healthier culture will need focused management efforts that embed processes that make a healthy work/life balance something people can realistically repeat day-in and day-out. This is the tedious work in the trenches that will make improvements that can be sustained.
“Going on this journey to improve culture and reduce burnout is something hospital systems can’t afford not to do. It will ultimately pay for itself as the results can include reduced employee turnover, higher patient satisfaction, and healthier balance for clinicians — all things we both want and need.”
Which, I thought, was a hopeful invitation to further conversation for those in the medical field.