Cases That Test Your Skills

The emotionally exhausted physician

Current Psychiatry. 2018 August;17(8):e3-e8

References

1. World Health Organization. Mental health: a state of well-being. http://www.who.int/features/factfiles/mental_health/en/. Updated August 2014. Accessed March 17, 2017.
2. Maslach C, Jackson S, Leiter M. Maslach burnout inventory manual, 3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996.
3. Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC: American Psychiatric Association; 2013.
4. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613.
5. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385.
6. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114(6):513-519.
7. Balch CM, Shanafelt TD. Combating stress and burnout in surgical practice: a review. Adv Surg. 2010;44:29-47.
8. Shanafelt TD, Oreskovich MR, Dyrbye LN, et al. Avoiding burnout: the personal health habits and wellness practices of US Surgeons. Ann Surg. 2012;255(4):625-633.
9. Karasek RA Jr. Job demands, job decision latitude, and mental strain: implications for job redesign. Adm Sci Q. 1979;24(2):285-308.
10. Johnson JV. Collective control: strategies for survival in the workplace. Int J Health Serv. 1989;19(3):469-480.
11. Siegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol. 1996;1(1):27-41.
12. Lesser LI, Cohen DA, Brook RH. Changing eating habits for the medical profession. JAMA. 2012;308(10):983-984.
13. Bleich SN, Bennett WL, Gudzune KA, et al. Impact of physician BMI on obesity care and beliefs. Obesity (Silver Spring). 2012;20(5):999-1005.
14. Stanford FC, Durkin MW, Blair SN, et al. Determining levels of physical activity in attending physicians, resident and fellow physicians, and medical students in the USA. Br J Sports Med. 2012;46(5):360-364.
15. Tucker P, Bejerot E, Kecklund G, et al. Stress Research Institute at Stockholm University. Stress Research Report-doctors’ work hours in Sweden: their impact on sleep, health, work-family balance, patient care and thoughts about work. https://www.stressforskning.su.se/polopoly_fs/1.233341.1429526778!/menu/standard/file/sfr325.pdf. Accessed March 17, 2017.
16. Wisetborisut A, Angkurawaranon C, Jiraporncharoen W, et al. Shift work and burnout among health care workers. Occup Med (Lond). 2014;64(4):279-286.
17. Eckleberry-Hunt J, Lick D, Boura J, et al. An exploratory study of resident burnout and wellness. Acad Med. 2009;84(2):269-277.
18. Peters M, King J. Perfectionism in doctors. BMJ. 2012;344:e1674. doi: https://doi.org/10.1136/bmj.e1674.
19. Jager AJ, Tutty MA, Kao AC. Association between physician burnout and identification with medicine as a calling. Mayo Clin Proc. 2017;92(3):415-422.
20. Waytz A, Hershfield HE, Tamir DI. Neural and behavioral evidence for the role of mental simulation in meaning in life. J Pers Soc Psychol. 2015;108(2):336-355.
21. SMART Criteria. https://en.wikipedia.org/wiki/SMART_criteria. Accessed March 17, 2017.
22. Hu YY, Fix ML, Hevelone ND, et al. Physicians’ needs in coping with emotional stressors: the case for peer support. Arch Surg. 2012;147(3):212-217.
23. Wallace JE, Lemaire J. On physician well being–you’ll get by with a little help from your friends. Soc Sci Med. 2007;64(12):2565-2577.

If we do our jobs well, the next part is easy. We have them set specific short- and long-term goals related to their situation. This is something we do every day in our practices. It may help to make sure we’re using SMART (Specific, Measurable, Achievable, Relevant, Time-Bound), a well-known mnemonic used for goals (Table 1²¹), and brush up on our motivational interviewing skills (see Related Resources). It is especially important to make sure our colleagues have goals that are relevant—the “R” in the SMART mnemonic—to their situation.

Finally, we do a better job of reaching our goals and engaging more at work and at home when we have good social support. For physicians, co-worker support has been found to be directly related to our well-being as well as buffering the negative effects of work demands.²²Furthermore, our colleagues are the most acceptable sources of support when we are faced with stressful situations.²³ Thus, as psychiatrists, we can doubly help our physician patients by providing collegial support and doing our usual job of holding them accountable to their goals (Table 2).

OUTCOME Goal-setting, priorities, accountability

As we’re exploring goals with Dr. D, she makes a conscious decision to spend less time on documentation and start focusing on being present with her patients. She returns in 1 month to tell you time management is still a struggle, but her visit with you was instrumental in making her realize how important it was to get home on time for her kids’ activities. She says it greatly helped that you kept her accountable, yet also validated her struggles and gave her permission to design her life within the constraints of her situation and without the burden of having to be perfect at everything.

Bottom Line

We can best help our physician colleagues who are experiencing burnout by shifting our paradigm to a wellness model that focuses on helping them reach their potential and balance their professional and personal lives.

Related Resources

Balch CM, Shanafelt TD. Combating stress and burnout in surgical practice: a review. Thorac Surg Clin. 2011;21(3):417-430.
Miller WR, Rollnick S. Motivational interviewing: preparing people for change, 2nd ed. New York, NY: The Guilford Press; 2002.
Stanford Medicine WellMD. Stress & Burnout. https://wellmd.stanford.edu.

The emotionally exhausted physician

References

OUTCOME Goal-setting, priorities, accountability

Bottom Line

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