________________________________________________________________________ Burnout in Physicians
Improve Work-Life Balance As noted, work-life balance and work-life conflicts are sig- nificantly associated with job satisfaction and burnout. One challenge in achieving an appropriate work-life balance is that physicians often search for a single solution to solve the prob- lem. Drummond, who coaches physicians on how to avoid burnout, notes that burnout is more of a dilemma and so requires ongoing strategies to ensure finding and maintaining an appropriate balance [98]. Physicians who participate regularly in hobbies, personal interests, and meaningful volunteerism are at lower risk of burnout and are more likely to have higher quality of life [92; 96]. Experts recommend scheduling time each week to pursue hobbies and participate in activities of interest [92; 99; 100]. Participating in hobbies was reported by 40% of physicians as a way they avoid burnout [94]. Other strategies include setting strict boundaries between work and home, making time for friends and family, taking regular vacations, and remaining clear about priorities [65; 93; 94; 99]. Personal relationships and personal boundaries were reported by 37% (each) of physicians as a way to avoid burn- out. As practical advice, Drummond suggests that physicians work with their families to develop a master “life calendar” that includes not only social events such as having coffee with a friend, reading, and exercise, but also all family members’ schedules and special events [100]. Physicians should keep an electronic calendar or take a picture of the calendar with their cell phone, check the calendar when a potential work commitment arises, and learn to say no to colleagues’ requests when necessary. Engage in Mindfulness Training Mindfulness is defined as purposeful and nonjudgmental attention to one’s own experience, thoughts, and feelings [101]. Interventions to enhance mindfulness in primary care physicians have led to short-term and sustained improvements in well-being, reductions in indicators of stress and depression, and lower scores on the emotional exhaustion and deperson- alization scales of the MBI [102; 103]. A nine-month interven- tion that involved facilitated physician discussion groups that integrated elements of mindfulness with reflection, shared experience, and small-group learning significantly decreased scores on the depersonalization subscale that was sustained 12 months after the end of the program [104]. Scores on the emotional exhaustion subscale and overall burnout scores also decreased substantially. The intervention improved physicians’ sense of meaning in their work but did not lead to significant differences in stress, symptoms of depression, or job satisfaction [104]. Mindfulness has also been associated with more patient- centered communication and an increase in the number of satisfied patients [101].
The concept of self-care is emphasized in every book or article on preventing job stress and burnout across occupations. Self- care warrants particular emphasis for physicians, as they have been trained to put the care of others ahead of themselves and are not typically good at caring for themselves [89]. Self-care is essential for energizing, restoring, and maintaining the physical and emotional stamina to manage stress and helps increase job satisfaction [6; 44; 90]. The following strategies to prevent stress and burnout are recommended on the basis of studies of interventions as well as guidance from burnout experts and physicians who have successfully prevented stress and burnout. The strategies address changes in personal and professional lifestyle habits. PERSONAL AND PROFESSIONAL LIFESTYLE STRATEGIES Enhance Well-Being The most important first step in preventing stress and burnout is to enhance well-being. Self-care, improving work-life balance, and mindfulness training and other structured interventions are key elements for maintaining physical and emotional well- being ( Table 8 ) [19; 65; 90; 91; 92; 93; 94]. Enhancing physi- cians’ well-being is vital not only to address the consequences of stress and burnout but also to improve patient outcomes. The relationship between physician well-being and patient outcomes is understudied, but a systematic review (18 studies) showed that well-being was associated positively with patient satisfaction, patient adherence to treatment, and interpersonal aspects of patient care [95]. The authors of the review noted that most of the studies were observational and of average quality. Make Self-Care a Priority Self-care involves several universal lifestyle measures, such as healthy eating habits, exercise, sleep, and regular health care. The results of studies and surveys have shown that physicians who maintain a healthy diet and follow the Centers for Disease Control and Prevention guidelines for exercise are less likely to be burned out [31; 92; 96]. Physicians who have successfully avoided burnout recommend self-care as a strategy, with physi- cal well-being ranked as the most common strategy (60%) in a small study of hospice and palliative care physicians [93; 94]. Attention to self-care should begin in medical training, and one program was developed to help second-year medical students focus better on personal behaviors, such as exercise, eating habits, sleep, and emotional health. The students were asked to target a specific area for change, set a goal, track their prog- ress toward the goal, and assess their success [97]. Although approximately 50% of the students had not reached their goal by the end of the program, 80% said they were healthier because of the program and 82% said they would use the program again. Such programs during medical training can help foster self-care as a priority.
64
MDPA2126
Powered by FlippingBook