AAP 2017: Physician Wellness at the Personal, Institutional and Cultural Levels
Do you know we have record rates of physician burnout, dissatisfaction, and suicide? Ongoing shortages in primary care, without improvement in sight? Physicians exiting medicine earlier than in the past?
What about burnout? Do you know it affects patients as well as their doctors? Affects physicians’ families and friends? Increases mistakes and malpractice risk? Affects patient adherence and outcomes? Is costly to the entire system?
How do we start to fix this? The framework for a discussion on physician wellness begins with attention to three levels: personal wellness, organizational wellness and wellness within the culture of medicine.
Physician wellness at the personal level includes what we all know and preach: Get adequate sleep. Eat healthy foods, mostly vegetables. Lead an active lifestyle. Surround yourself with healthy people. Set healthy boundaries. Develop a support network. Establish care with a primary care physician. Manage your finances. Care for your spiritual needs. Maintain intellectual pursuits across your lifetime. Physician wellness at this level focuses on life skills and habits that support our resiliency and promote our overall well-being.
The high level of physician burnout indicates that addressing wellness at the personal level is not enough. It speaks to a systemic rather than individual etiology. Organizations have begun to recognize it is in their best interest to keep their physicians happy. Losing even one physician to burnout is expensive. In addition, burned out physicians are liabilities. Mistakes increase. Productivity decreases. Patient satisfaction decreases. Ripples effects touch other members of the team, which leads to further burnout. If for no other reason, physician wellness at the organizational level matters since it affects the bottom line.
Fixes at the institutional level have primarily focused on time. Physicians have too little time to do what we need to do and to do it well. The EMR is regularly blamed as a time sink. But what we do with our time also matters. We need systems that allow each person to work at the highest level of their training. Doctors can practice medicine while other team members do what they do best. Finally, we need to acknowledge the inherent conflict between the business of medicine and the practice of medicine — something physicians wear every day as we work with our patients. Making these changes at the institutional level requires a re-focusing of institutional values to include physician wellness.
Wellness within the culture of medicine is the third level of our framework. Western medicine has its own set of customs, traditions and values that are learned early in the course of medical training. The value of sound scientific methods, the importance placed on logic and reason, and the significance of professional integrity are examples. Hard work, sacrifice and commitment are also included. Unhealthy values include harsh judgment, shame, a sense of superiority, and perfection.
When examining physician wellness at the cultural level, we must also address discrimination within medicine. Overt racism, misogyny, ageism and discrimination based upon sexual orientation are everyday occurrences and affect everyone within the culture of medicine. It’s difficult to experience wellness at the same time as discrimination.
At every level, physician wellness depends upon continuous, usually low-tech, activities and habits based upon individual and shared values. Identifying and shaping these shared values is not going to happen on its own. We all have an obligation to speak and act up. We need improved physician health. Our families, our communities, patients, and even the institution of medicine deserves better.
