Posted on Nov 05, 2019, 2 p.m.
Clinical practice and medical training are associated with stress, but this is often considered to be a positive motivating factor, that is until recently, and it likely has a great deal to do with the health system becoming increasingly dehumanized and depersonalized.
The ongoing triad of emotional exhaustion, depersonalisation, and reduced professional efficacy is defining physician burnout, and it justifiably questions the role of stress in clinical practice. It has the potential to put patient care at risk and it has a detrimental effect on medical workforce retainment.
Healthcare systems under pressure also contribute to professional burnout with all the long hours, outdated and not fit for purpose technologies, and the mounting documentation requirements that shift the focus away from patient care which cause work-life imbalance, insufficient job resources, ineffective multidisciplinary teams, and a dismissive organisational culture.
Physician burnout is now finally recognised as a global health care predicament, and in America alone it affects over half of all practising physicians, and just as troubling it is on the rise among medical students and trainees. Other high income countries such as the UK as well as low income and middle income countries such as China are also reporting similar trends.
The National Academy of Medicine published a report in response to the concerning rate of burnout among American clinicians and trainees, aiming to find solutions to burnout by shifting the focus away from the individual via proposing systemic changes in healthcare organisations, academic institutions, and at all levels of government.
This report is focused on prevention and mitigation of burnout by promoting wellbeing; the idea is not to create additional burdens on healthcare systems rather to encourage prioritisation of tasks that most benefit patients in need of care and the physicians who treat them.
Recommendations propose to create a positive work environment that fosters wellbeing and enhances care while reducing the risk of burnout. Organisations are urged to adopt system models that balance job demands and resources with regular assessment of physician burnout, and aim to eliminate eroding professional wellbeing factors which includes outdated technology and unnecessary paperwork.
Recommendations also propose academic institutions should create engaging learning environments by focusing on real life hospital scenarios and applying situational clinical judgment that may help to lower the risk of future burnout associated with the stress of uncertainty. Additionally, medical students should be encouraged to become aware of and access confidentially relevant support programs.
A human centered approach is recommended to help lower the unnecessary administrative burdens; technology solutions should be improved by collaborations with clinicians and vendors regarding its design, function, and deployment.
Regulatory policies need to ensure optimal flow of data within the health information system, and clinicians’ personal health information should be confidential and not admissible in malpractice litigation proceedings according to the report.
The report also calls for further investment into a co-ordinated research agenda aiming to identify the best measures for addressing clinician burnout. While this report is designed for an American audience it still has global implications as it recognises how personal stress management strategies may be insufficient to address burnout.
System wide issues originating from workplace culture, healthcare policy, and public expectations need to be acknowledged. System specific characteristics may vary highly among countries with different effects on physician burnout such as the scarcity of high quality primary healthcare provision putting additional pressures in secondary care systems in China putting hospital doctors at more risk.
Theories suggest that burnout stems from doctors no longer feeling connected with the healthcare system, and the perceived loss of autonomy in the provision of care. Global healthcare systems have shifted towards enhanced cost effective performance via going digital which may have triggered its progressive dehumanisation.
This pressurised health system which is burdened with corporate greed, administration, changing financial incentives, outdated technology, altered professional expectations, and regulatory policies insufficiently aligned with professional values may have made the art of medicine corrode itself. On the other hand patient centered health systems which reinstate a physician’s sense of purpose and promote a higher degree of physician interconnectedness have potential to rehumanise healthcare to what it once was, and longs to be once more.
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This article is not intended to provide medical diagnosis, advice, treatment, or endorsement.