In recent years, there has been growing recognition of the importance of stress and burnout among physicians and other healthcare workers. During these challenging times, it is more important than ever for doctors to take care of themselves. While one would assume that physicians with an interest in integrative medicine are likely to pay more attention to self-care than the average doc, this is not always the case. In this article I will share some interesting tidbits from the literature on physician stress and burnout, and some evidence-based options for prevention and self-care.
Burnout refers to a prolonged response to chronic stressors. It is a multidimensional experience whose domains have been called emotional exhaustion, depersonalization and reduced personal accomplishment. Intervention studies on burnout typically use the Maslach Burnout Inventory, which uses 22 items scored from 0 to 6 to assess these three domains. There is a version of the MBI for use in medical personnel, and it can be licensed from Mind Garden (mindgarden.com) for use in your hospital or healthcare organization.
Estimates of the prevalence of physician burnout have varied widely, with a recent systematic review reporting rates from 0 to 87% (JAMA 2018;320:1131-50). Studies have reported that burned-out physicians and nurses suffer from more substance abuse, broken interpersonal relationships and suicidal ideation, they believe they deliver poorer quality care and patients seem to be less satisfied with their care.
A meta-analysis of interventions to reduce burnout of physicians and nurses identified 22 such studies (Medicine (Baltimore) 2020;99:26(e20992)). Interventions either targeted individuals, organizations or both. The former group received instruction in yoga, massage, mindfulness, communication skills, emotional regulation and self-care. Organizational interventions targeted workload or schedule changes, teamwork, telehealth and greater use of medical assistants and interdisciplinary care teams.
The coronavirus pandemic has obviously caused an increase in stress for people everywhere. Amazingly, a systematic review found 62 published studies on the psychological impact of the pandemic since it began in November 2019. (Psychiatry Res 2020;291:113190). Survey data from over 162,639 participants worldwide revealed that patients who had been infected by COVID and those with pre-existing conditions were nearly twice as likely to suffer from anxiety and depression as the general population. Interestingly, healthcare workers were not at increased risk of either anxiety or depression in this study.
It seems that we have all adapted somewhat to this historic global shock, but it should come as no surprise that emergency workers are a particularly resilient bunch. In a longitudinal prospective study of Emergency Medicine provider wellness across ten academic and community hospitals, markers of mental health, burnout and resilience all improved considerably over a four-week period at the start of the pandemic. Interestingly, women were nearly twice as likely as men to report feelings of isolation, and those who worked part-time carried the highest risk of burnout. (Res Sq 2020;doi:10.21203/rs.3.rs-87786/v1).
I found a brief but excellent review of some simple practices that physicians can use to improve their mental well-being that may also help prevent burnout. (J Am Coll Radiol 2020;746:doi.10.1016). The authors describe mindfulness micropractices during opportune moments throughout the day. These can be done while brushing your teeth, waiting at a traffic light, or waiting to log into your EMR. They advise devoting one slow, deep breath to noticing whether you are hungry or thirsty, and paying attention to what you are feeling. They also cite evidence that supports the benefit of gratitude, suggesting that we write down three things we are grateful for on a daily basis.
Integrative doctors understand the impact of cold stress and less sunlight on immune function, and this makes many of us worry that there will be difficult times ahead this winter. Many of us are also frustrated and disappointed by the narrow focus on infection rates and feel the need for more a more complete assessment of the many different kinds of impact that the pandemic and the lockdown have had on society. While we must expect the unexpected, we must find it within ourselves to stay calm and carry on. As physicians, we also have a duty to uplift and support the patients and communities that depend on us more than ever during times like these. Take care of yourselves, everyone. We will get through this.