The April 18, 2019 Department of Internal Medicine Medical Grand Rounds, “Reducing Burnout & Promoting Professional Fulfillment: Organizational Approaches to Physician Well-Being,” was presented by guest speaker Tait Shanafelt, MD, Jeanie and Stewart Richie Professor of Medicine; associate dean, chief wellness officer, Stanford Medicine and director, WellMD Center.
Shanafelt started with the following question to the audience, “If I suggested that there was a system issue at your hospital, at your medical center, but it is really across the country and it was increasing medical errors, eroding quality of care, undermining patient satisfaction, and reducing access to care. And it was so pervasive that in some form or another, it may impact half of the patients seeking care in your hospitals and clinics. You can imagine the type of response you would mount as a medical center or a country if that were plaguing our health care system.”
His talk set out to discuss the current state of physician satisfaction and burnout, the causes and consequences, and future individual and organizational approaches to promote well-being.
Shanafelt defined burnout as a syndrome of depersonalization, emotional exhaustion, and low personal accomplishment leading to decreased effectiveness at work. He outlined his team’s multi-variate analysis of physicians and the factors that are associated with burnout and the gap within the population when looking at physicians, PAs, and other caregivers. He did note that the gap doesn’t exist when analyzing nurses.
When looking at a graph of work/life integration and burnout, Shanafelt noted that different specialties have a profile of what dimensions are a challenge for them. “We tend to assume that these are two dimensions that will move together, that both are favorable or unfavorable and that can we true [for some], but it is often not actually the case,” said Shanafelt. “If we change the Y axis and look at fatigue, or meaning of work, all the dots shift again.”
He stressed that this is an important issue to care about because of the personal and professional consequences. Shanafelt not only discussed physician suicide, but also the problematic, infectious component of burnout.
If I suggested that there was a system issue at your hospital, at your medical center, but it is really across the country and it was increasing medical errors, eroding quality of care, undermining patient satisfaction, and reducing access to care. You can imagine the type of response you would mount as a medical center or a country if that were plaguing our health care system.
Dr. Tait Shanafelt
He talked about a construction worker having protective gear and asked about the equivalent of protective gear for physicians. He addressed some steps that individual physicians can take in self-care but also what an organization can do to combat the issue. He noted that the biggest opportunity is within an individual division or department.
“What I often say is that if you have good leadership in a division, you believe you have meaningful work, you have strong sense of community and connection with your colleagues, you will put up with darn near anything, and you will circle the wagons. And even if you don’t like some broader factors, you will circle the wagons and shoot outward because things are working well,” said Shanafelt.
He concluded by challenging the audience to ‘take the next step and learn from each other on this road.’
Yale New Haven Hospital’s Office of the Chief Medical Officer and Physician Liaison Services supported this week’s Medical Grand Rounds.