During my attendance at the Harvard Macy Institute Health Care Education 2.0 course, I was surprised when we were asked to participate in a mindfulness exercise every morning. I must admit that I wasn’t comfortable with the idea of spending time focusing on my breathing when I could be utilizing that time to work or learn. As the course carried on, I began to realize how we, as professionals, can be so focused on outcomes that we lose track of the journey, and how it affects us.
While healthcare providers, with their rigorous selection process and training, are expected to be resilient under significant physical and emotional stress, the numbers say quite the opposite. Levels of burnout (exhaustion of physical or emotional strength and lack of motivation) among healthcare providers are increasing every year, and have reached nearly 60% in some disciplines. Rates of provider distress (burnout, anxiety, depression, and suicide) are higher than the general population. These numbers have implications beyond the affected healthcare provider, as studies have associated providers in distress with inferior quality of care, increased errors, decreased patient satisfaction, and even increased patient mortality.
One must wonder, what lead us here? Many of the factors contributing to healthcare provider distress – for example, increased workload, increased work inefficiency, and a lack of autonomy or meaning in work – are by-products of the modern healthcare work environment. For example, today’s providers spend up to half of their workday entering data into electronic health record systems, instead of interacting with patients. Another set of significant contributors relate to work-life balance. Many healthcare careers involve a substantial financial investment and unusual working hours, causing difficulty in keeping time aside for family and friends. In addition, maintaining a healthy diet and regular exercise can become a burden under these circumstances. Unfortunately, healthcare providers are often conditioned to be susceptible to burnout even before they begin medical practice. Dr. Mike Drummond describes the usual individual choosing a career in medicine as a workaholic perfectionist who seeks to be the superhero with all the answers. He explains that while providers are intentionally taught that the “patient comes first,” they are also unintentionally trained to “never show weakness.” These conditions, while helpful during medical training and practice, are a recipe for eventual distress.
How can such a complex problem be addressed? Some key figures in the field suggest that healthcare provider distress cannot be managed without changes to the institutional environment. Others advocate engaging the providers on a personal level, increasing their resilience to distress through education. In reality, a one-sided approach is unlikely to be effective. The most resilient individuals can still experience distress under extreme circumstances, and the most thoughtful institutional efforts might not help individuals who can’t find balance in their personal lives.
Many corporations outside the healthcare industry have been actively investing in employee well-being initiatives, calling them “low-cost means to a happier, healthier, more present, more productive workforce.” Similar positive results have been observed in healthcare institutions implementing well-being programs, with returns on investment reaching up to 5:1. Communication between providers and institutional leadership with regards to persistent workplace stressors should be encouraged, as many of these stressors can be feasibly addressed. Education plays a pivotal role in fighting the wave of physician distress. Key authorities in the medical education field, such as the AAMC and ACGME, are actively advocating for learner well-being. Many academic institutes are implementing well-being curriculums as part of their educational efforts. Through role-modeling and mentorship, educators can lead the well-being movement by example. Providers need to be aware of potential contributors to their well-being or distress, and willing to take active steps to address these contributors. Even small efforts, such as a reflective journal, a 20-minute daily exercise, or good sleep hygiene can have significant effects on an individual’s well-being.
When healthcare providers arrive to work every day, they bring more than a capable mind and a skilled pair of hands. How we function as professionals is strongly affected by our environments at work and home. Healthcare institutions, educators, and providers need to invest in well-being efforts, as the benefits extend beyond the providers to the patients they serve.
Mohammad Zaher (Health Care Educators 2.0, ’17) is an emergency physician, medical educator, and wellness coach in training. He is an international fellow of the STRATUS Center for Medical Simulation at Brigham and Women’s Hospital. You can follow him on Twitter @MohammadZaher