Consultations & Comments

Preventing Burnout: Talking to Colleagues Is Good Medicine

Volume 59 - Issue 2 - February 2019

Author:
Dean Gianakos, MD

Citation:
Gianakos D. Preventing burnout: talking to colleagues is good medicine. Consultant. 2019;59(2):49,52.

 

I didn’t know it at the time, but I needed the help of a colleague to keep my septic patient alive. The patient was a 60-year-old man who had presented to the emergency department with hypotension, bilateral pneumonia, and acute respiratory failure. He had been intubated and placed on a ventilator in the intensive care unit. Despite the administration of fluids and pressors, the patient had remained hypotensive. It was 2 am, and I was alone with the patient.

After an hour of putting in lines and monitoring the patient, I looked up from my stool at the bedside to see the emergency department physician who had called me to admit the patient.

“I thought I’d pop my head in,” he said. “He’s a very sick guy. It looks to me as if you’re doing all the right things. I’m around if you need me.”

It was early in my career as a pulmonologist in the early 1990s. His unexpected presence and words meant everything to me.

I remember another time when a colleague offered me terse words of solace after a pneumothorax complication from a procedure. As we passed one another in the intensive care unit, he gently clapped my shoulder and said, “Complications are tough, aren’t they?”

Those few words let me know I was not alone in my feelings of guilt and inadequacy.

Since the 1990s, isolation and loneliness among physicians seem to be increasing. As one family physician notes,1

"In all of the current handwringing about physician burnout and dysphoria, the loss of professional connections and relationships among physicians—being a part of a professional community—is rarely mentioned as a source of professional unhappiness. Being a physician in today’s world begins to feel lonely and isolated, particularly in larger systems which increasingly dominate medicine. While relationships with patients over time are acknowledged as the source of satisfaction that keeps physicians vital, dedicated, and learning, there are fewer discussions about the changing relationships with colleagues."

Physician burnout is a chronic stress syndrome characterized by emotional exhaustion, depersonalization, and a low sense of personal achievement. Greater than 50% of physicians report burnout symptoms.2 Having said that, a recent systematic review of the literature on physician burnout revealed significant inconsistencies in definitions, assessment methods, and study quality.3 An accompanying editorial framed it this way: “Physician burnout—a serious symptom, but of what?”4

I could easily ask a similar question: Physician loneliness—a serious symptom, but of what? Is loneliness a serious symptom of burnout, or is it a cause of burnout? Although we do not have clear answers to these questions, we do have evidence that loneliness and social isolation are associated with increased mortality.5,6 We also know that physician suicide rates are twice the rate of the general population. I believe making time to talk with colleagues is preventive medicine.

There are many measures that organizations and physicians can take to reduce social isolation and increase collegiality. Years ago, the Mayo Clinic created COMPASS (Colleagues Meeting to Promote and Sustain Satisfaction) groups.7 Six to 10 physicians have lunch together biweekly for an hour to discuss topics central to what it means to be a physician in today’s complex medical world.

“What participants have told us is simply having that time to be with their colleagues, having that be protected and endorsed by the organization, is valuable in and of itself. Now we’ve added a layer to that with the curriculum,” said Colin P. West, MD, who initiated the COMPASS program.7

If organizations cannot support doctor lunches, they can consider rebuilding doctors’ dining rooms. Physicians need well-designed physical spaces that facilitate social interactions and enhance well-being. In the dining room or lounge, physicians can strive to be more intentional about introducing themselves to new physicians or to physicians whom they do not know well. Even small talk, eye contact, and a smile can increase feelings of connectedness.

If group gatherings are not feasible, physicians might consider inviting a friend to lunch or coffee. Having trusted colleagues to discuss achievements, difficult patients, or medical errors is invaluable. They can help physicians to gain different perspectives on troubling issues, as well as offer encouragement. Collegiality and social connection naturally evolve from these conversations.

Years ago, I remember seeing a consult for an excellent family physician. The patient had a history of moderate asthma. After carefully reviewing the medical records and evaluating the patient, I concluded that the patient was on an optimal medical regimen. In the recommendation section of my note, I wrote the following: “Plan to continue current therapy. I have no further recommendations to make.”

Weeks later, I ran into my colleague in the hospital.

“I want to thank you for your thorough evaluation of that asthma patient I recently referred to you,” he said. “I also want to thank you for not unnecessarily changing or adding medications to the patient’s regimen. Your note lifted my confidence.”

His kind words elevated my own confidence.

Speaking words of encouragement and gratitude to our colleagues may seem like a small thing. Not so—it is an important, easy way to reduce social isolation among physicians and restore meaning to the practice of medicine.

Dean Gianakos, MD, is Director of Medical Education at Centra Health in Lynchburg, Virginia, and is on the Consultant Editorial Board.

 

References:

  1. Frey JJ III. Professional loneliness and the loss of the doctors’ dining room. Ann Fam Med. 2018;16(5):461-463.
  2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613.
  3. Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of burnout among physicians: a systematic review. JAMA. 2018;320(11):1131-1150.
  4. Schwenk TL, Gold KJ. Physician burnout—a serious symptom, but of what? JAMA. 2018;320(11):1109-1110.
  5. Daaleman TP. The long loneliness of primary care. Ann Fam Med. 2018;​16(5):388-389.
  6. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227-237.
  7. Swenson S, West CP. Getting back to medicine as a community. NEJM Catalyst. https://catalyst.nejm.org/getting-back-medicine-community/. Published July 21, 2016. Accessed January 18, 2019.