Tepper: Growing rates of burnout among doctors has consequences for everyone’s health,
You don’t have to be a doctor to know that things are tough in the medical profession right now.
Doctors often feel under siege from the media, their colleagues, governments, regulatory bodies and from the increasing expectations of the system and patients. Over the past couple of years, I have had patients surprise me by countering my questions about their health with a question back to me along the lines of: “How are you doing with all this stuff going on?”
According to a growing body of literature, the answer to this question is, for many of us, “not very well.”
The National Physician Health Survey put out by the Canadian Medical Association shows 30 per cent of Canadian doctors polled have psychological symptoms of burnout while 8 per cent had suicidal ideation in the past 12 months.
Others have characterized doctors as suffering “moral injury” — the anguish felt from being unable to provide quality care and meet patients’ needs in the current health care system.
This week, about 500 doctors from around the world will gather in Toronto to discuss physician health and wellbeing and will look at innovative programs that are helping physicians deal with the high-pressure environment in which they work.
It’s not only doctors who are affected. There is evidence of stress and health impacts for nurses and others in health care, too.
There are risks and potential repercussions to this discontent and burnout — and they affect everyone. One of the consequences is likely a diminished quality of care that health care practitioners are able to provide. As recently as last month, the Canadian Medical Association Journal detailed research showing an association between burnout and reduced patient safety. Showing physicians who had signs of burnout were 2.2 times more likely to report a perceived medical error.
What’s the solution? The path to wellness is not simple. However, there are four broad areas where we can collectively work to find answers:
Involvement: Clinicians need to feel they have meaningful involvement in helping manage the health care system of which they are a part. A white paper by the Canadian Society of Physician Leaders released last year states this is often not the case.
Technology: While technology is an invaluable aid to physicians, too often new technologies, such as electronic medical records, are seen as adding significantly to clinician workloads and stress. Ways to better integrate technology into clinician workflow are needed.
Autonomy: Physicians, like nurses, pharmacists and many others are a selfgoverning profession, but they can feel their autonomy is being eroded by bureaucratic oversight and government regulation. We need a system that respects the knowledge and skills of our talented health workforce and empowers them to safely and effectively deliver care to their patients.
Support: There is a growing focus on having physicians and others not just deliver care for patients today, but think about how to improve care for tomorrow. There is unprecedented data that documents the gaps in quality in our health care system, and front line professionals are critical leaders in any quality improvement exercise. However, they need the training and resources to help lead needed improvements.
Each of these are big topics and they intersect with one other. Some require resources in an environment of scarcity, but some just demand us to pursue new or different conversations. These conversations then become our culture and involve health care managers, governments, other health professionals and, of course, doctors and nurses themselves.
They need to happen in an environment of honesty and psychological safety. They need to be rooted in a belief in a quality health care system that is safe, timely, efficient, effective, patient-centered and equitable.
I would also suggest that we would benefit by including patients in this discussion. They have a unique view of the health care system, its challenges and successes. As well, many have been there themselves and bring empathy that may lead to constructive solutions to burnout. The path forward to reducing health professional burnout is not entirely clear, but what is certain is the tremendous need to find one. The wellbeing of our health professionals matters. To all of us.