Approach aims to deepen doctors' connections with patients, colleagues
By JULIE MINDA
Research demonstrates that physician burnout is taking a toll not only on the physicians themselves but also in some cases on the patients they treat. CHI Health neurologist Dr. Prasanna Tadi believes that physician burnout has reached "public crisis" level, and he is looking for remedies that work.
Dr. Prasanna Tadi, left, talks with research co-investigators about protocols for his studies on reducing physician burnout. Shown from center to right are Creighton University medical students Emma Parks, Serenity McAndrews and Elizabeth Hartley.
Tadi's approach engages medical students, residents and physicians in a community of their peers to celebrate their accomplishments, talk about the issues they are facing, explore ways to improve their well-being and adapt healthy routines that mitigate the impact of their demanding, high-stress career path. He also is exploring ways to deepen the spirit-replenishing connections between physicians and their patients. Tadi is spearheading a series of pilot studies and related research to determine how well these interventions work. He'll use the findings to refine and/or expand this approach.
Tadi says, "Physicians are losing the sense of having meaning in their work. My big hope is that we find some solutions for this burnout — some evidence-based solutions." In addition to his role at Omaha, Neb.-based CHI Health, Tadi is director of a neurology clerkship, director of wellness and an assistant professor of neurology at Creighton University, a Jesuit school in Omaha.
Studies have shown that burnout can lead to physicians providing lower-quality care and it can be associated with reduced patient satisfaction, increased medical errors and more malpractice payouts as well as increased staff turnover, which can contribute to physician shortages. Tadi says that attending physicians, residents and medical students suffer from higher rates of depression, anxiety and suicide, as compared with people outside the medical profession.
He has experienced periods of burnout, to the point that he once considered exiting the profession. "We became doctors to make a change" for the better in the lives of suffering people. But, he says, many physicians find once they begin to practice that they do not have much control over their schedule, and this can mean that they cannot spend as much time as they wish with each patient. Given the hectic pace of medical practice, Tadi says, "We can miss the personal touch and the caring" that provide professional fulfillment.
Time is so short, he says, practitioners may find it difficult to determine the best treatment options for an individual patient. Another real concern for physicians is patients who can't afford to follow doctors' orders and take their prescription meds as directed.
Elizabeth Hartley and Eric Villanueva are fourth-year medical students at the Creighton University School of Medicine, and co-investigators in some of Tadi's physician well-being research. Hartley says medical students are susceptible to burnout because of the workload, career uncertainties, feelings of inadequacy and feelings of isolation that seem to be part and parcel of medical school.
Villanueva says he has seen numerous peers suffering from exhaustion. He adds that physicians and medical students often are expected to demonstrate superhuman resilience, never letting their personal struggles interfere with their pursuit of perfection, and so they may resist seeking help when they feel burned out.
Tadi believes that encouraging physicians to create a community of support and a safe space to address burnout can be an essential part of the remedy. And so he has developed a model that links physicians and physicians-to-be in peer groups that meet on a regular basis. Tadi uses the acronym CHEER to represent the activities that are part of these gatherings. Participants:
- Celebrate their accomplishments
- Hear one another's successes and challenges in a safe environment
- Invite the Expertise of wellness experts
- Engage in discussion about how to apply those experts' advice
- Recharge by putting wellness routines into practice in their daily lives
For more than a year, Tadi has been assembling research teams made up of physicians, residents and medical students to implement the CHEER model and to conduct research on its effectiveness. (See sidebar.)
Tadi says he is optimistic that these pilot programs and studies of the CHEER model will encourage physicians to create their own support communities and that this will prompt them to talk about the stressors in their lives, improve the culture, form friendships and build trust with one another. He anticipates that increased trust among physician colleagues will help to reduce the stigma around medical providers seeking help for themselves.
Hartley says, "On a systemic level, the problems within the medical system that lead to physician burnout are copious, convoluted, complicated, and will not be solved with our relatively simple research."
However, she says she hopes that the research team can show that building community, emphasizing the positives of the profession, enhancing relationships and nurturing healthful lifestyles can improve the well-being of individual clinicians.
"I hope that this research is able to create a program or a set of guidelines that can be applied to medical schools and residency programs across the country," she says.
Research looks at whether, how structured peer support eases physician burnout
CHI Health neurologist Dr. Prasanna Tadi and his research teams are studying the impact of structured support on reducing stress responses in four separate groups: medical residents at CHI Health Creighton University Medical Center – Bergan Mercy, first- and second-year medical students at Creighton University School of Medicine, physician leaders at CHI Health Immanuel and neurologists practicing at CHI Health Immanuel. These facilities are in Omaha, Neb.
The researchers this summer completed the physician leader study with about 15 participants; the medical resident study is underway with about 80 participants; the medical student study is underway with about 60 participants; and the neurologist study is to start within the next half year. The physician leader study was not intended to produce publishable results. The other studies are structured to be statistically valid and the results will be published, Tadi says.
The studies of medical students and neurologists will be "crossover" studies that begin with half of the study participants in each group taking part in the structured support intervention — the CHEER meetings — once every four or five weeks for five months and half not. At that point the groups switch. The researchers administer a survey tool to assess wellness and burnout levels prior to, halfway through and at the end of the study.
The study of medical residents involves patient participation. Residents in the research cohort are part of a multidisciplinary team that focuses on a particular patient with a complex sociomedical background. The multidisciplinary team will spend 30 minutes each day at the bedside with the patient and family to talk about the patient's personal and social background, hobbies and interests. During this time, the group also will talk through the patient's condition in-depth, hashing out any concerns or challenges. Patients in the study can be at any inpatient unit and are normally in the hospital for one or two weeks, though their lengths of stay can vary.
Residents and patients taking part in this study will participate in the monthly CHEER meeting of residents. If the patient(s) have been discharged earlier, the researchers can arrange for and fund their transportation, if need be, says Tadi.
— JULIE MINDA
Study shows burnout prevalent among physicians; most do not seek help
A significant percentage of physicians experience burnout, but few are seeking or plan to seek help. Those are some standout findings from the "Medscape National Physician Burnout, Depression & Suicide Report 2019." Medscape surveyed more than 15,000 physicians in over 29 specialties.
Among the findings:
- 44 percent of respondents reported feeling burned out, 11 percent were colloquially depressed, and 4 percent were clinically depressed. Colloquial depression is feeling down, blue or sad, according to Medscape, whereas clinical depression is prolonged severe depression.
- 14 percent of respondents reported having thoughts of suicide, though they said they had not attempted it, while 1 percent said they had tried.
- 64 percent of physicians responding said they have not sought help for burnout in the past, nor do they plan to; 16 percent said they were seeking help or planning to; and 13 percent said they'd sought help in the past but no longer plan to.
- Of those who have not sought help, 50 percent said it is because they felt the symptoms were not severe enough, 47 percent said it is because they thought they can deal with it on their own, 39 percent said they were too busy and 20 percent because they did not wish to risk disclosure. (The numbers here and in categories below may add up to more than 100 percent because respondents could choose multiple answers.)
- Factors identified as contributing to burnout included having too many bureaucratic tasks, 59 percent identified this as an issue; 34 percent said they spent too many hours at work; 32 percent cited increased computerization in their practice; and 30 percent said the lack of respect from administrators, colleagues or staff contributed most.
- 48 percent of respondents said they cope with burnout by exercising, 43 percent by talking with family members or close friends, 41 percent by isolating themselves from others, and 39 percent by sleeping. A small percentage used potentially unhealthy coping mechanisms, with 32 percent eating junk food, 23 percent drinking alcohol and 19 percent binge eating.
- For those respondents who reported experiencing depression, 47 percent said it does not affect their interactions with patients, 35 percent said the impact was that they are easily exasperated with patients, 26 percent said they are unmotivated to take copious patient notes, 16 percent said they express frustrations in front of patients and 14 percent said they make errors they normally wouldn't make.
- For those physicians reporting experiencing depression, 47 percent said they are more easily exasperated with staff and peers because of the depression, 40 percent said they express their frustration in front of staff and peers, and 29 percent said the depression does not impact their interactions with staff and peers.
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