Vox Medicus

This section of DOC-Line is devoted to editorials from members of the Medical Staff. If you wish to submit an editorial, contact Dr. Matt Miller (matthew.miller@wchn.org).

In this edition Dr. Charles Herrick, Chair, Department of Psychiatry writes about Physician Burnout

Physician Burn Out: Avoid the noise.

There are a couple of well-known experiments on stress response: Train a rat to avoid shocks by having it press a lever and then remove the lever and watch a massive stress response develop. Give the lever back without it being connected to the electric shock, and the rat's stress response attenuates. With humans, the psychologists substitute shocks with loud noxious noises and levers with buttons. Those who have a button, even if the button is not connected or is not even pressed, have lower blood pressure than those who do not. Having a sense of control is one important part of how we react to stress. Remove this and disaster looms. Numerous occupational studies have born this out. High demand, low control jobs are a recipe for high stress and low morale. Over time it leads to burn-out and all the chronic health conditions that now consume most of our clinical time.

Noise, that noxious experimental stimulus, is a good way to summarize the stress that we as physicians are increasingly subject to in our professional lives. The "noise" here is the noise of information-overload provided to us and demanded from us by the ever encroaching presence of the computer.

As a resource for information, the computer overloads us with unreliable and irrelevant data, overwhelming our attention with pointless news bits, advertisements and emails. Try locating and reviewing a progress note generated by the EMR today and we can spend endless hours searching for the information we need. As a demand for information, we have become data entry "clerks", whether to meet "quality" or "productivity" metrics. Now, the button or the mouse click is perversely turned into another generator of noise. Is it any wonder why we feel we have lost control and rates of burnout are reaching unprecedented levels? To paraphrase Nate Silver's book, we have lost the signal of our calling from the noise of information.

So how do you cope? Turn off the noise.

First, regularly remind yourself why you chose your career. It was for a devotion to learning and the challenge of mastery; it was a commitment to service. Believing there is a better career out there is the "grass is always greener effect". To quote a recent piece by Alain de Botton when writing of marriage, "Choosing whom to commit ourselves to is merely a case of identifying which particular variety of suffering we would most like to sacrifice ourselves for....We should learn to adopt a more forgiving, humorous and kindly perspective...." (Why You Will Marry the Wrong Person, NYT, May 26, 2016). In this case your "partners" are your specialties. And learning to "adopt a more humorous and kindly perspective" is exactly what is needed. If you can't remind yourself why you do what you do by thinking it then remind yourself by doing it. Get involved with global health. Spend time practicing in a less privileged country. It will reinvigorate both your sense of purpose and that your problems are trivial by comparison.

Second, ignore and turn off the meaningless information. All of the "dangers" you are bombarded with are infinitesimally small when applied to your little world here along the Route 7 corridor. Divorce yourselves from the audience of viewers and commentators, especially the commentators who complain about you and everything else. It is mostly illusory. Carve out a piece of every day for yourself, not out of obligation but out of desire and devotion. Choose something you can do daily, that you can become passionate about and escape to. Choose a community to do it with. They will support and motivate you. What you choose is less important than the fact that you enjoy it and the people you do it with. A passion supported by a community outside of work and home plays a powerful role in preventing burn-out.

Third, focus on what you can control. You can't change the ACA, meaningful use, PQRS, CPT coding or MACRA. But you can certainly voice your opinions in whatever forum you feel is necessary. More importantly, regaining control is not about your work load as about your work design, about the supports you have to perform it, and about whether your leaders are authoritarian or authoritative, slave drivers or resources. If the former you need to speak up. Life is too short to work under those conditions. It is also about making the processes more predictable. Ask leadership to support you in designing your work and not the other way around. In that regard build in flexibility. After all, it all boils down to time or money. You have to be able to trade one for the other depending upon your own needs and desires. You need to create a win-win for both yourself and your practice. It is the difference between feeling like an employee and feeling like you own the practice. Take ownership and regain control!

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