Simple Reminders for Calming Physician Overwhelm

In our current healthcare system, feeling overwhelmed is common among physicians and a huge contributing factor to burnout. One of the main reasons physicians feel overwhelmed is that they have been trained to shoulder the majority of the responsibility, even in areas that are unrelated to patient care. During these times there are simple, positive ways to calm the overwhelm. In this article, we are going to offer up three helpful reminders all physicians can use when feeling overwhelmed.

 
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Expect the Unexpected

Despite your best efforts, unexpected challenges are sure to crop up during the course of your day. Training yourself to expect the unexpected, and accept the unexpected, will help you better prepare for difficult situations when they arise.

Prioritize Your Time & Efforts

There is always more to be done! Our first one or two priorities usually get done but we cannot do it all! Keep doing a great job of managing the urgent and important tasks.  However, moving down the list, how do you address non-urgent tasks? These usually create the most angst when neglected for too long, because they are often on our mind but frequently incomplete. 

Which takes us to our third reminder.

Delegate & Rely on Staff

As physicians, many of us were taught to pick up the slack and do things ourselves. But this is a great way to welcome feelings of overwhelm, especially when we often don’t account for our lives outside of medicine. What tasks can YOU delegate and empower your staff with? That’s why they’re there, after all! 

Calming the feeling of overwhelm by having simple strategies to process important tasks are both helpful. 

What common circumstances are present when you start to feel overwhelmed? 

What strategies have you used to gain control of the situation?

SurgeonMasters provides a supportive, nonjudgmental, and enriching environment for self-development. Here, practicing surgeons can evaluate their current practices, create short- and long-term goals, refine their focus and self-inquiry, manage stress and frustration, and develop strong relationships with their peers. Check out our vast array of wellness and burnout prevention resources.

Reach out to Team@SurgeonMasters.com to learn more.

Moving Away from Second Victim Syndrome

A recent article published on kevinmd.com titled “Second victim syndrome: a doctor’s hidden struggle” outlined the concept of second victim syndrome and its impact on physicians experiencing burnout. In this article, I’d like to offer my perspective on this concept and how we can better approach it to prevent burnout and promote well-being.

 
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What is “Second Victim Syndrome?”

Second victim syndrome is a term coined in 2000 by Dr. Andrew Wu that refers to the psychological trauma that a physician may experience in cases of medical error. In a case of medical error, the patient is the first victim and the physician or healthcare professional is the second victim.

Severe cases of harm can lead to severe feelings and thoughts. Mild and moderate cases of harm still stir these feelings and are generally under appreciated for long-term effects. In these cases, the hospital performs root cause analyses and tries to determine ways to prevent errors in the future, while the physician is left alone to deal with the psychological trauma.

These analyses are appropriate if there are lessons learned. Often the system wants or insists that a new lesson is learned. Most frequently the root cause is not new to the system, though it may be new to that physician. To many physicians, the root cause analysis prioritizes the process and even the analysis rather than the humans involved. When lessons are learned, this is a great thing. When NOT, they may not realize the additional harm that is caused to the humans in overanalyzing the medical error. Whether an error actually occurred is not as simple as you might think. Similarly, who made the error makes it even more confusing. Internally, human minds are processing this information very rapidly, while the system processes at a different pace. The humans are further isolated and the feelings are can be GREATLY exacerbated.

So what can we do to help physicians deal with second victim syndrome?

Changing the Language from “Second Victim Syndrome”

First, what if we change the language of "Second Victim Syndrome?"

Many physicians don't want to be considered a victim (nor should we be). Healing, recovery, and learning is strengthened by the concept of moving out of the victim mindset. What if we just call these “adverse outcomes?” What if we appreciated that all involved in the adverse outcome have needs to heal, recover, and learn?

Emotional First Aid & Employee Assistance

Second, the best programs are not in place for surgeons and physicians to leverage when they need assistance. We need to get past “solutions” that are essentially just lipstick on a pig, and invest in real education and resources. For instance, we don't teach healthy empathy and very little attention is placed on emotional intelligence or skills in our training.

Few physicians are even aware if an employee assistance program exists or they might not have access if they are not employed by a hospital or system. Even when available, surgeons are internally and culturally least likely to reach out for support or "feel" that the support "doesn’t get us." Physicians and surgeons are not trusting of confidentiality and safety, as often these have been violated by the system. Lastly, physicians might accept support, but only after repeated offers. We have much more training in giving versus receiving care and support.

We need to offer peer-support that is built around the individual. Each situation is unique, and right now our healthcare system isn’t offering the support physicians need. Too often the support is lacking adequate funding, scheduling conflicts with clinical or personal time, and clarity of physician purpose and goals. There are best practices for peer-support, and we all have to be willing to embrace them.

We all know there’s a long way to go in creating the change our system requires. When medical errors do happen, what if we started with a truly confidential physician-to-physician conversation with someone who understands what we are going through?

With a vast array of resources, including physician coaching, advocacy blogs and podcasts, health and exercise guidance, and resilience training, SurgeonMasters provides a supportive, nonjudgmental, and enriching environment for self-development. Coaching is one avenue that provides an environment for confidential peer-to-peer connections.

Reach out to Team@SurgeonMasters.com to learn more.


How to Ensure Physician Wellness Programs are NOT Like Lipstick on a Pig

In her KevinMD.com article entitled “Physician wellness programs are lipstick on a pig” Linda Drozdowicz, MD argues that physician wellness programs are essentially lipstick on a pig, and do not address the underlying issues that lead to burnout. She goes on to state that these programs can act as a form of unintended victim blaming - giving the impression that doctors just need to take better care of themselves to not feel burnout. In this article, we are going to discuss how physician wellness programs are NOT like lipstick on a pig when the right conditions and commitments from stakeholders are met.

 
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Physician Wellness Requires the Right Tools

Dr. Drozdowicz brings up some salient points about the state of the healthcare system and how it is set up to lead doctors down the path to burnout. However, I would like for her and others to consider that physician wellness programs can be effective when deployed correctly and when victim blaming is avoided.

Physician wellness efforts are not inherently bad. They tend to be ineffective when they don’t have adequate funding or are seemingly intended to just check a box. They work best if certain conditions are in place. These include:

  • Education and Resources - Education designed to raise awareness and offer next steps is a great start. No program provides a magic elixir. Let’s offer helpful resources without shame and blame. Since we all view wellness a little differently, we can expect that a successful wellness program will have a menu of items from which to select.

  • Leadership AND Grassroots Support and Input - It is critical to have leadership active in the conversation, AND active input from the players most directly impacted. Dialogue isn’t nearly enough - those directly involved in patient care need to feel like their voices are being heard in the actions taken by the leadership.

  • Financial and Administrative Investment - Healthcare is not free, and neither is the care of healthcare professionals. What is invested upfront in our well-being will be paid back in multiple ways, including improved patient safety, outcomes, and satisfaction, as well as lower litigation risk, physician turnover, and dissatisfaction.

  • Effort to Control the Causes of Stress and Frustration - There’s no doubt about what is frustrating physicians most - everything in the system that isn’t directly about patient care! Let’s make REAL efforts to minimize the impact of these causes - like EHR and paperwork - and we’ll start to see our environment improve.

With these conditions in place, wellness programs can go a long way to preventing burnout and encouraging healthy lives for physicians both at work and at home.

Awareness Resources

If you are interested in more physician wellness resources, SurgeonMasters has you covered. We regularly post blogs, podcasts, and webinars with helpful tips on how to prevent burnout and sustain a thriving surgical career. Interested in 1-on-1 coaching, or coach training?

Reach out to Team@SurgeonMasters.com to learn more.


Maintenance of Certification, Aging, & Our Patients

An article published in the Harvard Business Review set out to answer the question: “do doctors get worse as they get older?” With an aging population of physicians and the ever-changing nature of technology and medicine, it’s important that physicians maintain their clinical skills as they age. So what’s the best method for making sure that happens? We consider our options and make a suggestion in this blog article.

Current Standards

First off, let’s talk about the standards that are currently in place to ensure physicians keep up with the changing medical landscape. The American Board of Internal Medicine requires Internists to pass Maintenance of Certification (MOC) exams every 10 years in order to maintain their board-certification. Almost every surgical specialty has a different process for monitoring or mandating continuing education, certification, and tracking competency. But many are concerned that these assessments are not the best way to incentivize physicians to keep up with the latest technologies and improve patient care. Some have suggested a better way would be to measure patient outcomes. From the article:

“While there is some evidence that physicians’ clinical knowledge, adherence with up-to-date standards of care, and performance on process measures may wane as they get older, little is known about whether and how age impacts physicians’ practice and their patient outcomes.”

 
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Improving Performance & Outcomes

Even the methods for measuring our performance and outcomes is heavily debated. While it has not been well studied or reported on historically, patient outcomes have been shown to drop as a physician ages. There are many potential reasons for this, including:

  • It may be that many of us have difficulty adapting to change and older physicians may be last to adjust to advancements in technology.

  • It may be that some technical skills decline with physical decline, aging and mental processing delays, and each of us reaches a different tipping point where knowledge and experience overcomes these changes.

  • It may be that there are biases in the way the studies are performed.

When we go beyond understanding concepts of performance improvement as well as performance decline, my belief is that both are ideal for coaching. In many ways, we know ourselves best. We know the inner workings of our thoughts, feelings, and bodies. In other ways, coaching principles encourage one to receive constructive feedback, challenge thinking, ask empowering questions, and improve empathy in a more confidential and less judgemental environment. When you combine the expertise of a well-trained surgeon with that of a well-trained coach, the opportunities to improve and grow almost become endless. Whether early or late in one’s surgical career, most of us explore how and in what capacity we can apply our knowledge and skills to the benefit of ourselves and others.

What if our surgeons had coaches?

What if we used coaches to assist us to maintain and/or improve our skills?

What if coaches improved patient care, outcomes and experience?

SurgeonMasters is a physician coaching company delivering strategies tools aimed at preventing burnout and promoting wellness in the medical community. Have a suggestion for a blog article or podcast episode? Email Team@SurgeonMasters.com us to get involved!


Training and Leading Physicians for the Fight Against Moral Injury

Note: This is part two of an ongoing blog series on burnout vs. moral injury. In the first installment, we learned that almost no one wins in our current system. Here, we will discuss how the Quadruple Aim is the most effective in achieving a more efficient and sustainable solution.

It is pretty clear we have an injurious healthcare system that overburdens healthcare professionals and under-provides for too many patients. The Triple Aim, Introduced in 2008 as a means to improve patient care, while commendable, fails to account for important players in the healthcare system. It is hard to argue that improved outcomes, better patient experience, and lower costs are important goals. If we were to achieve them our healthcare system would make vast improvements. The problem with the The Triple Aim is it doesn’t adequately address the full scope of the problem. In this article, we argue the Quadruple Aim is a better model for improving healthcare, and we offer three steps leaders can take in the fight against moral injury and burnout.

Post-Fight Analysis - Who Is The Real Opponent

In Part 1 the decision was unanimous - there is no winner in the fight arguing over the terms moral injury versus burnout. Instead, the fight should be against moral injury. The opponent IS burnout. With that in mind, how do we move forward? I strongly believe the path forward is to allow physicians to continue to fulfill their mission to provide high quality care (improve patient outcomes), to provide personal care (improve patient experience), and to encourage self-care, well-being, and anything that will enhance the healthcare professional’s experience or satisfaction. The fighter must be and stay healthy. If we are not healthy, how can we deliver the best care? If we are to encourage health for our patients, what if we actually modelled it?!

Once again, I commend the authors for advancing the discussion. The first key is to raise awareness and understanding.


 
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Training Physicians for the Future Fights

The second key to achieving the Quadruple Aim is training. How do we train and empower our physicians for future fights? Training physicians should be ongoing, rather than just at the beginning of a career. Training needs to include the awareness and understanding of burnout and the effects of moral injury. Training must include management as well as prevention of burnout. How should we allow rest and recovery in our “fighting” career? How does one dodge the punches, avoid the many cuts, and at worst, the knock-out blow?

In my opinion, training should include burnout prevention, self-care, wellness, and positive resilience training. Our existing training focuses way too much on negative resilience training techniques! Burnout is not a failure of resourcefulness or resilience. Burnout is the result of our resourcefulness and resilience at the expense of our own well-being and satisfaction.

The way to achieve wellness and healthcare professional satisfaction is to PRACTICE it.

Who are Our Coaches, Managers and Leaders?

The third key is that our leaders must embrace healthcare professional wellness and satisfaction. I agree with the authors that simple wellness programs and wellness officers will not solve the problem. I do know from my experience that mindfulness, positive resilience training, and forms of cognitive behavioral therapy are proven wellness strategies. The fighter will benefit by practicing many of these techniques that were not part of traditional medical training.

However, we need outstanding coaches, managers, and leaders who understand that physicians are not weak and do not lack resilience. We will see the greatest impact on wellness and burnout prevention when our leaders understand what causes moral injury and take steps to avoid the counterproductive actions that burden physicians. Establishing wellness programs and training wellness officers / leaders will be an investment of time, energy, and money to be effective. We must train wellness officers who are strong health professional advocates and enlist wellness programs that challenge old ideas.

It is time for our leaders to embrace the fourth aim and start championing physician well-being and satisfaction. If we do, we can reverse the current trends and fight moral injury and burnout.

If we do, patients, health professionals, and the healthcare system will win.

SurgeonMasters is building a community of surgeons and physicians focused on changing the practice of medicine. Email Team@surgeonmasters.com to contribute your voice to the conversation.