Simple Tools to Attack Symptoms of Burnout

When most people go to the doctor, they have their own ailments on their mind and don’t necessarily think about how their physician is doing. However, doctors also have stress and are human too. A study published in Medscape found that burnout among physicians increased from 40% in 2013 to 51% in 2017. It is increasingly accepted that a healthcare system burning out physicians is bad for our doctors as well as the patients they treat. In this article, we’re going to outline a few reasons why physician burnout is becoming an epidemic, and what individuals in the system can do about it.

Symptoms of Burnout

There are many signs that might indicate burnout, such as:

• fatigue

• situational sadness

• decreased sleep

• increased stress and anger

• decreased job satisfaction

• decrease in connection with patients

• avoiding friends and family

Even though symptoms are pervasive among doctors, they are well trained in managing and hiding the symptoms. The culture of “hiding the pain” among physicians can make things worse and even very difficult to diagnose. To make it even more complex, burnout is not equal to poor performance. The intense training has some benefits. Many doctors are not aware of the signs or symptoms, or that there are more effective ways to manage the challenges of being a doctor.  They don’t seek help, and there is not much offered to help. These negatives are a sort of catch 22.

Equipping Doctors with the Tools They Need

Historically, burnout has not been a prominent topic in medical school. As a result, many physicians find themselves unequipped to properly deal with burnout when it arises. We need to start talking openly about these issues and developing programs that can equip doctors with the tools they need to fight burnout. This will include integration of resilience skills into medical school curricula, as well as on-the-job programs available to physicians to focus on their own wellness.

Here are just a few simple tools or actions we have identified as helpful, including:

• Improved Sleep Hygiene - Bring increased awareness to your sleep hygiene. We learned from sleep expert, Dominic Munafo, MD, many ways to improve our sleep. And more importantly, as physicians, we learned ways to increase our alertness without impacting our ability when we do have a chance to recover. Learn more on the SurgeonMasters Podcast, Sleep Hygiene 1! and Sleep Hygiene 2!

• Engaging Your Passion - Find a way to connect with your passion. Whether you are a young doctor starting your practice or a veteran hardened by years of battle scars, it is critical to tap into our inner motivations and drive. A great example of a surgeon engaging their passion for patient care is Kristin Long, MD, who frequently travels abroad on medical mission trips to perform medical procedures. While the work is difficult and long, the purpose in the work brings fulfilment instead of exhaustion that mundane tasks like EHR bring. Learn more about Kristin Long’s humanitarian trips by clicking here.  

• Connecting with Others - Connecting with peers who are facing or have faced similar circumstances can be incredibly helpful. The everyday stressors of being a physician are much different from the stressors of other careers. That’s why it’s important to connect with other like-minded physicians who are experiencing the same things you are. Talk about the stresses (as well as the joys) of life as a surgeon, and support each other through mutual understanding.  

Working Towards Solutions

If you are a surgeon experiencing the signs and symptoms of burnout, it’s important that you take proactive steps for your own well-being. SurgeonMasters offers educational tips, webinars, podcasts, as well as live-meetups – all with the express goal of educating surgeons on burnout and wellness. We are a group of like-minded surgeons who share knowledge in the hopes of building thriving, lifestyle-friendly practices. Reach out to us today to learn more!

Source:

Medscape Lifestyle Report 2017

Sick as a Doc? Doctors Are Burning Out — and It's Serious

Purpose, Fulfillment and Shared Goals

In this article, I would like to review a recent blog written by SurgeonMasters contributor Kristin Long, MD, FACS. Dr. Long recently returned from a two week surgical mission trip to rural western Kenya, where she and her team performed 62 surgical procedures and treated upwards of 475 patients in 4 clinical days. Upon her return she had many insights into the overwhelming nature of such trips and what she had to deal with when she got back to her job.

Exhaustion & Emotional Fulfillment

“Thinking back on the incredible levels of stress and exhaustion we all endured, I’m even more amazed by the scope and quality of work we were able to accomplish,” Dr. Long writes. “Within a few short days of returning, I found myself digging through a backlogged email inbox, EMR in basket, and life in general.  Among my favorites were the administrative email noting that I had one week in which to complete my “respiratory fit testing” or my hospital privileges would be revoked, as well as a reminder of a delinquency for the annual online HIPAA training module.”

When our hard and exhausting work appears to have purpose, we are fulfilled emotionally, even though we may be drained mentally and physically (as well as emotionally). The overall experience is POSITIVE!

In contrast, her "productive" work getting caught up on emails, EMR in-basket, and administrative tasks? These activities were lacking in purpose. The results were almost completely a drain or feeling of "empty" when the tasks were completed.

When the purpose is trivial to us, it is not fulfilling. These burdens are typically not about providing care to patients. There may be a purpose to those who created the rule or policy. However, the presentation as mandatory or that we are delinquent immediately puts us on the defensive. Often the training is common sense, and little effort is placed on the value of our time and goals. This is counterproductive to decreasing burnout and creating wellness. In fact, it creates disillusionment. 

Receiving Inspiration Through Shared Goals

“We came together, working for a common goal, and let that guide us,” Dr. Long remembers of the mission in Keyna.  “Everyone stayed late, everyone checked in on one another, and NO ONE uttered the phrase “that’s not my job.” The spirit of camaraderie and dedication was enough to remind each of us why we went into health CARE in the first place.” 

What Dr. Long describes here is her Passion for Performance Improvement. It’s easy to lose sight of this during our day to day work as surgeons. Sometimes we need to take a step back and re-examine our situation, and the world at large to find our center again and continue doing the important work that we do.

At SurgeonMasters, our goal is to help physicians create sustainable and lifestyle-friendly practices. We are a collective of like-minded surgeons offering educational resources (articles, podcasts, webinars and more) to help physicians prevent burnout and improve well-being.

The original article, “What If We Were Friends?” was published September 6th, 2018 in KenyaRelief.org.

Author Bio

Kristin Long, MD, FACS is an assistant professor in the Division of Endocrine Surgery and the Division of General Surgery in the Department of Surgery at the University of Wisconsin School of Medicine and Public Health. She specializes in treating both benign and malignant disease of the thyroid, parathyroid and adrenal glands. She is an active member of several specialty societies, including the American College of Surgeons, the American Association of Endocrine Surgeons, and the Association for Academic Surgery. Dr. Long is particularly interested in the surgical treatment and management of thyroid carcinoma and hereditary endocrine disorders such as Multiple Endocrine Neoplasia syndromes. She is also interested in global surgery, particularly in developing countries, and improving access to specialized care for patients with unique endocrine disorders.

Can We Prevent Career Ending Musculoskeletal Injuries in Surgeons?

A recent review published in JAMA found that surgeons are at a high risk of sustaining work-related musculoskeletal injuries. It is safe to say the orthopaedic surgeons in my circle and I are not good examples of applying the knowledge we have about acute and chronic overuse injuries to ourselves. I personally believe this is part of our extremely negative healthcare culture that leaves no room for self-care. What if we started encouraging best practices in musculoskeletal health and ergonomics for all surgeons? In this article, we are going to explore some of the findings of the JAMA review article and offer some tips for surgeons to reduce on-the-job musculoskeletal injuries.

Musculoskeletal Injuries

Acute

Performing surgical procedures does not often result in acute injuries, mainly due to a more present focus on surgical safety. That being said, most surgeons I know are able to share many stories of acute injuries they have sustained. Even with these events, the pervasive opinion would be that these things are inevitable, and if there is no harm to the patient, then no big deal. Needlesticks and other “sharp” injuries don’t usually involve the musculoskeletal system. However, each tool we use in surgery carries a risk of harm. Every time we lift a patient, we place ourselves at risk of injuring our neck, back, or shoulders in particular.

Acute on Chronic

At this point in my career, these are the most common. Every time I am asked to assist in the transfer of a patient to the operating table, I comment that I will do my best and that it might impact my performance of the surgery when it really matters. Rarely does anyone understand and few even care. However, on occasion, these moves lead to an increase of my baseline back pain, and at a minimum, risk causing distraction and delay in performance of the procedure. I have also performed plenty of operations where I need to hold a steady, sometimes awkward position, and I can feel a worsening of baseline numbness or tingling in my hand/arm or my foot/leg. Believe me, I am not unique. I know many surgeons who have rotator cuff problems, “tennis” elbow, wrist or thumb arthritis, and so on, where almost every move they make causes pain. We “learn” to endure and sometimes modify, but what if we could learn to prevent, mend or perhaps recover from these injuries.

Chronic

For surgeons, most musculoskeletal injuries are caused by standing in static (often uncomfortable) positions for long periods of time and performing repetitive motions during procedures. This, coupled with the fact that many surgeons wear heavy lead aprons, awkward headgear, and other equipment can lead to overuse injuries. Over time these factors can build and cause repetitive stress injuries like carpal tunnel syndrome, arthritis, and more. My goal is to raise awareness, so that most of our younger and future surgeons can either prevent or at least lessen the damage from our noble work. One effort to raise awareness was our web-conference, Ergonomics: Best Practices for Longevity. Thus far, personally, I have been successful in managing my chronic injuries with some physical therapy and a lot of yoga with core strengthening. My episodes of back pain are much less severe and much less frequent. What if you could avoid or stall musculoskeletal injuries significantly in your career?

Tips for Preventing Work Injuries

Here are a few simple tips to help prevent or delay these types of injuries at work:

• Stay in Shape - The better shape you’re in, the better you’ll be able to handle the physical demands of being a surgeon.

• Take Breaks - If you’ve got back to back procedures, try to take even a few minutes break to rest, take a walk or do a “mini” or 5-minute workout (cross-training) before heading back into the OR.

• Stretch - Doing simple stretches before, during, and after a long procedure can significantly help avoid injury.

• PRACTICE Improvement for Injury Management - We recommend taking on the complex problem of injury management in surgeons with our PRACTICE improvement methodology. Reflect on your injury situation with our 8 PRACTICEs checklist to either get back in the game sooner with the least harm or stay in the game longer. Make a plan with realistic goals. Intentionally adjust your surgical practice to recover well. Repeat until Well! Try the SurgeonMasters Performance Improvement Tool to assist your recovery. Check it out here.

SurgeonMasters

At SurgeonMasters, our goal is to provide surgeons with the tools they need to build sustainable practices. We offer a variety of educational materials including regular blog articles, podcasts, webinars, and in-person meetups. We also deliver surgeon and physician coaching to individuals and teams to power improved performance inside and outside the OR. Contact us today to learn more about our offerings, or join our mailing list to stay up to date with the latest from SurgeonMasters!

Source: Epstein S, Sparer EH, Tran BN, et al. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and InterventionalistsA Systematic Review and Meta-analysis. JAMA Surg. 2018;153(2):e174947. doi:10.1001/jamasurg.2017.4947

The Straw that Broke the Camel's Back

“A series of irritating occurrences that eventually lead to one final thing that causes a person to lose their patience or react in a strong way.” 

Sounds a lot like post-traumatic stress or burnout to me!

Everyone’s life experience is different, but you might be able to relate to mine.

In my first full-time job as a surgeon, the irritating occurrences were many. In one very difficult operation, a surgical device attached to the patient’s femur trapped my hand with an excessive amount of force. A scrub nurse trying to assist me inadvertently increased the force on my fingers. Over the next minute, which felt like ten, I finally released my hand just before I would have passed out. With the assistance of the residents, we proceeded to complete the surgery, and the patient’s outcome was good. In our system of training and practice, I never would have considered taking time off for an injury such as that.

How about the time I sustained a needlestick injury during suturing a wound on a patient that was Hepatitis C positive? The future wonderful news that both my positive and the patient’s positive screening tests were false positives did not seem to allow a full recovery from the stressful decisions that I had to make regarding very high-risk anti-viral drugs for myself, as well as the risks to my wife and our sex life.

My job also had lots of unreachable dangled carrots. In addition, the inefficiencies in providing quality patient care and associated emotional challenges were numerous. One time, I was accused of Medicare fraud by the mother of a high-level physician administrator for whom I bent over backward taking over the care of her wrist fracture treated four weeks earlier in another state. I converted a plaster splint to a removable wrist brace, which had the same CPT code and led her to believe Medicare was being billed twice. The brace company and I both had to eat the cost of care on that one, but the harder pill to swallow was that the patient and her son never appreciated the lack of fraud. In another instance, we were accused of malpractice by a patient who had tremendous muscle disruption of the gastric muscle from the 2000 or more pound object that fell on his leg. At the time of fasciotomies, he had no muscle ischemia for an early compartment syndrome. He felt he could not work more than 8 hour days or run on the treadmill the same after a year. He sued and the university settled because the nurse had not adequately documented the notes while in pre-op.

Despite these events that could easily lead to paranoia, I have remained completely dedicated to the welfare of my patients. What is best for my patient? How can I see that my patient receives the care that they need? What can I do to provide my patient with the most straightforward path to recovery? Unfortunately, one day, when I saw my patient being blocked from surgery, it was the straw that broke the camel’s back. My sudden reaction brought out a lot of negative energy. This uncharacteristic, as well as unacceptable, behavior, resulted in some anger management counseling as prescribed by the hospital administration. As this was the first event in my file, I was able to recover my job and my career. Interestingly, the comments provided to me and my superiors after this event included signs that I was burning out. While I accepted responsibility for my actions, the overall system did not change. No one offered assistance for burnout. No one actually seemed to care. And I kept performing at the high-stress level expected of someone in my profession because the system doesn’t offer reciprocity in its relationship with physicians. The system gives very little, and it takes a tremendous amount from us.

Camels are amazing animals capable of surviving the very harsh conditions of the desert. In particular, they are able to go for a long period of time without water.  When they do drink, they can drink up to 20 gallons or more.  Like the camel, the surgeon appears to be sustainable with very little self-care. The surgeon trains to handle limited energy, some amount of sleep deprivation, high adrenaline situations, several thousand pieces of straw, and other adverse conditions like the barren desert with very little water. Surgeons are capable of going a very long time without normal wellness efforts and activities. Or so we think. We adopt the old adage of “don’t fix something if it ain’t broke.” But why don’t we try to fix something before it breaks? Before it burns out. How do we know what will be the final straw? How can we prevent the break before it occurs?

Through the evolution of the surgeon and adaptive training, the surgeon and physician learns to carry every increasing burden. The system continues to put more and more straw on our backs. We are expected to carry the straw longer distances.

Now I have choices. I choose how much straw I am willing to carry. I also choose to drink lots of water. We also have a choice to change the system, so that we do not overload our physicians and we provide wellness to both patients and our colleagues.

If not, eventually not enough wellness and just one more burden will be the straw that breaks the camel’s back.

At SurgeonMasters, we are committed to helping physicians struggling with burnout. We offer coaching services, wellness programs, podcasts, webinars, and much more aimed at arming physicians with the tools they need to thrive in their careers.

Contact us today to learn more about our programs and join our mailing list to get regular updates.

Addressing Physician Suicide

At the 19th Annual Chicago Orthopaedic Trauma Symposium, Dr. Pamela Wible presented data and findings from studying physician suicides. You cannot imagine my excitement! Am I crazy to be excited about physician suicide? These events are devastating to me! Rather I am excited that my friend and colleague Dr. Matthew Jimenez invited Dr. Wible to his annual course to share her ever expanding experience with perhaps one of the most challenging topics in medicine. I am excited that our profession may be starting to listen and heed what she is uncovering. In this article, I’d like to examine some of Dr. Wible’s findings and how we can use them to raise awareness, and hopefully prevent future physician suicides. 

What Factors Lead to Physician Suicide?

First things, first – I have always argued that suicide can be both irrational and rational. What causes physicians to take their own lives? From studying over a thousand documented cases of physician suicide, Dr. Wible has discovered several potential causes and/or risk factors. Here are a few of her very important findings which I find very relevant to surgeons:

• Many physicians know a colleague who has committed suicide. On top of that, those who are affected are not allowed to grieve. What if we demanded time, resources, and opportunities for our colleagues to grieve?

• “Happy” Doctors commit suicide too. Physicians who appear to be happy and well-adjusted are not exempt from the dangers of burnout and suicidal thoughts. Many physicians are experts at disguising their emotions and putting on a good face. If we don’t know who is overwhelmed, suffering, or risk of choosing suicide from their outward appearance, what if we assumed we are all at risk?

• Patient deaths & mistakes haunt physicians. When a doctor makes an honest mistake, or loses a patient (even if it wasn’t their fault), they are often haunted by it for the rest of their lives. What if we focused on adult learning theories such as growth and constructive feedback rather than punishment and controlling of others.

• Physicians experience post-traumatic stress and can develop symptoms of PTSD. While early research suggests that we experience secondary stress through our patients’ traumatic events, I have observed that we experience our own significant primary stress as victims of bullying, physical, mental, emotional and sexual abuse, and the patient death and patient harm.

• Malpractice suits can have a serious impact. Everyone makes mistakes. But when a physician makes a mistake, they are quite publicly shamed in court and in the media. What if the majority of lawsuits result from a misunderstanding rather than a mistake?

• Ignoring the problem only makes it worse. Sweeping physician suicides under the rug is only going to make the problem worse.

Preventing Physician Suicide

There will be additional lost lives. However, I don't think it will be in silence. These issues are real. Now that people are listening we need to continue to highlight possible solutions.  Here are some of the simple steps we can all take to help prevent physician suicides:  

• Expect mistakes and train for them

• Work to prevent bullying, such as stepping in to defend or deflect

• Encourage physicians to either seek mental health care or utilize confidential coaching resources

• Set up a “Buddy” system for all physicians

• Build a life outside of your practice with friends and family

• When it comes to whistleblowers and bullies, don’t remain silent. At least have a private conversation of potential support.

• Talk about physician suicide openly and amongst our peers

If you or a colleague have any of the risks for burnout or suicide, please contact Pam,  another coach, or me. If you or a colleague you know is having suicidal thoughts, please reach out now for help. 

Suicide Prevention Lifeline

American Foundation for Suicide Prevention

Physician and Medical Student Depression and Suicide Prevention

Pamela Wible, MD

Source: 33 orthopaedic surgeon suicides. How to prevent #34.