Monday, April 25, 2016

Does talking about burnout cause more burnout?

Almost every day over the last few years, someone has written about physician burnout or depression.

The problems begin in medical school. A recent paper featured drawings that medical students had done depicting faculty as monsters. One student felt so intimidated during a teaching session that she drew a picture of her urinating herself.
The paper equated faculty and residents supervising students to “zombies, vampires, ghosts, and other supernatural figures.” In dealing with the state of the world today, the authors cited a comment by the novelist Stephen King saying that to cope with adversity, people make up horror stories. That sounds pretty serious.

Could the problem be declining student resilience? An article about college students in Psychology Today pointed out that they are less able to deal with seemingly minor affronts. And teachers are reluctant to “give low grades for poor performance, because of the subsequent emotional crises they would have to deal with in their offices.”

This has forced faculty “do more handholding, lower their academic standards, and not challenge students too much.” The article pointed out that college students exhibit more anxiety and depression and take more prescription drugs for these problems than ever before.

It’s not just students.

A systematic review of 54 studies found that 29% of resident physicians were depressed or had depressive symptoms. The number ranged from 20.9% to 43.2%, depending on the method studies used to assess depression.

Investigators from the Mayo Clinic and the AMA found that more than 50% of practicing physicians surveyed exhibit symptoms of burnout, and the problem has worsened since 2011. Depression and suicidal thoughts are also common.

All of these studies have been covered extensively by media such as the Washington Post, NPR, Time Magazine, Forbes, among many others and were widely discussed on Twitter.

Here’s a thought. What about “emotional contagion,” the subject of a 2014 paper published in PNAS? The authors studied 689,000 Facebook users and found that negative emotions can be transferred from one person to another without direct contact. They concluded, “…emotions expressed by others on Facebook influence our own emotions, constituting experimental evidence for massive-scale contagion via social networks.” If emotional contagion has such an impact on Facebook users, maybe all these stories about burnout and depression have an impact on students and doctors too.

There is certainly much to be depressed about in medicine—stress, declining reimbursements, soul-sucking electronic medical records, long hours, arbitrary rules, and much more.

Could it be that the more stories written about burnout and depression, the more burned out and depressed doctors become?


PGYx said...

This comment in a recent Medscape article says it all: "The large institutions treat us like interchangeable cogs," a doctor commented. "We cannot offload any work onto the nursing staff in verbal orders. We are responsible for every quality improvement initiative and are to maintain our relative value units. Every nuance of every visit, positive or negative, needs to be recorded, or we are assumed to be cheating, and every nurse practitioner thinks they can do our job with 18 months of training. The new electronic health records (EHRs) are hospital-centric and cumbersome, leaving us less face time to placate an already-demanding patient population. Add this to our worrying about Press Ganey patient survey scores while decreasing our prescribing habits. Include a legal system that can't seem to spit out enough attorneys with television ads ready to sue us for using medications that are indicated. Lastly, throw in our governing bodies (American Medical Association or American Osteopathic Association) that have sold out to big government and allowed healthcare reform without physician input. What's to be burned-out about?"

Skeptical Scalpel said...

PGYx, I think you listed most of the major factors causing burnout. I'm not saying burnout doesn't exist. I just wondered if talking about it so much is influencing some doctors to feel burned out when maybe they wouldn't have.

Anonymous said...

Considering on another "big" blog, we have a doctor who works barely part time, doesn't do Medicare/Medicaid, and then is hawking their products and fluffing the comments EVERY time it gets brought up, I'd say that should tell you a lot.

Maybe the person should get back to doctoring in the trenches and they'd know more about what their fellow MD's are suffering.

William Reichert said...

I went to medical school in NYC. in the 60's It was not unheard of for a student to jump off the tallest building in the hospital because of the nasty attendings who were complete a.......s. I departed to California and it was better but still there were a......s.
Now, however, the students are having to respond to the requests of forces outside the hospital as well as the jerks within as outlined by PGXy.
Everyone who is not a doctor has an idea of how to make medicine better. But to enact these ideas requires that somebody has to do the extra work. I find that the number one thing that business or professional leaders do, their "raison d'etre" is try to find ways to make the workers do more work for the same pay. This is called in the business schools as enhancing productivity.Of course the
profit from the productivity goes to the CEO and is not shared
by those doing the extra work. IN England today the junior doctors are striking because they are being asked to work weekends without pay to compensate them for it. Just yesterday
the governor of my state sent out a demand that physicians now
accept responsibility for dealing with the problem of domestic violence.To my knowledge there is no known medical treatment for domestic violence.Yet here we are with this new unfunded
demand on our time. Naturally this nonsense has to stop. Until it does,I believe that burnout, depression, or the urge to leave the profession will continue to plague medicine.

George Gasman said...

Domestic violence...

I used to work at a outpatient surgical location. Once, while delivering a patient to the Recovery Room...oops, excuse me, PACU...I heard a nurse doing a pre-op telephone assessment. One of the question she asked was, "Do you feel safe at home, has anyone threatened you?"


Skeptical Scalpel said...

"Everyone who is not a doctor has an idea of how to make medicine better." You said it.

I agree. What is a doctor supposed to do if someone answers yes to the question about domestic violence? Refer the patient to a shelter? Counseling? Have a chat with the abusing spouse?

I think most victims of domestic violence are aware of some of their options, but they are afraid to do anything. How does a doctor getting in the middle help?

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