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04/30/2019

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Stress & Preventing Physician Burnout in the Healthcare Profession

By Sonya Pease, MD, Chief Medical Officer, Anesthesiology

What do military veterans and healthcare workers have in common? Unfortunately, the answer is combat fatigue, post-mission depression, compassion fatigue, PTSD and other mental health stress disorders like litigation stress syndrome and second victim syndrome. Both occupations can have extremely stressful work environments and both occupations can have life or death consequences because of our work.

I was at a charity event a few months back for our community food bank when I overheard a conversation some friends were having. One friend asked, “What is the most gut-wrenching thing you’ve ever seen?” and the other proceeded to tell him all about a tragic event they had witnessed years ago. I took pause because when I think about that question, it doesn’t just bring up the events that happened in the distant past, it brings up unspeakable events over the last 30 years of my clinical career including an incredibly tragic and senseless event last week. I don’t know any nurse, physician or advanced practice clinician (APC) who does not have at least one gut-wrenching event they have had to survive.

As healthcare professionals, we are held to an impossible standard of perfection such that any emotional pain we experience is somehow supposed to be processed out by our thick skins and level heads. But it takes more than just thick skin and level heads. With clinician burnout and healthcare suicides on the rise, I believe we have to treat this with the same awareness campaigns and prevention tactics that have been developed for our military veterans since this crisis is just as real and just as impactful to our communities and to the patients we serve as to the nation our military veterans have served.

I have spent the last few months asking dozens of our colleagues across the country a simple question: “Think about the last gut-wrenching event you have been involved in, and tell me how you survived it emotionally and professionally?” As I deal with most of our risk management events and work with our legal team and clinical operations team when an adverse event occurs, I purposefully targeted clinicians I knew where having to deal with something big and hairy and awful, and below is what I heard. Please note: names and events have been altered to preserve anonymity.

Ben has been named in a lawsuit involving a young patient death. His care was spot on but delays in care beyond his control have now become pivotal to the case, and he is being held co-responsible for the delays leading to this death. Ben said the stress has been enormous–it has made him question his clinical acumen, made him angry and unreasonable at home and made him want to walk away from his job at least a dozen times. What brought him back to being able to love his work, family and himself again was getting involved in his kids’ lives. As he puts it: “I wanted to not be a loser dad on top of everything else. I helped my daughter sell the most cookies in her Girl Scout troop, helped my son build an award-winning electrical circuit board for school and forced myself to laugh at what they laughed at. I even started watching their Netflix favorites as a way to escape the negative thoughts that kept me awake at night.” He said he has learned to “shape shift” from physician to father and husband by focusing on putting smiles on their faces.

It happened in a flash. Sara turned her back to close the Omnicell and finalize medication waste when her patient suddenly took a nosedive off the operating room table while the circulating nurse removing the belt was moving the stretcher into position at that exact moment. The patient was fine–no injuries or sequela, but the stress of being judged in peer review, the fear of losing her job, the judgement of her colleagues, the feeling that she had failed to prevent this and the professional inadequacy she felt as the situation was disclosed to the patient and family made her feel like she’d lost her professional standing and respect as a clinician. She said what helped her the most was that her colleagues and a surgeon comforted her and validated her professionally. They stood up for her in peer review and put in place policy changes to prevent this event from occurring again. She said, “When the surgeon physically hugged me and told me he didn’t blame me, it made me realize I have to forgive myself as well and focus on harm prevention even more. It’s become my crusade. This could happen to anyone.”

Clint was involved in the Pulse nightclub shooting a few years ago. He is a gay man and said he really identified with these victims. “The worst part is that the shooting victims just kept coming in,” he said. “There were so many in critical condition, so many young people who aren’t supposed to die, and they kept asking us to save them. That still echoes in my mind: “Save me; don’t let me die.” At one point I looked around and realized this was a battlefield. I’m proud of my team and how heroic everyone was in saving every life that came to us, but I still have nightmares. I’m afraid to go into crowded public situations, and I lost sight of the good in humanity for a while. I heard about a mission trip to Puerto Rico after the hurricane and immediately volunteered to go. I felt like I had the qualifications to deal with this type of disaster better than most. The trip gave me back my faith in humanity, and I’ve gotten more involved in other community outreach events and missions where I can make a difference.”

So, my take away to building resiliency and surviving the work we do is that there is no single right answer for all of us. Research tells us that those who are able to keep a positive outlook, those who have a strong sense of spirituality, those who seek active coping-type therapies, those that build self-confidence through challenging activities, those who continue learning and making meaning in their lives, and those who are accepting of the limits of what they can and cannot do are the ones that are the happiest and most energized by their work.

As a community of healthcare veterans, we have to band together and take care of each other and ourselves. We have to find purpose and seek help for ourselves and our colleagues without feeling like this makes us weak and inadequate. We owe this to our patients, to our families and to each other. As you go throughout your day today, take pause. Look to your right and to your left and see who needs an emotional hug, who needs a mentor, who needs an act of kindness or encouragement to seek additional support to find their mindfulness and balance again.

TeamHealth cares about its healthcare veterans and has set up confidential support resources to help those who need it and educate those of us who can now be the mentors and coaches for others. Clinicians can take a personalized and confidential Maslach Burnout Inventory (MBI) assessment within the Zenith platform. The MBI is the most widely accepted tool that provides individual insights and meaningful information regarding work-life balance and resiliency.

As always, thank you for taking such great care or your patients, for taking care of each other and, most importantly, for taking care of yourself.

I’d like to leave you with a song by Ziggy Marley.

“We got to give a little love, have a little hope, make this world a little better…see what we can do together.”

As a part of TeamHealth’s commitment to physical and mental well-being, we invest in programs to aid in clinician wellness. In 2016, we enhanced available wellness resources through our LiveWell WorkLife Services to help colleagues combat personal challenges—burnout, depression, anxiety, financial and legal issues and more. For more information on this program visit our clinician wellness page, or contact megan_norman@teamhealth.com.