Editor’s Corner
Physician (Un)wellness
I
The content of the Editor’s Corner is
the opinion of the author and does
not represent the official position of
the American Society of Hematology
unless so stated.
’VE BEEN MULLING over the concept of wellness, or really on
unwellness, for the past several months. You can’t read a publica-
tion without someone going on about “cultivating a culture of
wellness” or “avoiding physician burnout.” My own institution
recently installed a “chief wellness officer” to add focus to the
issue. I was planning to roll my eyes and make snarky comments,
but then I heard her speak and I unrolled my eyes and bit back
the snark. She gets it. Moreover, it appears that my institution, or
rather the folks at the top of my institution, seem to get it too.
Burnout, defined as emotional exhaustion, interpersonal
disengagement, and a low sense of personal accomplishment,
appears to be growing by leaps and bounds amongst physicians.
It occurs across all career stages – in the young idealists and
those on the verge of retirement and, most ominously, in folks
in the middle of their careers. Up to 50% of us are so roasty
toasty that you could make s’mores over the flames of our bad
attitudes.
As our wellness officer, the amazing Samantha Meltzer-
Brody, MD, MPH, explained to us, physician wellness is where
the discussion of quality was 10 years ago. The Institute of Med-
icine (now the National Academy of Medicine) had announced
that medical errors were a significant cause of patient morbidity
and mortality, and health care institutions across the country
decided that the blame should be placed on the backs of the
physicians. If those doctors could just “be more careful” and
“quit making mistakes,” the problem would be solved. Joe and
Terry Graedon, hosts of the popular NPR show “The People’s
Pharmacy,” wrote a book with a title that still makes my teeth
clench: Top Screwups Doctors Make and How to Avoid Them.
Obviously, putting the onus solely on providers didn’t work.
Health care systems now have entire departments dedicated
to quality improvement because it takes more than individual
effort to ensure that medical errors don’t occur.
So, where are we today? Well, physician burnout is a major
problem, and it seems that the solution is back on the plate of
the individual provider. If we all just attend to our wellness and
improve our resiliency by taking a yoga class, journaling, listen-
ing to mindfulness seminars, or meditating on gratefulness, the
problem will go away. Before that, though, let’s all make sure we
fill out the many, many, many mandatory surveys to document
how burnt out we are.
What’s driving the effort to prevent burnout? You guessed it:
cash (in addition to compassion and altruism). The American
Medical Association estimates that replacing one physician can
range from $500,000 to more than $1 million. 1 This estimate
includes recruitment, sign-on bonuses, lost billings, and onboard-
ing costs for replacement physicians. That’s not including indirect
costs of burnout such as medical errors, higher malpractice risk,
reduced patient satisfaction, and damage to the organization’s
reputation and patients’ loyalty. The departure of a physician also
results in increased stress on the remaining providers – we’ve all
been through it.
The savvy institution will read the writing on the wall – carved
by the jagged bitten fingernails of frustrated providers – and start
to tackle wellness beyond the
individual level. True change will
require institutional efforts to im-
prove the culture of wellness and
efficiency of practice, in addition
to support for the encouragement
of individual resilience.
I see some rays of hope. I had
been complaining bitterly that
ordering a red cell transfusion
Alice Ma, MD, is professor
for an outpatient in my center’s
of medicine in the Division of
electronic health record (EHR)
Hematology and Oncology at
system took twice the number of
the University of North Carolina
School of Medicine in Chapel Hill.
keystrokes that it should, since
the order set was for both red
cells and platelets. In order to get
red cells for the patient, I had to de-select all of the orders for a
platelet transfusion.
When I asked why in the blue blazes we couldn’t have sepa-
rate orders for red cells and for platelets, I was told, “It’s easier
for the IT people if the transfusion orders are bundled.” Yup,
the IT people clearly need to have their lives made easier at the
expense of patients and frontline physicians. The flames on the
burnout meter rose by about 300 degrees.
But to my great surprise, the most recent EHR update in-
cluded a change: We can now select the order sets we want from
the transfusion menu. It’s almost like someone was listening to
the ranting (OK, I was pretty loud) and decided to do some-
thing. It’s not quite as easy as ordering red cells, since I have
to click 12 separate orders to opt in to the orders I want, but it
eliminates another 18 clicks to opt out of the platelet order set.
Small progress is still progress, I guess.
While I’m on the topic, I’d like to acknowledge standout
physician/comedian/performer/sarcasm genius Zubin Damania,
MD, (aka ZDoggMD) for his awesome video, “It’s Not Burnout,
It’s Moral Injury.” This one isn’t a parody of a music video, like
my other favorites. It’s a cry from the heart that burnout is “moral
injury,” or the end result of forcing medical providers to sublimate
the conflict between serving the best interests of the patient and
the best interests of a profit-oriented health industry. If you haven’t
watched it, I highly recommend you do. It doesn’t offer solutions,
but it’s great at articulating the problem. It doesn’t absolve the
individual of the need to cultivate resilience, but boy, it had a room
full of clinic providers on their feet with upraised fists.
After which we all focused on deep breathing and grateful-
ness meditation.
Alice Ma, MD
Associate Editor
REFERENCE
1. American Medical Association. How much physician burnout is costing your organization. Accessed
May 6, 2019, from https://www.ama-assn.org/practice-management/economics/how-much-physician-
burnout-costing-your-organization.
Have a comment about this editorial?
Let us know what you think; we
welcome your feedback. Email the
editor at [email protected].
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