Editor’s Note: In August 2015, GLMS President Dr. Robert Couch wrote about the dangers of
physician burnout and his hopes of beginning a program to assist physicians in need. Now
the GLMS Physician Wellness Program in Louisville is a reality. Revisit Dr. Couch’s thoughts
below and learn more about our new program on the opposite page.
A
s a profession, we are driven. We
wouldn’t be physicians in the first
place if we weren’t. We often deal
with physical and emotional exhaustion
as well as self-doubt. An EM colleague at
Georgetown University, Dr. Joelle Borhart,
wrote about the “Imposter Syndrome,” the
feeling that as physicians, we don’t feel as
smart or as competent as others think we are. It’s the feeling that
“Eventually, people will find out that I have no idea what I am doing.”
It leads to further emotional stress and can limit us in what we try to
achieve. In actuality, imposter syndrome only affects high achievers.
Most of us feel inadequate at some time in our lives. Dealing with
the stresses of being a physician is the key to limiting burnout and
its consequences, such as leaving medicine, depression or suicide.
These aren’t new concepts. When Sir William Osler left Philadelphia
in 1889, his farewell address Aequanimitas was on the equanimity
necessary for physicians.
Physician satisfaction should be our aim point. There’s much being
said about patient satisfaction, and while important, I don’t think
that should be our ultimate goal. We’ve heard a great deal about
the triple-aim: Improving the patient experience of care, including
quality and satisfaction; improving the health of populations; and
reducing the per capita cost of health care. Drs. Bodenheimer and
Sinsky recently published an article that suggested we should be
considering a quadruple aim instead, adding the goal of improving
the work life of all health care providers, including clinicians and
staff. It is only by ensuring that physicians can somehow find and
maintain the joy of medicine that we can achieve the fundamental
goal of elevating the quality of care while minimizing its cost.
I’ve been concerned about physician burnout for my entire career.
When I entered residency in Emergency Medicine many years ago,
naysayers often told me, “This might sound good now, but there
are no old ER doctors.” The pace of the ER then has become what
most all physicians are facing now – long hours, over-regulation,
loss of autonomy and control, all of which can lead to depression
and dysfunction. A recent study published in Annals of Internal
Medicine showed that burnout rates were indeed highest for emergency medicine, but my specialty was closely followed by internal
medicine, neurology, family medicine and otolaryngology.
Achieving a work-life balance is important. Burnout is often
characterized by a loss of enthusiasm, feelings of cynicism, and a
low sense of personal accomplishment. It ultimately can influence
quality of care and lead to early retirement. Burnout takes a high
toll on physicians, leading to broken relationships, substance abuse
and suicidal ideation.
The rate of suicide in the physician population is enormous, estimated at more than 400 per year. As many have said, that’s