From the
PRESIDENT
ROBERT “BOB” H. COUCH, MD, MBA
GLMS President | [email protected]
TAKING CARE
I
recently spoke to the new residents and
fellows at orientation for their first year
at the University of Louisville. There were
many young faces, eager to learn. Most were
new to Louisville, and they were getting tips
on starting their new lives in health care.
They heard from several speakers regarding
the need to seek balance in their work lives
to allow for a happy, productive career in
medicine. I welcomed these new physicians
and surgeons to the family of medicine in
Louisville.
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 remember those early days in my career.
Can I ever learn it all?
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.
As 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 selfdoubt. 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;
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 equal
to an entire medical school – every year.
If we accept the estimate that the average
family medicine specialist sees about 2,400
patients each year, which means almost one
million patients are losing a doctor to suicide each year. We, as physicians, must be
responsible for stopping this epidemic.
How do we help physicians manage these
stresses, and succeed in managing the worklife balance? Some medical societies are
attacking this head on. The Lane County
Medical Society in Eugene, Oregon, decided to act when their ph