It’s difficult to avoid physician burnout when the demands keep increasing and it feels like the system is against you. For some, burnout becomes the norm, and it takes a big toll. In case you’re unsure, here are the three components of burnout:
Emotional exhaustion and depletion
Cynicism, depersonalization, and withdrawal from your work
Inability to connect with your strengths and your accomplishments
These run together, creating a downward cycle. Looking at the last one, however, we see how a focus on one’s weaknesses can set the stage for burnout. As physicians, we are often our own harshest critics, saying things to ourselves that we wouldn’t say to others. Among the hundreds of physicians I’ve coached, I’ve seen many hyper-focused on their perceived inadequacies. Perhaps you can relate to this? Here are a few questions to help you see if you’re leaning in this direction:
Do you tend to see your strengths or your weaknesses? Do you pay attention to what you’ve accomplished or what you haven’t? Do you notice what’s going well or what isn’t?
If you answered yes, know that you probably come by these patterns honestly. They’re the result of our education, our workplace environments, and the broader culture we live in. Changing these habits takes some practice, but it’s a sure way to reverse the cycle of burnout.
Roadblocks to Seeing Our Strengths
Medical training tends to be deficit-based. In residency, our noses were often rubbed in any mistake we made. An Internal Medicine resident recently told me, “On my Onc rotation, the attending kept focusing on how few of the chemo regimens I was up on. On my Cards rotation, the fellow kept at my not being up on the latest STEMI trials. No one seems to notice when I do know something. It’s been so long since I’ve gotten any positive feedback, I’m not even sure if I have any strengths at all.” These types of hypercritical experiences of belittlement create stress, worsen physical and mental health, and can even lead to suicidal thoughts.
Most physicians have stories from their residency about being “pimped,” asked question after question by an attending, just so they’d finally get to the inevitable embarrassment of not knowing the answer. This pattern can leave us focused on our weaknesses.
Experiences like these are pervasive in our training and, for some, may be reminiscent of messages we received earlier in life. Whatever the origin, these self-defeating messages can fuel the downward spiral of burnout.
Physician Burnout and Negative Self-Talk
Let me share with you an example of just how deep this goes. When I give talks on resilience to physicians, I ask:
What’s your typical ratio of self-promoting to self-defeating messages?
And do you know their typical response?
What is a self-promoting message?
Physicians are so used to the self-defeating voices that it’s difficult to identify with the concept of positive self-talk.
In addition to what we learn in our training, this also may result from perfectionism. Many physicians consider perfectionism an asset. And, while it may have served us in taking tests, perfectionism can hold us back today.
Physician Burnout and Perfectionism
Here’s one way of thinking about perfectionism:
Holding out for a barely attainable standard and then berate yourself for not achieving it.
Procrastinating to avoid facing self-criticism.
Believing that berating yourself will improve your performance.
Ruminating and experiencing anxiety about your performance.
Experiencing a lack of confidence.
Bottom line: Difficulty appreciating your strengths and successes.
A different frame to consider is: Have I done my very best? Can that be good enough?
Physician Burnout and a Strengths-Based Approach
If this resonates and you notice that the negatives dominate your thought processes, practice giving more attention to your positives. As discussed in a previous post, a strengths-based approach tends to be more motivating than whipping ourselves about our deficits. Here are some practical ways for you to shift focus to your strengths.
Notice when you get stuck focusing on your weaknesses.
Push yourself to shift attention to what’s going well.
Notice the “bright spots” in each day—times when something good happens; when you utilize your strengths.
When you find yourself back in the cycle of self-defeating thoughts, ask yourself:
What’s right about me?
What am I doing well?
What are the three things I’ve accomplished today?
Develop the habit of noticing what’s going well. Celebrate doing your best and practice letting “good enough” be enough. You may just find that this frees up your energy, replacing physician burnout with physician resilience.
Demystifying Mindfulness In Medicine: Part 5 of 12
Demystifying Mindfulness is your mini-crash course in mindfulness. I’ve gathered 12 real-life physician issues that contribute to stress, anxiety, frustration, anger, overwork, and overwhelm, and I’ve broken them down with real practices that cost you nothing but a little time and attention. Whether your challenges show up in your day-to-day work or you’re dealing with big-picture issues, you can build a practice in mindfulness to transform your work and your life and get back to the reason you’re doing what you do. This installment of Demystifying Mindfulness addresses the impact of physician burnout on medical error. Read on to find four tools for finally getting over your burnout and check out other posts in the series for more real questions and answers from one physician to another.
Today’s Topic: Medical Error And Physician burnout
We all know that there’s an epidemic of physician burnout. Many physicians spend hours on the computer after long days in the office, feeling drained and overwhelmed, losing any sense of meaning and purpose. And then there’s the spillover into family life. We can often be so consumed with our work that we’re unable to be present with loved ones. But the burnout epidemic is even more costly than this. In addition to the profound impact on quality of life at work and at home, there is increasing data showing that physician burnout correlates with increased incidence of medical errors.
In a recent study published in the Mayo Clinic Proceedings, a nationwide random sampling of 6,695 physicians in active practice completed the gold standard assessment of physician burnout, the Maslach Burnout Inventory (MBI). In this cohort, 54% were categorized as having burnout. 10.5% reported a self-perceived major medical error in the previous three months, largely error in judgment, making the wrong diagnosis, or a technical mistake. Most of these errors had no perceived effect on patient outcomes, but 5.3% resulted in “significant permanent morbidity” and 4.5% in patient death. The 691 physicians who reported errors had a higher prevalence of overall burnout than the 5,895 who did not report errors (77.6% vs. 51.5%).
The impact of burnout isn’t area-specific. After adjusting for specialty, work hours, fatigue, and work unit safety rating, physicians with burnout were found to have twice as much self-reported medical error. Other studies corroborate these findings. A meta-analysis and a systematic review also established a strong correlation between physician burnout and medical error.
These same systematic reviews have demonstrated that organizational interventions can reduce burnout, but what if your healthcare system hasn’t invested in addressing the burdens that impact physician burnout and patient safety? And, if your health system is not making this a top priority, where does that leave you?
It’s not just your patients’ safety but your own at stake. You may be aware of the term “second victims” regarding medical error:
“Fatal errors and those that cause harm are known to haunt healthcare practitioners throughout their lives. The impact of the errors is felt in their private lives, in interactions with professional colleagues, and in the context of their social lives.” (Grissinger)
Self-awareness doesn’t require you to change the system, get a new job, or take a two-month vacation. You can start now by cultivating mindfulness. Consider what you’re already noticing in yourself. A key element of physician burnout is the depersonalization of patients—seeing them as objects rather than the whole human beings they are. When you’re struggling, do you put in less effort with your patients? It’s worth taking some time to make note of your burnout symptoms and consider how they show up in practice for you, whether that’s depersonalization, distraction, disinterest, a combination of these, or something more. With awareness, the cornerstone of mindfulness, these patterns can serve as early warning systems to help you realize how burnout may be putting you at risk. And just as with early warning signs in disease, not intervening can be costly.
Four Steps To Lower Your Risk of Medical Error
But just how can you affect change? Let’s come back to the concept of self-awareness—it’s important to know where your attention lies, how you’re showing up for your patients, and what your goals in your work as a physician really are. Giving attention to these questions is a practice in mindfulness. Here are four concrete steps you can work with to lower your risk for medical errors. I encourage you to take some time today and give these a try.
Reconnect with why you went into medicine in the first place. If it was to take care of others, remind yourself to keep your eyes on this prize.
Set a daily intention to be more present with each and every patient.
Recognize and attend to your own suffering. Make space for this outside of the time you spend with patients. If you find yourself mentally railing against “the system,” use that moment to remind yourself that you’re doing the best you can. Acknowledge all the ways you’re working at maximum capacity. This may sound trivial, but this self-validation is key.
Utilize any opportunity you can to voice your experience and concerns with your healthcare institution. Keep your emphasis on the shared goal of patient safety rather than your personal complaints.
It’s challenging when you have so many demands on your time, but give yourself a chance to change the patterns that aren’t working and bring vitality back to your practice and your life. Based on my work coaching hundreds of physicians, I think you’ll be pleasantly surprised at the impact a mindful approach can have. I’d love to hear about your experience.
Focusing on Your Weaknesses Won’t Make You Stronger
In this week’s post, I break down why physicians should Stress Strengths rather than Strengthen Stress in order to combat physician burnout.
Last week, I was speaking with a medical director at a large practice who was telling me that he couldn’t understand why the physicians in his group were having trouble getting their charts done on time. I asked him what sorts of strategies he’d employed to try and make the situation better, and he told me he had:
Issued email warnings
told physicians that their pay would be docked if they didn’t do better, and
posted comparison charts of members of the group. He could not fathom why the performance wasn’t improving.
I also recently sat in on a meeting with a client of mine (an internist) and her non-physician supervisor. To my disappointment, the entire meeting was focused on patient wait times, an area where the supervisor determined she was not meeting targets. Not one word was spoken about the internist’s improved Press Ganey scores, the gains she’d made in consistently starting her day on time, and the positive comments staff had made about her performance. At the end of the meeting, my client broke down in tears.
“How can anyone expect me to succeed when all they do is point out my shortcomings?”
Physicians are hyper-focused on their own flaws; we don’t need a supervisor to point them out for us. Negative reinforcement is an old and outdated leadership approach. A person’s path to growth and improvement lies in mobilizing their areas of strength. Meeting with “the big bully” and seeing the “wall of shame” erode self-esteem and don’t lead to improvement. If you’ve been on the receiving end, you have no difficulty understanding how damaging these strategies can be.
What Research Shows About Negative Reinforcement
Gallup conducted a study when they analyzed over one million work teams. They found that only 9% of employees who are forced to work in an area of weakness are engaged, while 74% of their counterparts who are allowed to work in an area that uses their strengths are engaged. This isn’t a minor difference either; the gap is staggering.
For the first ever Physician Mindfulness Retreat, 20 physicians came from across the US to learn during the Martin Luther King holiday in January. There was a wide range of medical specialties represented, from Psychiatry to Family Medicine, Palliative Care to Radiology, General Internal Medicine to Obstetrics. Physicians trudged bravely to Massachusetts in the dead of winter from such points as California, Washington state, Wisconsin, Louisiana, Michigan, North Carolina, and Florida. The commonality was a desire to develop tools to manage the many stressors of practice.
What Physicians Had to Say about the Physician Mindfulness Retreat
The learning was completely experiential from interactive exercises to journaling to yoga. Mornings began with morning meditation and yoga. Dr. Paula Gardiner and I gave talks but there was no boring powerpoint!
How training sets us up for burnout and doesn’t give us the skills we need to manage it
Ways to work with your judging mind to decrease suffering
Building self-compassion as a way to manage self-doubt and the Imposter Syndrome
Strategies to manage challenging emotions and cultivate positive ones
Tips for spending more time being and less time doing
From a walking meditation to the ocean, to the hot tub (with suits!), to delicious chef-prepared meals, and time with new colleagues, in addition to all the learning, this physician resilience retreat provided many opportunities to relax and renew.
A Second Physician Mindfulness Retreat is Coming October 2018!
Mindfulness-based Coaching: Beyond The Physician Retreat
Mindfulness-based Physician Coaching™ is Dr. Gazelle’s unique approach to helping physicians avoid burnout, decreasing reactivity, improving leadership, and developing true presence at work and at home.
Utilizing a wide variety of evidence-based techniques, Mindfulness-based Physician Coaching™ helps physicians improve work satisfaction, create more balance, and lead more fulfilling lives.
“With Gail’s mindfulness coaching, I have more authenticity, ease, and enjoyment both at work and at home. The challenges in professional and family life remain, but I am more efficient and at ease with my clinical work, more comfortable with a wider range of emotions, and am living a much happier and full life.”
Every organization has a leader, from presidents to department chiefs to CEOs, CFOs, CMOs, and even CROs (Chief Risk Officers). So what is a CLO? It’s the most important one of all: Chief Life Officer. It’s a position that is open in each of our lives but the one that’s least likely to be filled.
Many people live according to the wishes and desires of others, living with a sense that they don’t take enough charge. Some may take charge in one area of their life but let others slide. Others may simply let the winds of life decide their course. Wherever you are on the spectrum, there is often a lot of dissatisfaction with the perceived amount of day-to-day control. If you want to become more resilient to life’s challenges, it’s vital that you have a sense of internal control. It’s thought that strengthening internal control decreases burnout. Thinking of yourself as your CLO is a good way to strengthen this sense.
Becoming your own Chief Life Officer involves taking stock, thinking about what is most important to you, and questioning how you define success for yourself. It’s about aligning your life with your deepest values and claiming the meaning you want. Here are five key questions to help you build an individualized “job description” for your CLO.
What are your core values? Is it having meaningful relationships?For many, the meaningful relationships in their lives are what they hold as most important. Or is it determination? Trust? Is it behaving with integrity, fighting injustice, appreciating nature, maintaining orderliness, or acting with compassion?A simple exercise you can do is to picture an experience where you feel you acted at your best. This could be anywhere — at work, on a vacation, or with family or friends. Take a few minutes to identify and recall that experience. See if you can relive it vividly, right now, mentally, physically, and emotionally. As you do so, focus on why you picked this particular experience. Notice what it was about how you acted that felt so right. Look at this list of values and notice which ones resonate for you. It’s the things you uphold when you’re acting at your best, as defined by you, that is your shortlist of core values.
Are you living according to your own internal compass?Once you’ve established a clearer sense of what is most important to you, perform an internal “audit” to see whether you’re living in a way that is aligned with your core values. Look over the past few weeks of your life. Did you act according to what’s most deeply important to you? Look at what’s on your calendar for the week ahead. Can you think about how really living these values can help you with tasks and challenges? The more you can uphold what is truly important to you, the more you’ll be in the driver’s seat of your life, and the more you’ll feel proud of your actions, small or large.
How do you define success for yourself?For many of us, much of our sense of success has been built on external measures or what we think others expect of us. It’s all too easy to follow the path we believe we should follow rather than the one we truly want. We may base our sense of self on external parameters such as job stature or expectations from others. Take time to notice which successes truly matter to you and which ones don’t.Establishing your own definition of success allows you to find happiness, satisfaction, and a more fulfilling life. Wherever you are on your life path, your CLO can help take you a few steps further.
What’s your vision of your life?When you think about who you are at your best, what is it that you offer to the world? We each bring unique gifts, strengths, and talents to our community, workplace, and to those around us. At times you may feel small or like you have little control over your life. In reality, though, you are the only person who has control over your own mind and over your actions. If you don’t develop and pursue your own vision, you can be sure that no one else will.One way to develop your vision is to think about who you want to be in the future. Jump ahead five years and picture what you want your life to look like. Combine your core values, your definition of success, and your uniqueness. Let yourself think large. Take some time this week to think about what you dream about achieving and about what legacy you want to leave. Begin writing your personal vision statement.
Are you spending time in ways that reflect what’s truly important to you?When you’re clearer about your vision, you can think more about how you spend your time and make more mindful choices. Although you may be working more than you’d like or doing many things you need do to stay afloat, being in touch with your CLO helps you carve out time each and every week to move closer to the things that are truly important in your life. It may be only a few minutes, but it’s critical that you delegate where possible, say “no” to extras, and say “yes” to things that are in alignment with your life vision.
It’s hard work and takes a lot of practice, but it’s your life we’re talking about here. What could be more important?
As with any new position, there’s a learning curve to becoming your CLO. It won’t happen overnight. It’s a process of self-examination, self-awareness, and intentionality in your actions. What step can you take today to begin to fill this vital role? If you don’t fill this role, who will?
Leave your comments and suggestions below so others can learn from your experience.