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A Sampling of Burnout Intervention Dishes Du Jour

November 06, 2019

By H. Steven Moffic, MD
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

Burnout in physicians and other health and mental healthcare clinicians and administrators has been receiving extraordinary attention in recent years. And no wonder. As one example, it is at epidemic levels in physicians, around 50%, depending on the assessment tool. Physicians suffer, their loved ones suffer, and quality of care for patients suffers.

The major cause seems to be systems that don’t engage clinicians in decision making and unnecessarily block their ability to heal as well as circumstances would allow. Too much time may be spent in non-clinical care activities, like EHRs, that seem more designed for risk management and billing than patient care. A smaller part of the etiology has to do with the individual vulnerabilities of clinicians.

So far, various interventions are being tried. Many of them emphasize a single focus and seem to be popular for a while, then less so as time goes on. Hence, I call them the dishes du jour for wellness, akin to the changing popularity of various dishes in restaurants. Here are a few of them, in order of their appearance of popularity

Resilience

This is a dish that likely resonates with the Kobe steak tough-as-nails lovers.

Now, who doesn’t want to develop more resilience after inevitable traumatic or difficult times? Then, you can potentially come out of such suffering stronger, that is with post-traumatic growth, with the help of others by processing what happened and seeing new opportunities. No wonder increasing resilience became a very popular wellness strategy for physicians and other healthcare healers. The only trouble was that most physicians, like most clinicians who learn to take care of patients, were already quite resilient, having to overcome demanding teachers, needy patients and some poor outcomes along the way. Moreover, being too resilient can contribute to not noticing that one is burning out along the way as we just grit our teeth and plow ahead. Just like eating Kobe steak day after day, this dish has become less tasty over time, at least as an everyday meal.

Chief wellness officer (CWO)

The CWO is probably a fan of grocery stores stocked with lots of foods that are touted as being good for you.

As organizations came to accept that their systems could be improved, many added a CWO to the administrative team. They are supposed to do whatever is necessary to ensure wellness and reduce burnout. Sounds good, no? And it can be good as long as they have enough power to do so, which begs the question as to why their boss, the chief medical officer or administrator, didn’t—and doesn’t—do this in the first place. Another concern may be the name itself. If they focus mainly on wellness, there can be a “blame the victim” implication or just “window dressing” to suggest the organization is working on the challenge more than it actually is. Moreover, emphasizing basic wellness activities like diet, exercise and rest is all well and good for everyone, but won’t prevent burnout. So far, as I’ve seen in my presentations to various mental healthcare organizations, there are differences of opinion as to how well the CWO is doing so far.

Moral injury

Some become vegan and may feel it is morally wrong to eat food that comes from animals, especially when that also releases so much carbon and methane in the process of growing, feeding and processing the animals for food, contributing substantially to climate instability.

It seems that “moral injury” in our clinicians is beginning to replace resilience as the new dish du jour. Moral injury previously became a concern in the military when the troops returned home from the endless war in the Middle East, wondering if what they did, and why they did it, was worth what they and their families went through. When that question is part of PTSD, it also needs to be addressed. Indeed, everyday micro traumas seem to be implicated in the development of burnout in healthcare. Nurses have used moral injury as an alternative term for burnout over the years. It makes psychological sense that if we can’t heal as we can and morally want to, and if we don’t meet even minimal ethical standards of competent care, then we would feel morally injured. So far, it is unclear whether moral injury is another term for burnout or, more likely, a powerful contributing factor to its development. One potential drawback to emphasizing it is the potential perception that those morally injured are failing morally and that the public and patients will feel that we are falling short, no matter what. With food, too, it is often hard to tell what is really “organic” and what are the side effects that go into producing food.

Time

Time can be a driving force for fast food lovers who also have to hurry to return to work to meet productivity standards.

There are a few other dishes du jour that have been apparent. Time is one of them, in the call that clinicians may be working too many hours, including being more on call with current technology. That, though, ignores that physicians, for example, worked even more hours in the past without burning out because they felt more in control and not wasting time on non-clinical activities. They may have had work/life imbalance in the past, but not burnout. A diet of mainly fast food is not healthy in the long run.

Compassion fatigue

Those on the high end of being compassionate may want to find ways to get leftovers to the needy one way or another.

Compassion fatigue is sometimes used as a synonym for burnout. But that is almost the opposite. Compassion fatigue comes from giving more than is humanly possible without time to recover. So, in this case, it is not being blocked from providing care, but caring too much for too long. Some studies indicate the most compassionate clinicians are unfortunately more prone to burning out. Sometimes such clinicians are accused of having rescue fantasies. Sometimes when we do anything in life to help others, including providing food, we can end up being drained from the depth of the needs.

Recommendations

Whereas all of these dishes du jour are potentially delicious, they need to be part of the solutions for very complex system and individual problems and needs. That is our administrative and leadership challenge. Whatever can be measured along the way should be for accountability and proof of outcomes. So far, there are potentially useful tools to measure burnout and resilience. There is one for moral injury in the military which is being adapted for healthcare workers. All should be given periodically to check for progress and success in the system and individuals, as well as assessing whether there is enough allocated time for recovery and rejuvenation.

Satisfying meals day after day depend on a variety of nourishing and tasty factors provided by expert chefs with adequate resources. Indeed, tech companies have discovered that having tasting food around helps job satisfaction and productivity. The same may be true for health and mental healthcare. The key for each clinician and administrator is to find the best fit for your passion and expertise with the nature and resources of your workplace.

Let’s toast to that: Here’s to your good health!

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