Marcia Frellick

March 09, 2016

SAN DIEGO — For hospitalists, burnout is a constant threat, given the high acuity of patients and the exposure to loss, but several strategies can help reduce the risk, according to speakers here at the Society of Hospital Medicine 2016 Annual Meeting.

"Burnout is characterized in part by loss of connection to a sense of engagement or meaning in your work," said Denah Joseph, MFT, from the University of California, San Francisco, who presented the strategies with her colleague Steven Pantilat, MD, professor of clinical medicine and director of the palliative care program.

Taking time to reflect on what being a hospitalist means to you or practicing reflective writing can help you reconnect, Joseph explained, as can taking a moment for meditation to be aware of your surroundings and listen to the sounds of your breathing.

Reconnecting doesn't have to take time out of your day, she pointed out. It can be something you do while washing your hands between patients, for instance, or while walking your dog.

Practicing spirituality — which Joseph defined as connecting with something beyond yourself, and could include anything from playing with kids, to singing, to praying — "can be incredibly important," she explained.

Another practice is "appreciative inquiry," or asking a colleague to exchange ideas on what you both find meaningful about your work, Dr Pantilat said. Talking about the positive aspects of the job can help crowd out negative, stress-inducing thoughts.

Burnout is characterized in part by loss of connection to a sense of engagement or meaning in your work.

Finding a place for that inside or outside work can help release tension. Members of his palliative care team have lunch every Friday to talk about their week. "It seems like not that much, but it's turned out to be really important and really helpful," he said.

Health systems can lead the way by building provider stress reduction into systemwide goals and making people accountable, he added.

In fact, he reported, "there's a system now looking at tying executive compensation to provider wellbeing."

More Than Half of All Doctors Have Experienced Burnout

The number of physicians experiencing burnout is increasing by the year, as reported by Medscape. A recent study showed that significantly more physicians reported at least one symptom of burnout, defined by the Maslach Burnout Inventory, in 2014 than in 2011 (54.4% vs 45.5%; < .001) (Mayo Clin Proc. 2015;90:1600-1613).

The Maslach Burnout Inventory helps gauge burnout in three general areas: emotional exhaustion from work; depersonalization, such as referring to patients by their condition or having unfeeling responses toward them; and lack of realizing personal competence or achievement.

Burnout is bad for providers, patients, and healthcare. "We don't want to lose doctors who leave and go into other professions," Dr Pantilat said. "That's very costly and very unfortunate."

In fact, Arthur Caplan, PhD, from the division of medical ethics at New York University Langone Medical Center in New York City, called physician burnout "a public health crisis" in a Medscape videoblog.

Burnout is one of the hottest topics this year for hospitalists, and is the focus, along with work–life balance, of several breakout sessions, said Melissa Mattison, MD, from the Massachusetts General Hospital in Boston, who is course director for the conference.

Feelings of Guilt if Patient Doesn't Get Better

The job can take a very personal toll, saidKeely Fischbach, MD, a hospitalist from the Baptist Medical Center in Jacksonville, Florida.

"You're supposed to have an emotional connection with 20 new people a day. Not many jobs require that," she told Medscape Medical News. "And if the patient doesn't get better, you have the feelings of guilt or failing."

She said she knows that the strategies the speakers mentioned help, and she regularly takes time to remember the meaning of her work.

"I check in every couple of weeks to ask myself, 'What do I like about this?' There's no other job that I would choose," she said. "I know I have the right career, I just want to find ways to sustain it."

Ms Joseph, Dr Pantilat, Dr Mattison, and Dr Fischbach have disclosed no relevant financial relationships.

Society of Hospital Medicine 2016 Annual Meeting. Presented March 7, 2016.

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