By Amy Locke
This is my third blog on teaching Integrative Medicine in medical education, and I would like to focus on a problem that is commonplace, regardless of a person’s job or level of training.
Burnout is a popular topic of discussion among healthcare professionals, but preventing it often eludes us. While burnout is common in many professions, it is particularly present in healthcare. Some estimates put the rates of burnout as high as 75-80 percent among physicians-in-training. Even after a potential grueling training is done, burnout rates remain high. This burnout is associated with detachment from those around them and feelings of isolation. These physicians lose their ability to empathize with patients and colleagues. Medical errors increase. Their own health, as well as the health of the patients they care for, suffers. If physicians can learn to prevent burnout in themselves, they can help others avoid it, too.
There are a number of factors that put physicians and those in training at high risk of burnout. Certain personality traits are associated and include obsessive and compulsive traits, competitiveness, placing others' needs first, and repressed emotion. These are often the same traits that can help a person be successful in healthcare. On top of these baseline characteristics, students and residents are often under great stress, both emotional and physical. They are held to very high expectations and work long hours. They become very good at delayed gratification and putting others before themselves. Over time, it is common to experience emotional exhaustion. This depersonalization leads to cynicism and apathy. This entire process leads to a feeling of loss of self. Burnout is associated with increased heart disease and depression. Suicide rates among physicians are significantly higher than the general population.
In medical education we have the opportunity to help learners develop strategies to prevent burnout. If successful, it can not only lead to better health for the physician but also for their future patients. Preventing burnout is not just for health care professionals. Many can benefit from these same strategies.
The first step to preventing burnout is to take your own health seriously. That doesn’t just mean go to a doctor and take medications. This means taking care of all facets of the whole person. I often use a wellness wheel to demonstrate this idea. Health in only one component is unlikely to lead to someone feeling well. Looking at the wheel can help a person identify strengths and areas that need work. Many physicians counsel their patients to attend to the Foundations of Health, such as nutrition, physical activity, sleep and stress management; however, it is not uncommon to struggle to practice them.
People, physician or not, often feel that they must put others first. Their own needs can wait. Unfortunately, this frequently means that it is even harder to care for others. Delayed gratification can be great when it comes to saving money or getting work done, but it is not a good strategy for dealing with health. It is important to teach that taking your own health seriously is not a luxury, something to consider when finished with one training program or another. Health is something that must be a primary focus from childhood through old age.
Another way of preventing burnout among students is to incorporate humanities into the medical curriculum. Studies of this strategy show that it improves students’ observational skills, cultural sensitivity, and empathy. The University of Michigan Medical School incorporates humanities into the first two years of medical school and has done research on this intervention. We have also offered workshops to residents to express emotion through writing and art. Residents found these exercises helpful to re-frame difficult experiences, manage stress, and help with comfort in self-expression.
In the long term, maintaining health and preventing burnout, requires ongoing vigilance. Balance between many competing demands can be struck by regular consideration of priorities. Mindfulness-based stress reduction and other techniques can be used to help maintain a focus on the present. Prevention is essential to dealing with this crippling rampant problem.
Amy B. Locke, M.D., is Assistant Professor and Director of Integrative Medicine, Department of Family Medicine, Director of the University of Michigan Integrative Medicine Fellowship, Integrative Family Medicine Clinic. She has been on the faculty at the UM since 2002 and has practiced at the Integrative Medicine Wellness Clinic since 2007.