Physician well-being is essential to optimal patient care

I chose to leave clinical medicine in 1996 after just three years as a general internist. At the time, I was certain that it was the right decision and necessary for my overall health, but could not have articulated all the reasons why I needed to leave. I loved both the intellectual challenge and the art of medicine. I thoroughly enjoyed my connections with patients. I regarded my professional life as a privilege.

And yet I felt emotionally drained. The struggle to provide safe care in an environment that seemed ill-equipped to mitigate human errors felt unending. I found it difficult to leave work at work. I suffered from sleep disturbances. I tried different practice environments, but was unable to find a situation that worked for me.

Becoming a freelance writer gave me the freedom to focus my attention on understanding the problems that frustrated and worried me in training and practice. In my second career I apply my clinical experience every day to communicate knowledgably about the flaws in our health care system — and the solutions that innovative individuals and organizations are using to solve these complex problems. I feel gratified to have a clear mission today that aligns with the reasons I chose medicine in the first place: to improve patient care.

It’s my belief that physician well-being is essential to optimal patient care, especially in the face of recent changes in the health care arena, such as value-based contracting and the patient-centered medical home model. Burned out physicians cannot take on the additional requirements inherent in these initiatives, such as embracing the EMR, enhancing patient engagement, leading effective teams, and ensuring care continuity. With additional stress, they may experience more severe symptoms of burnout, hindering their ability to provide ideal care, or they may leave practice, as I did. I was fortunate enough to land on my feet. Others do not.

I heard a statistic last fall at the Massachusetts Medical Society conference on physician well-being that prompted me to action: Female physicians have a suicide rate that is 130 percent higher than women in the general population (for male physicians the rate is 40 percent higher). Although the data do not draw a direct correlation between physician stress and suicide, I did. I decided to share my story — to put a face on physician burnout and to highlight the importance of the problem.

In October 2013 I wrote a guest blog for WBUR. The response — 20,000 hits through Facebook, more than 300 comments, and many emails — suggests that the post hit a nerve. Since the posting I’ve had many conversations with physicians who have reached out to share their stories of burnout and exhaustion. Their frustrations with the current practice environment. Their desire to spend more time with patients. Their sense of hopelessness.

I wanted to find ways to support physicians who are experiencing stress and burnout. Editing the submissions for the “What Works 4 Me” blog is one step I’m taking to lend support. By offering suggestions about what works, the blog underscores both the scope of physician stress and the importance of physician wellness. And it offers hope. Stress is inherent in the practice of medicine. Burnout doesn’t need to be.

Diane Shannon is an internal medicine physician.  This article originally appeared in What Works For Me, a joint project by the Massachusetts Medical Society and the Institute of Lifestyle Medicine.

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  • NPPCP

    Dr. Shannon, I have to comment – your well being is no more important than mine, an electrician’s, or a biochemist’s. I don’t understand where this hyperfocus on “physician well-being” comes from.? Every individual needs well-being to function every day. You, my friend, are not special – VERY respectfully. I guess I could copy and paste your article and change a few words and it would be just as important or more important than this original article. I would call it “Nurse Practitioner well-being is essential to optimal patient care.”

    • ErnieG

      ^troll

      • NPPCP

        I think you know I’m not a troll. I have been posting on here longer than you. There is absolutely nothing trollish or untrue about my statement. By calling me a troll are you insinuating that a physician’s well-being to care for patients is more important than mine? Except for physician colleagues, I can confidently say no one else will agree with you. As for the “troll” comment, look in the mirror.

    • azmd

      Maybe we could all agree on “healthcare workers’ wellbeing?”
      I personally think that Dr. Shannon has a valid and critical point. Healthcare workers are expected to be compassionate and caring, while also doing work that is increasingly cognitively complex, in shorter and shorter periods of time, while contending with increasing levels of distraction related to documentation requirements, compounded by the steady erosion of support services.
      The fact that this applies to nurses as well as physicians doesn’t really take away from her fundamental argument.

  • SteveCaley

    That is unfortunately the underpinning that presages disaster. An unkind, fragmented and uncaring CIVILIZATION cannot create a caring, integrated and kind HEALTHCARE system. I am not offering a moral lecture – merely a sociological observation that societies live under Darwin’s rules.

  • buzzkillerjsmith

    Three years? Couldn’t find a practice that worked for you?

    You weren’t cut out to be a doctor. Sure medicine is hard, but that’s not the main problem with you. Admit it.

    If you pulled the plug after 3 years, you do not have standing to “support physicians.” I for one will call bull@%&$ on you for this.

    I have had the crap kicked out of me for 25 years and will start seeing pts at 9 am tomorrow with a smile on my face–a wary smile, but a smile nonetheless. I was cut out for this.

    • JTDO

      This type of response is exactly why doctors do not feel safe sharing their struggles with colleagues. This sort of ‘I can handle it so why can’t you’ and ‘every doctor is an island’ mentality is a contributing factor to doctors feeling isolated and alone in their profession. And feeling isolated and alone isn’t exactly the best antidote for depression and suicidal ideation. It’s great that you are “cut out for this.” But be careful how harshly you judge others with your ‘you aren’t cut out for this’ declarations. Every one of us is one bad patient encounter or one bad outcome away from disaster. As a profession, we should be much more supportive of one another instead of tearing each other down. No wonder the insurance companies and lawyers have been able to destroy our profession so successfully — we don’t defend or protect or support each other. Divided we fall. And oh how we have fallen.

      • buzzkillerjsmith

        Hey, if this doc wants to pull the plug, for whatever reason, that’s her call.

        But come on. Three years and tellin’ us all about how the world is. Tellin’ us all about it. Three years. That takes some gall. Talkin’ the talk but not walkin’ the walk.

        If I want support I won’t look for it from Dr. S. I suggest you do the same.

  • Suzi Q 38

    I am glad that you have at least decided NOT to practice medicine.

    I am surprised, though, that you have not explored or utilized another “avenue” with which to use your prior years of hard earned education and skills.

    Being a writer is fantastic. Are you truly so gifted of a writer that this ability would overtake your desire and skill to help others in a medical or non- medical way? Can you make a decent living with the proceeds from your writing projects?

    I am curious if you have had to borrow money to pay for your medical school and post medical training. Were you able to pay all of those loans off and start with a new life without the loans?

    You say that female physicians have a higher rate than male physicians of suicide. Did you know that overall, this doesn’t mean much to you if you are aware and not prone to being depressed and suicidal?

    Overall, though I have not found evidence that physicians alone commit more suicide than the general population of people.

    Sometimes, if you picked the wrong career, it is better to change it early in life. You have done that. I am just curious how you are paying all of you bills.

    • JTDO

      You have not found evidence that doctors have a suicide problem? Really? Have you looked?
      http://www.afsp.org — section on physician depression/suicide

      http://emedicine.medscape.com/article/806779-overview#showall

      http://www.medscape.com/viewarticle/410643_2

      And the list goes on and on.

      • Suzi Q 38

        I definitely will read all of this when I have time, thank you.
        Also, isn’t the suicide occurrence about 300 a year?
        While this is tragic, the occurrence of suicide for the general public is about 1% of the general population….

        Any life taken on purpose by suicide and otherwise is tragic. Physicians are not a select group that do this to themselves.

        It is very sad, but they are very depressed…so are others who commit this act.

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