How medical humanities can help physician burnout

Something odd happens in medical school. It affects you as a patient, me as a provider, and state and federal budgets.

For the first two years of medical school, empathy levels stay the same while we bubble in multiple choice questions. Then third year comes. Eagerly, we drop the backpacks and pick up the stethoscope ready to see real life patients. What happens during this long awaited year? Empathy levels tank. And you know what? They never return to baseline. All in all, about 1 out of 3 medical students report burnout.

Why does it even matter?

The most obvious reason is that physician burnout and lack of empathy is bad for you as a patient. It’s bad for your spouse, your parents, and your children. It is serious. Studies show increased medical errors, decreased quality of care, and lack of adherence to treatments associated with physician burnout. Patients whose physicians are burned out are more dissatisfied and have less trust and confidence in their doctors. “Did she even listen to me?” you might ask walking out of the clinic.

Burnout is hazardous to financial health, too. In California fiscally conservative citizens won’t like how we’ve seen a 50 percent increase in enrollment in government-funded insurance plans since the Affordable Care Act took effect. Combine that with the doubling of annual health care for public retirees in the past decade and it is easy to see how the state budget is threatened by health care costs. At the federal level, good luck to Trump or Clinton, because they’ll have to deal with the fact that health care costs eat up 17 percent of the GDP.

Physician burnout hurts CEOs as well. It leads to more lawsuits and less stability in the workforce. Replacing a physician is expensive — to the tune of $250,000. Where’s the value in that?  Studies also show that the docs who don’t quit will riddle your health care system with erratic referrals and pollute it with decreased professionalism.

So what’s a solution to physician burnout?

Well, medical schools like Stanford, UCSF, Yale, and Harvard are giving this a shot: medical humanities. It’s a loose term made up of different disciplines — art, literature, philosophy, and ethics. The idea is that exposing medical students to the humanities and arts will increase empathy and decrease burnout.

As a medical student, I remember patting a patient on her frail, thin shoulder, her face dignified with wrinkles and the joints in her hands swollen. No one else was in the room while the sun set outside.  Her eyes seemed to beg the question, “Where is my family? Why I am I here alone?”  I briefly wondered the same, but then moved on to my next patient.

The importance of such moments is often lost.  My medical humanities class, Art of Doctoring, gave me permission to pause and reflect on that moment. Did I do the right thing? Classic literature revealed why that simple gesture mattered, both to the patient and to me.  What did the patient’s aloneness say about how we age? Philosophical texts offered insight. What is our capacity for forgiveness? Song lyrics uncovered a new perspective. Once unpaused, I knocked on the next patient’s door with a deeper understanding for the value of respect, humanism, and caring in patient encounters.

My classmates similarly reflected on their own experiences in various ways: expressive iambic pentameter, stunning ocean photography, and revealing whispered words confided in small groups. The value of processing these encounters was affirmed. New reservoirs of strength were revealed.  Such learning is more than just chatting with a friend — it is exposing us to disciplines we never would have been exposed to precisely when we need them the most: when we are wrestling with who we will be as doctors.

Another entitled millennial?

Look, we aren’t asking to be babied. We want the full spectrum — just to be equipped with the tools to deal with it in a healthy manner. We aren’t asking to be out of the hospital more. It is about being more engaged and efficient when we are there. We aren’t asking for more money. Money won’t solve this. To the physicians who came before us, we humbly submit that medicine has changed. In some ways it is better, in other ways it is worse. Overall though we can say it is different. While you have had your own set of challenges we currently have ours.

Does it work?

Does increasing empathy and decreasing burnout in physicians really work? Research says yes. You as a patient are more likely to trust your provider, thrive with boosted immune function, receive the right medication, and control diabetes better when you perceive your doctor to be empathic. What about the financial bottom line though? Well, health care costs went down and malpractice claims plummeted by 70 percent.

So, the next time you see a batch of young doctors-to-be with their newly pressed white coats, hope that part of their training includes a medical humanities course. It just might help them cultivate perspective and build resiliency, while protecting you, as a patient, and the financial health of our nation.

Daniel Orlovich is an anesthesiology resident.

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