Preventing Physician Burnout: Reclaiming Your Dignity
This article appeared in a slightly different version on the KevinMD website.
Treating patients with dignity is a fundamental cornerstone of our profession. Although we can all cite situations where we or our colleagues fell short, most of us aspire to helping our patients feel safe and respected. Yet the flip side of this equation is rarely mentioned. And the truth is that physicians are often not treated with the same dignity by their systems or their patients.
In this article, I’ll go over the fundamental changes that have contributed to this situation, and I’ll give you five strategies you can use to combat the disrespect and reclaim your dignity.
We've been conditioned to expect and even accept that patients in distress may lash out, but the fallout has been enormous over the past few years. As recently as five years ago, there was an expectation of respect for the expertise and sacrifice that a physician’s work entails.
But disrespect from patients is currently at an all-time high, sometimes even escalating to physical violence from patients. A recent study found that more than one third of public health workers in the US experience some form of workplace violence. Examples included stigma or discrimination, job-related threats, and bullying or harassment.
Adding fuel to the fire is the rise of administrative oversight of physicians and their practices by people who may have little experience in direct patient care. Their reach extends not only to metrics and billing, but into personal and professional decisions that once would have been completely off limits.
What’s more, employed physicians may have little say into whether threatening patients can be dismissed from their practices.
And at the intersection of patient and administrative stress are the widely published patient satisfaction scores. Despite these scores having little relevance to patient outcomes, physicians are increasingly required to perform in such a way as to meet an arbitrarily defined level of satisfaction. Consequently, this may undermine their ability to do their best work.
Although physicians are tasked with regular training in sensitivity and respect for patients and employees, they get little instruction in how to protect their own dignity. Often physicians are advised to just let it go.
It’s not unusual for doctors, especially women, to attempt to deal with these situations with passivity and even self-deprecation, in a misguided attempt to get along. Younger physicians who lack strong mentorship may be especially vulnerable to these situations.
Unfortunately, these well-meaning and ingratiating responses often simply serve to empower the bully, and do nothing to improve the situation.
So how can physicians begin to reclaim their dignity? Here are five ideas that you can implement right now:
1. Establish Boundaries:
Boundaries are crucial in maintaining professional relationships and protecting personal dignity. Being a caring and compassionate physician is not the same as being a friend.
Avoid social media interactions with patients and administrators and keep your work and personal lives separate. Modeling clear expectations for behavior and interactions can help prevent disrespectful situations.
2. Advocate for a Respectful Work Environment:
If you don’t speak up for yourself, it is unlikely that anyone else will. Engage your colleagues and address disrespectful behaviors from patients, administrators, and other physicians.
Initiating open discussions about mutual respect and dignity at staff meetings or even through anonymous feedback systems can encourage positive changes. Remind yourself that these are reasonable requests. Pushing for policies that address the root causes of disrespect and burnout can create a more supportive and dignified atmosphere for the entire team.
3. Focus on Doctor-Patient Communication:
Respectful communication is a cornerstone of the physician-patient relationship. Through empathetic and compassionate communication, you’ll foster and model civil discussion. Active listening, showing genuine interest in patients' concerns, and involving them in decision-making can help build trust and respect.
Keeping EHR messages brief and focused can help to maintain your professional boundaries while addressing patient concerns.
4. Don’t Accept Disrespect:
Firmly but politely calling out an incident of disrespect can be a first step towards creating a solution. Rather than simply going along to get along, modeling appropriate behavior can set the tone for future communication. And when the misbehavior is significant or repetitive, documentation can make your point much more clearly than a complaint.
But if you feel that your safety or that of your staff is at risk, don’t allow yourself to be talked into accepting a dangerous situation. Sometimes engaging with and reporting to security or even law enforcement personnel is your best option.
5. Take Care of Yourself:
Prioritize your own well-being. Explore self-care practices such as exercise, meditation, and hobbies to help you recharge emotionally and mentally. Mindfulness techniques can assist you in staying present, focused, and composed during difficult interactions, preventing potential escalation.
Don’t overlook the importance of making time for your family, friends and loved ones. By nurturing these ties, you will stay connected to the world outside of your practice.
Reclaiming your dignity as a physician will require commitment and test your resilience. Although you didn’t create the problem, it is unlikely that it will change without strong advocacy by and for physicians. By following the steps I’ve outlined above, you can begin to cultivate a more dignified and sustainable working environment. And ultimately everyone, including the patients you care for, will benefit.
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