Burnout impairs orthopedists’ ability to care for patients, avoid errors
With 54% of American physicians reporting burnout, the topic consistently comes to the forefront of discussion. Experts at a recent NEJM Catalyst live web event called for leadership to work toward finding the camaraderie and joy in medicine again, giving physicians a vaccine for burnout.
“If you look at the fundamental drivers of professional burnout, one of the drivers is moral distress and values dissonance,” Stephen Swensen, MD, MMM, FACR, medical director of professionalism and peer support at Intermountain Healthcare, said in his keynote speech. “If we work in systems that promote the rendering of care that we wouldn’t choose for ourselves, that creates moral distress and values dissonance and professional burnout. Not only is it good for patients to put their interests first. It’s good for us.”
A review by S. Elizabeth Ames, MD, and her colleagues in The Journal of Bone and Joint Surgery this month noted leaders, learners and orthopedic colleagues all face the challenges of burnout. They noted burnout rates among orthopedists are not only among the highest across medical specialties, but they steadily increase during medical education prior to residency.
Wayne M. Sotile, PhD, founder of the Center for Physician Resilience, in Davidson, N.C., told Orthopedics Today the incidence of burnout among orthopedic surgeons ranges from 50% to 60%. He said burnout can increase the probability of surgical errors, career dissatisfaction and discord in the home.
“Even a 1-point increase in burnout carried with it about 11% increase incidence of making a surgical error, according to research sponsored by the American College of Surgeons,” Sotile said. “If burnout goes up, physicians are more likely to make errors, are more likely to have dissatisfaction in their careers, are less likely to be people other people enjoy working with and less likely to be people other people like living with.”
Burnout can lead to orthopedists having less compliant patients, according to John D. Kelly IV, MD, an Orthopedics Today Editorial Board Member and professor of orthopedic surgery at the University of Pennsylvania.
“[Burnout] impairs care,” Kelly said. “Patients are not happy, doctors that are burnt out have less compliant patients. They are less effective in performing their duties.”
He continued, “Basically, you cannot give what you do not have. [Orthopedists] cannot give the patient care the patient deserves and that they would like to give them.”
Some organizations are in a position to help prevent burnout by creating a dialogue between non-physician and physician leaders on improving efficiencies and effectiveness in the work place, said Sotile, who is on the clinical teaching faculty in the department of orthopedic surgery at Tulane Medical School, in New Orleans.
“In the process, they develop a collaboration of mutual respectfulness that shapes a positive emotional workplace culture and creates a sense of community in the medical staff or between the orthopedic group or within the orthopedic group in hospitals or within their own clinics,” he said.
Orthopedic surgeons who feel burnt out may also need to rethink their career in discussions with their partner or spouse.
“The attitude of the life mate toward the group or the department or the division in which the orthopedic surgeon is working in shapes the orthopedic surgeons’ attitude toward their workplace,” Sotile said. “Needless to say, what the orthopedic surgeon comes home saying about the work place shapes [his or her] life mate’s attitudes toward their workplace. So, it is important as a family to rethink.”
Most important is for orthopedists to pay attention to their bodies for cues on when it is time to take a break, according to Kelly. He noted that orthopedists should “focus on what is essential in [their] life and create boundaries,” and they should practice self-care with yoga, mindfulness, relaxation techniques, exercise and fitness. In addition, relationships must be nurtured and spirituality/meaning rediscovered, he said.
“Those things have been shown in several studies to prevent burnout because it is due to biopsychosocial factors. First learn how to create boundaries,” Kelly said. “Learn how to say no. Protect family time; protect timeless relationships; re-evaluate your week in terms of what is important and what is not.”
Each day, uplifting situations should be harvested and generated three to five times more than daily hassles, Sotile said.
“That might sound idealistic, but that is what orthopedic surgeons who still love practicing orthopedic surgery are doing,” he said. “They are not just noticing the patient who ... came in aggravated with them. They are noticing the ones who are grateful. They are not just noticing their frustration about what administration is doing and not doing; they are appreciating the incredible state of the art equipment they have.”
Finally, orthopedists must be able to admit when there is a problem and admit they need help, according to Kelly.
“You just cannot say I will avoid burnout,” he said. “You have to take a good look at your life and consider some counseling and invest in some wellness programs and stress management programs.” – by Casey Tingle and Katrina Altersitz
Ames SE, et al. J Bone Joint Surg Am. 2017;doi:10.2106/JBJS.16.01215.
For more information:
John D. Kelly, MD, can be reached at University of Pennsylvania, Department of Orthopedic Surgery, 34th and Spruce St., Philadelphia, PA 19104; email: firstname.lastname@example.org.
Wayne M. Sotile, PhD, can be reached at The Center for Physician Resilience, PO Box 2290, 215 S. Main St., Davidson, NC 28036; email: email@example.com.
Disclosure: Sotile reports he is paid for speaking on resilience for physicians. Kelly reports no relevant financial disclosures.