17 May 2017

Grateful Patients, Families Help Emergency Physicians Cope with Burnout

The physician burnout epidemic in the United States continues to worsen. Alarmingly, according to the new Medscape Lifestyle Report 2017: Race and Ethnicity, Bias and Burnout, Emergency medicine now has a burnout rate of nearly 60 percent—the highest of any medical specialty.

Most physicians enter the medical profession because the work is meaningful and gives them a sense of purpose. According to a recent article in NEJM Catalyst, “burnout becomes epidemic” when physicians’ frustration with the current healthcare system’s “demands, limitations, and inconsistencies” impede their efforts to deliver excellent care. 

A survey discussed in a recent Mayo Clinic Proceedings article found that “physicians who experience more burnout are less likely to identify with medicine as a calling,” and that when a doctor’s sense that medicine is his or her calling is eroded, it can negatively impact both the physician and patients.

Benjamin Thomas, M.D., an Emergency medicine resident at Highland Hospital in Oakland, California, recently wrote about another contributor to burnout: feelings of failure when things go wrong with patients. In a recent article in ACEP Now, Dr. Thomas explained that, as an intern, he had believed that burnout only affected physicians who had been in practice for a very long time. But that belief changed dramatically the first time a patient under his care died and he had to break the news to her family, including her young daughter. “Leaving the hospital that night, I questioned whether I was meant to do this and began to understand that burnout was a real phenomenon,” he remembered. Every subsequent bad outcome exacerbated those negative feelings and self-doubt and chipped away at his empathy and compassion. 

He had an epiphany several months later, when he saw the brother of that first patient who had passed away in the emergency department. Instead of the criticism or contempt that Dr. Thomas had been expecting, the brother expressed his gratitude for the physician’s care and his efforts to save his sister. For the doctor, whose feelings of having failed her were still raw, her brother’s words were like a balm. Dr. Thomas began to realize that his focus on negative outcomes during the prior few months had made him lose sight of “the overwhelmingly positive things that manifest on a daily basis.” From that point forward, he “began to accept the gratitude for the simple laceration repair or basic shoulder reduction.”

He cautioned Emergency medicine physicians that “ignoring the reality of burnout” is a setup for failure and encouraged them to focus on appreciating patients’ everyday expressions of gratitude to help restore meaning, purpose, and personal satisfaction to the practice of medicine.