You know the problem, join the solution

Burnout is a problem that plagued healthcare professionals long before the Covid-19 pandemic, but there is no doubt that the pandemic was, and is, a tipping point for many physicians. That tipping point became the opportunity for Jonathan Fisher, MD, to take action: to step away from the problem in order to seek a solution. The solution? The first Ending Physicians Burnout Global Summit. Fisher assembled a team, and on August 24, 2021, the solution became reality with the opening of the summit. Here is a recap of highlights from the 3-day event.

Day 1: Why Here, Why Now

Letting physicians actually practice medicine, rather than asking them to also perform administrative tasks, is a simple prophylactic measure to prevent physician burnout, according to keynote addresses that opened a 3-day conference devoted to burnout prevention.

As the keynote speaker at the first Ending Physicians Burnout Global Summit, James Doty, MD, clinical professor of neurosurgery at Stanford University in California, said, “We have had a dramatic uptick in suicide among health care workers; we have 50% of people saying they don’t want to be physicians or health care providers anymore. And this occurs in a time when there are so many challenges and burdens on the health care system.”

Doty said that when a person feels their self-worth has been degraded, so too is their ability to be an effective physician or health care provider.

“So many of us do not do adequate self-care, being compassionate to self,” he said. “It is common with healthcare professionals that they are so intent on being of service to others that they get lost and then no longer care for themselves.

“When that happens,” Doty continued, “it leads to burnout—decreased productivity, a sense of exhaustion, cynicism, and ultimately, at the end of the day, it impairs you from being the physician that you want to be. You end up being overwhelmed with patients; you become overwhelmed with corporate medicine and the challenges that go with that, which fundamentally include obstacles to your care: It can be the electronic medical record, it can be certain practices and protocols that hospitals implement, and sadly, in many ways, at least in the United States, it relates to making profit.”

As conceived by conference-founder Jonathan Fisher, MD, a cardiologist with Novant Health Heart and Vascular Institute, Presbyterian Hospital, Huntersville, North Carolina, the Ending Physician Burnout Global Summit is “a call to all of you to recognize your role as leaders whether or not you have that title behind your name, you all are leaders in health care. Your voice matters. You can say that if something is not okay, here is how we will make it better. Notice the ripple effects of raising your voice with courage and assertiveness—even though there will be many who tell you to keep quiet. Time for change is now.”

Fisher said the conference brings together more than 750 virtual attendees who are signing in from 43 countries on six continents to attend the meeting and its 57 sessions and workshops. In the lead up to the meeting, which Fisher promised would be an in-person event in 2022, the conference website scored 21,000 hits. For the non-profit conference—which is run by volunteers—the 28 corporate sponsors and attendee fee raised $150,000, which will be dispersed to organizations dedicated to mental health, physical health, and government.

“I’ve lost about a decade of my own practice,” Fisher said, “and I didn’t know what to call it but in retrospect it was burnout. It’s easier to say that I’m stressed out than I’m clinically depressed, and yet the numbers right now say that about 20% of doctors are clinically depressed; 50% to 60% are burned out, and this represents a pubic health crisis.

“It might have been helpful when I was a young doctor and resident,” he mused, “if there was one person in the world speaking out and saying that those of us who are trying to care for the rest of world are suffering ourselves. It might have been helpful to hear that message.

“So I hope the message that comes out of this meeting is: Wherever you are in the world, I see you.” Fisher said, “Doctors and nurses around the world are suffering. And I hate to say it, but many of us have had enough. We haven’t had enough of caring for people, but we have had enough of ’business as usual.’ Burnout was a crisis before Covid-19, and it is much worse now. “

Day 2: Actions = Attitude

Getting a handle on burnout among physicians and healthcare workers is about more than good intentions—it requires action. But action should start with simple things, like saying “thank you” to patients, and to nurses, as well as the maintenance staff that works to keep exam rooms, patient rooms, and emergency rooms clean, according to a nationally recognized expert on physician burnout.

Thom Mayer, MD, medical director of the National Football League Players Association and clinical professor of emergency medicine at George Washington University in Washington, DC, urged participants attending day 2 of the Ending Physician Burnout Global Summit to identify things that you love about work—and maximize it; find things that you hate and eliminate them, and determine what can be tolerated and minimize it.

Mayer asked his audience at the virtual summit to, “Think about new ways of doing things, act upon those things within 7 days—because otherwise you have a great group of notes and ideas, but you are not going to put them in action. If you don’t do it in 7 days, you won’t do it at all. “

For an example, he said, make it a goal to say ’thank you” at least 50 times a day at the job. “Say thank you to the patients when you enter the room; say thank you to the patients when you leave; say thank you to the nurse; say thank you to the people who clean up. If you have 20 patients you see a day, you are almost at the goal when you finish your rounds.”

Mayer said that what you may find is that saying “thank you” 50 times a day actually makes the job easier; “smiles beget smiles; success begets success.”

He said that is one step in the process to return to the “deep joy” that physicians have when they enter the healthcare field but is diminished through burnout. He showed a picture of a clinician obviously jumping for joy and asked if that is the way you feel when going to work or when you are leaving work. He suggested it should be both.

Mayer said another key to overcoming burnout is to step forward and lead, “lead yourself and lead your team… Every member of the team is a performance athlete just like players on a football team, and they have a cycle of ’performance, rest, and recovery.’ And we should treat ourselves that way.”

He also advocated for being an innovator, even if that means that some innovations will fail. “Innovation means we are saying that the system that we have is not working, and we have to find a better system,” Mayer said. “Unless you have about a 30% failure rate, you really are not innovating; you are simply adopting best practices a little bit faster than other people.”

“The unsettling fact is that half the [healthcare professional] team in today’s hospitals is burned out,” Mayer said. “We cannot afford not to deal with burnout. Every measure of quality gets worse with burnout. The literature is replete with that.” He also suggested that hospitals that invest in programs designed to end burnout are making smart business decisions, since it can cost hospitals from $500,000 to $1 million to replace a physician. If burnout can be ended, more doctors will stay in place.

Mayer also said that, just by existing, the global summit may be helping to end burnout. “What you have done is you have convened a learning community of passionate people,” he said in a one-on-one with session moderator and Global Summit founder, Jonathan Fisher, MD, a cardiologist with Novant Health Heart and Vascular Institute, Presbyterian Hospital, Huntersville, North Carolina. “This is going to create a better life for the physicians on this call and it will have ripples around the world. The ripple effect will be unbelievable, it will save lives,” Mayer said.

Fisher said the talk by Mayer “has been an absolute masterclass in how we can end burnout. Hopefully, within the next 7 days, everyone here will commit to one action.” He also praised Mayer for his insights and passion, noting that many virtual commenters admitted they were to tears.

Fisher noted that the 3-day conference has grown to include nearly 1,000 world-wide participants, representing at least 43 different countries.

Day 3: The Huffington Solution

Entrepreneur and businesswomen Arianna Huffington told doctors that stability in business and in life requires time to breathe.

While money and status make up two legs of the stool of success, she said at the virtual Ending Physicians Burnout Global Summit, the third leg and crucial support of that stool needs to be forged out of well-being, health, wisdom, and wonder.

In a conference-featured “fireside chat,” Huffington, the founder of The Huffington Post news outlet and now, Thrive Global, her foray into well-being, said that a simple one-minute breathing exercise, which she calls her reset, can help a person handle the stress of the day, and allow even hard-driven doctors and business executives to get a moment of relief for what she described as the “disease of civilization: Burnout.”

“I have not met a single human being who is in a perpetual state of Zen and calm,” Huffington said, “and I have met the Dalai Lama. If he can’t do it, I don’t think there is a chance any of us can. But a lot of science right now makes it clear that short breaks—like the breathing exercise—can have a real impact in moving us from the sympathetic to the parasympathetic nervous system and reducing harmful hormones in the body.

“That in 60 to 90 seconds we can achieve that gives me tremendous optimism,” she said. “We may not have time between medical work that so many here are doing to have a 20-minute meditation, but we all have the time to take a 60-second breathing break, or gratitude break, or stretching break.”

Moderator of the chat and chair of the conference Jonathan Fisher, MD, a cardiologist with Novant Health Heart and Vascular Institute, Presbyterian Hospital, Huntersville, North Carolina, could relate. “When I am in the hospital practicing as a cardiologist and I’m seeing very sick patients, I wish there was a quick way to get to ataraxia (serene calmness), and I know that breathing helps,” he said. He asked if there were other ways Huffington could recommend to find that place of calmness in the eye of the hurricane.

“All of us are living in the eye of a hurricane of sorts,” she said, “and those of you in the medical profession much more so than the rest of us. To get there requires a mindset change. We all have a place of peace, strength, and wisdom within us. That central place is really our birthright. When we recognize that—and we all have moments of that in our life in which we experience it. Nobody lives there all the time, but anything we can do during the day—these little breaks—help us return to that place, recharge from that place. It is something that we need to embed in our workflow.

“In our work with millions of people around the world, we have found that it is not enough to take a vacation,” Huffington said. “How often do you return from a great two-week vacation, and within 48 hours you become stressed out and even burned out. Stress is inevitable in our lives, but cumulative stress is avoidable. You know that as a cardiologist, it is cumulative stress that leads to hypertension and other problems that can lead to more serious heart disease.”

While Huffington was speaking of what individuals can do to break the stress that leads to burnout, Fisher wondered whether the workplace management had a role in burnout. “We need a cultural transformation,” she said in response. “Even though we may not have the power to change an organization, just by changing ourselves we can have an immediate impact.

“Someone once said, ’A crisis is a terrible thing to waste,’ and right now we are in a crisis, and often breakthroughs require breakdowns,” Huffington said. “My hope is that we are going to use this crisis as a catalyst to imagine and build a new system in medicine and in our culture in general.”

Edward Susman, Contributing Writer, BreakingMED™

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Topic ID: 505,510,254,791,510,556,730,192,925