It's not the doctor's fault – blame the system! That's the underlying message in the landmark report released October 23, 2019 by the prestigious National Academy of Medicine. "You can't just teach doctors meditation, yoga, and self-care. We need big, fundamental changes," said Christine Cassel, M.D., professor of medicine at University of California at San Francisco and co-chair of the committee of experts who wrote the report. "What this report is saying is that this is a systemic problem that requires systemic solutions." It's time to stop blaming the victim.More than half of all U.S. physicians are suffering from burnout, said Victor S. Dzau, M.D., the NAM president, citing the urgent need to eliminate the stigma associate with this epidemic. Physicians are often reluctant to seek help because they fear negative consequences for doing so. "Many medical license application questionnaires unfortunately have questions [such as] 'Have you ever seen a psychotherapist? Checking the 'Yes' box could potentially set off a series of dominos that put their very livelihood at risk. It's a really big issue," said committee member Lotte Dyrbye, M.D., associate director of the Mayo Clinic's Program on Physician Well-Being. There's also a cultural barrier, said Lindell Washington, M.D., another committee member. "It's not readily accepted by your peers when you raise your hand to seek help." Eliminating this stigma is a crucial component to addressing physician burnout.
The report emphasized that burnout prevention needs to start early – in medical school. To reduce stress on medical students, the committee recommends a curriculum redesign that uses a "pass/fail" model instead of letter grades, especially during the first two pre-clinical years. Medical schools should also "develop and pilot initiatives to improve the learning environment," said Dr. M. Lynn Crismon of the University of Texas at Austin. Dr. Crismon noted that burnout among medical school faculty is another concern that's been under-appreciated and in need of attention.
In addition, the 312-page report calls for a complete redesign of the practicing physician's daily workload. "Clinicians should not be spending time on low value activities, but on activities that have meaning, purpose, and contribute to patient care," said Pascale Carayon, Ph.D., committee co-chair and founding director of the University of Wisconsin at Madison's Institute for Healthcare Systems Engineering. Dr. Carayon said the breakdown of America's healthcare system is the primary reason behind, "the misalignment between what clinicians want to do...and what they're asked to do, whether by healthcare organizations or by patients." She admits that redesigning the system's infrastructure will not be an easy task, but with the right support, continuous improvement, and dedicated high-level leadership, she's confident the challenge will be met.
Ken Teufel, M.D.