Dr. Fay J. Hlubocky
Dr. Miko Rose
“As clinicians, we need to be empowered to enhance our own wellness while we’re charged with delivering care to others,” Session Chair Fay J. Hlubocky, PhD, MA, of the University of Chicago Medicine, said.
Presenter Ronald M. Epstein, MD, of the University of Rochester, said that focusing on the aspects of being a doctor that block the ability to find work fulfilling “will result in decreased effectiveness as a caregiver.” Dr. Epstein’s book, Attending: Medicine, Mindfulness, and Humanity, discusses how becoming more mindful helps clinicians to provide better patient care.
By definition, burnout is an occupational-related clinical syndrome that manifests as chronic occupational and interpersonal pressures that persevere over time. Resiliency, however, is a key factor in the prevention of burnout because it promotes individual strength and control.
“You can learn to regulate how you react,” Dr. Epstein said. “Being more mindful helps you to become more effective with your patients in your administrative roles. In addition, we can work with health care organizations to try to promote changes that are health promoting for those who work there.”
He hopes to show attendees how they can become more resilient.
Presenter Miko Rose, MD, of Michigan State University, said some medical schools (including two at Michigan State University) now offer courses and programming on emotional resilience, “including elective classes offered each year on the art of physician happiness.” During the session, Dr. Rose will provide interactive exercises created for those classes.
Part of building resiliency is learning how to overcome those sometimes overwhelming feelings of doom.
“We’re telling doctors that they can bounce back from adversity, thrive, and positively adapt to work stress,” Dr. Hlubocky said. “Resiliency is not something we’re necessarily born with, but it can be cultivated.”
Physicians are faced with societal and cultural norms to maintain “a ‘superhero’ complex—never allowing ourselves to be publicly vulnerable, with high stakes for reporting our moments of weakness,” Dr. Rose said. “Every year, the United States loses approximately 400 physicians to suicide—the equivalent of at least one entire medical school class.”
The suicide rate among male physicians is 1.41 times higher than the general male population. Among female physicians, the relative risk is even higher, at 2.27 times greater than the general female population.1
An ASCO membership survey found that 45% of medical oncologist members reported experiencing emotional exhaustion and/or depersonalization symptoms related to burnout.2
“Approximately 10 years ago, a study on community oncologists reported3 a 62% burnout rate. In Europe and Australia, the numbers are even higher—varying from 52% to about 80% depending on practice or specialty,”4,5 Dr. Hlubocky said. “We know that burnout, in itself, is an occupational-related syndrome. We know that this will happen. It’s a chronic syndrome that every physician will experience during at least one point in time.”
Stress and Technology
During clinical training, the skills needed to deal with the psychologic demands of being a clinician are not emphasized.
The focus is on facts and principles, “but not how to deal with grief and loss in yourself, learning how to balance closeness with equanimity, learning to forgive yourself after an error, or learning how to make changes so that errors aren’t repeated,” Dr. Epstein said. By the third year of medical school, there is a loss of common purpose and community, and students are more concerned with survival and impressing the attending physician, he said. Technology adds to the isolation—for every 1 patient hour, clinicians spend 2 hours on their electronic health records.6
“With upcoming changes in medical records and billing requirements, we will only continue more in the direction of that split, with more time required for documentation, and less time for our patients and each other,” Dr. Rose said.
“There’s not enough of a sense of camaraderie,” Dr. Epstein said. “Instead, we’re taught to move on, to develop a thick skin. As a life strategy, developing a thick skin doesn’t work.”
It’s not all doom and gloom, and there are strategies to cope with these issues.
“We commend ASCO in acknowledging the significance of burnout. We are working to develop a resiliency platform that will involve health promotion, mindfulness-based intervention, cognitive behavioral therapy, and learning how to relax or mindfully breathe during the day,” Dr. Hlubocky said.
–Michelle Dalton, ELS
*Program information updated as of March 15. For session time and location information, please refer to the ASCO iPlanner on the Attendee Resource Center.