Thursday, November 20, 2008 | Categories: Dr. Brian's Blog
This week, MDs from Canada and around the world gathered in London for an international conference called 'Doctors' Health Matters -- Finding the Balance'. As promised, I'd like to bring you some highlights. One session caught my attention. On Tuesday, November 18, one of the presenters posed three questions that health professionals should ask themselves about their lives in general to answered on a scale of 1 (extremely dissatisfied) to 7 (extremely satisfied):
1. When you think about your life at the moment, would you say that by and large you are satisfied with life or are you mostly dissatisfied?
2. If you were asked this question five years ago, what might your answer have been then?
3. What do you think your answer to this question will be five years from now?
Older surveys have suggested high rates of disatisfaction with working in health care. We are eagerly awaiting the results of a recent survey of physicians that was conducted by the Canadian Medical Association's Centre for Physician Health and Well-being, which should be out shortly.
In the meantime, if you missed this week's White Coat, Black Art show on burnout, you can download the podcast or listen on Saturday, November 22 at 430 pm (5 pm NT). Meanwhile, we've received a lot of heartfelt comments from you.
Liza Huzel writes:
As a physician who works primarily in a busy Intensive Care Unit, I am probably at high risk for developing burnout. Certainly, I often find that 5-6 days into a 7 day stretch is when I start to resent requests that are entirely reasonable, and even feel occasional flashes of anger if someone seems to be questioning my decisions/actions. Compassion fatigue is hard to avoid when you've had to fill out 4 death certificates in one day. Luckily, my schedule is one where I have intermittent blocks of time with absolutely no clinical responsibilities; I take this time to travel, take in cultural activities, and sometimes, I just veg out on the couch and listen to CBC podcasts and knit. But many physicians don't have the luxury of time for "R and R". It's very scary to think of what the burnout rates are going to be like in the near future. With decreasing numbers of practicing physicians, an increase in the elderly population, and consumerization of Canadian medicine, is it possible to change a medical culture which accepts overwork as normal?
I suspect that a lack of "extra-curricular activity" is a risk factor for burnout - if a doctor's whole identity/selfworth is wrapped up in medicine, they start to lose perspective. Perhaps medical schools should be encouraging physicians to maintain their non-medical activities, and laud the non-medical achievements of practicing physicians. I'd like to hear a WCBA episode that focuses on doctors who also have achieved success outside the realm of medicine (in arts, literature, politics, or sport) would be.
Thank you for the show.
Liza makes some very important points. I've met many MDs whose self esteem is wrapped up in what they do for a living. I have always found solace in writing. More than that, although I work hard when I'm on duty, I have always taken something less than a full time number of shifts. I'm not the first person to say that working part time is one route to work life balance.
Cynthia Tansley of Victoria, BC writes:
Dear Brian, I often miss the show, but I'm glad I heard this one. Something in the voice of the I.C.U. nurse really touched a nerve. I have been in hospital more times than I care to relate, and it infuriates me that good people are treated so badly by our health care system. Brian, I think that you are preaching to the converted - patients and health care workers who would like to improve the system. I wonder how many policy makers listen to the show and if they do, what they think of it. Maybe patients and health care providers should team up and picket a few government offices. I'll hold the sign if you push my wheelchair...cheers Cynthia Tansley
Not everyone sent in kudos. Les Blackwell, a ward clerk in the ER in North Bay, Ontario, sent us this:
I listen to your program every week, and I usually appreciate your guests and their stories. However, as I listened to your piece this week on burn-out, I had to take exception to two guests. Regarding Deborah, the RN from BC who complained that her training created false expectations for her: nearly everything she said betrayed a sense of entitlement in this young nurse that I find troubling. For example, she complained that she had to clean up bodily fluids and empty bed pans, but these are duties that even the people most remote from health care would expect a nurse to do. She further complained that she did not have enough decision making power and autonomy in her profession, and it sounded like she resented those things in the residents. To Deborah and others of her kind, I have a couple of comments to pass along. First, RNs (in Ontario anyway; I cannot speak for the whole country) make a respectable wage; some of the rank-and-file RNs in my department make 100,000+, through hard work and little complaining. Secondly, there is a chain of command in health care, no matter what liberal Nursing Universities try to suggest. Doctors give orders, nurses follow them. This is a practical and necessary arrangement that makes the system function. I say this as an ER worker who is even lower on the chain of command than the RNs, so I appreciate that sometimes the lower ranks are competent enough to make some hard decisions, but ultimately, the system requires the chain-of-command organization.
In my own (not insignificant) experience in a very busy and challenging ER, I can tell you that all front-line health care workers experience things that are difficult to deal with; from tragedies to bureaucratic nonsense, it all makes for a challenge. However, at some point people have to say this is the job; I better buck up and do it.
Thanks for a great program, Brian. I will keep listening every week!
As always, we welcome your comments.