Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Mindfulness is not the answer for burnout

Joy Liu, MD
Physician
June 5, 2018
Share
Tweet
Share

When I was an intern on the cardiology service, I rarely left before 10 p.m. Call days were longer. One day in the workroom, I noticed my co-intern sniffling as she typed progress notes. Her eyes were red. “Are you OK?” I asked.

She said, “I just cried in the bathroom for about ten minutes. It’s nothing bad; it’s just … I’m so tired. Do you ever feel so tired you just break down? I feel better now, don’t worry.”

All of us have a vague sense of what someone who is “burned out” looks like. Burnout manifests in many different ways: insomnia and nightmares about providing inadequate care, anger at a patient for not getting better, arguing over small details with other staff and, sometimes, crying out of sheer exhaustion in the bathroom. But there is a frustrating lack of specificity in defining burnout, despite widespread recognition that burnout contributes to higher rates of physician attrition, mental health issues and even suicide.

What is burnout? Is it a medical condition? It has an ICD-10 code: Z73.0. A social phenomenon? In 1974, Freudenberger described “burn-out” as more likely in people with certain attributes (“the dedicated and the committed”) in certain work environments. A personal failing? It has been written that burnout is merely a “ status symbol” of industrialized societies, the neurasthenia of the 21st century. Some complain that it is an invention of over-sensitive millennials who don’t understand what hard work is.

Classifying burnout matters because it determines how we can best approach it. If burnout is a medical condition, it can be treated. If burnout is a social phenomenon, it requires a social intervention. If burnout is a personal failing, well, then perhaps we need to take a good, hard look at ourselves. Even the literature on burnout is not consistently clear on what it is. There is a disturbing overlap with depression and anxiety, which are the proverbial elephants in the room. Are burnout and depression on the same spectrum? It is not clear. What is clear is that telling people who are burned out and depressed to “just stop being sad” and “when I was in training, we didn’t complain” is not helpful.

Resilience is often touted as a solution. It has even been suggested that resilience is an emotional competence that should be taught in medical school. But most of us learned perseverance, self-improvement, and coping through difficult experiences, not in the classroom. It is foolhardy to think that a lecture series on resilience will translate well. Instead, students who are already conditioned to never show weakness will hear the implicit message that gaining resilience is a matter of personal effort, and that if they struggle, it is their personal failure.

What of mindfulness? Mindfulness has been shown to improve focus, calmness, and memory over the long run — characteristics of productive, complacent employees. But non-judgment does not promote critical thinking skills. Emotion regulation is not an exercise in compassion, but rather, in emotional coolness. Awareness is not enough for physicians who want to fight back against the injustices their patients face. Mindfulness can be a useful tool in the toolbox of self-care. It is a great response to an acute stressor and can bring temporary relief in a hectic day. What it won’t do is take away the foundational problems in health care.

Is there anything that can heal burnout? Human connection. Returning to that day on the cardiology service, when one of the senior residents overheard my co-intern and I whispering, she spun around in her chair and turned to face the six other residents and interns in the room. “OK, who has not cried this month? Raise your hand.” No one raised their hand. Then, we started to laugh. We opened up about how we were coping and the sick patients that we had. That month on the cardiology service was among the most challenging of my residency, but moments like those made it bearable.

Physicians are most at risk for burnout if they feel like they are the only one experiencing it. How can physicians spend more time building relationships with their patients, supporting each other, engaging each other in their work and sharing their successes and venting frustrations that might otherwise be internalized?

Deliberate action from administrators, politicians, health care providers and patient advocates at the institutional and national level are required to address burnout. A recent NEJM Catalyst survey shows that although 98 percent of health care executives perceive physician burnout to be a moderate or serious problem, many are quoted as saying that their organizations are not doing much to address it. One bluntly describes it as “lip service.”

The four biggest perceived causes of burnout in this survey were increased documentation, increased work productivity expectations, payment/reimbursement and the “erosion of professionalism.” If stakeholders in health care want to make a real commitment to improving physicians’ work and reducing burnout, then they should focus on:

  • Reducing the burden of documentation in EHRs and increasing cross-system accessibility
  • Recruiting physicians of diverse backgrounds to institutional leadership
  • Enforcing anti-discrimination policies and taking reports of sexual harassment seriously
  • Making medicine family-friendly by supporting maternity/parental leave and subsidizing child care
  • Reducing the costs of board certification and test-taking burden
  • Improving health care team safety through violence prevention programs

There are definitely more action points that could be listed. We don’t have to agree on all or any of these. The conversations about these goals should take place in individual institutions as well as the national level and would ideally include physicians at all levels of training.

Being mindful of burnout is not the answer. Taking action to more clearly define it, having honest conversations about personal versions of burnout, and setting tangible goals to strengthen a sense of community and sustainable work environments will allow us to extinguish burnout for good.

ADVERTISEMENT

Joy Liu is an internal medicine resident who blogs at the Friendly Intern.

Image credit: Shutterstock.com

Prev

What you need to hear at your medical school graduation

June 5, 2018 Kevin 2
…
Next

The questionable ethics of ultrasound in pregnancy

June 6, 2018 Kevin 0
…

Tagged as: Cardiology, Hospital-Based Medicine

Post navigation

< Previous Post
What you need to hear at your medical school graduation
Next Post >
The questionable ethics of ultrasound in pregnancy

ADVERTISEMENT

Related Posts

  • Chasing numbers contributes to physician burnout

    DrizzleMD
  • Physician burnout is as much a legal problem as it is a medical one

    Sharona Hoffman, JD
  • Despite physician burnout, medical schools are still hard to get into. Why is that?

    Suneel Dhand, MD
  • A medical student’s reflection on burnout

    Sarah B. El Iskandarani
  • Burnout doesn’t start in medical school

    Anna Goshua
  • Why are we failing to solve burnout?

    Baird Brightman, PhD

More in Physician

  • Why Canada is losing its skilled immigrant doctors

    Olumuyiwa Bamgbade, MD
  • Why doctors are reclaiming control from burnout culture

    Maureen Gibbons, MD
  • Why screening for diseases you might have can backfire

    Andy Lazris, MD and Alan Roth, DO
  • Why “do no harm” might be harming modern medicine

    Sabooh S. Mubbashar, MD
  • International doctors blocked by visa delays as U.S. faces physician shortage

    Arthur Lazarus, MD, MBA
  • How I redesigned my life as a physician without abandoning medicine

    Ben Reinking, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 18 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Mindfulness is not the answer for burnout
18 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...