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

In the burnout epidemic, is mindfulness the new opioid?

Walter J. O’Donnell, MD, Wendy Dean, MD, and Simon G. Talbot, MD
Physician
November 1, 2020
Share
Tweet
Share

At a recent annual exam for one of us (Walter), the medical assistant had checked heart rate, blood pressure, temperature, and oxygen saturation. Inquiring cheerfully about the Fifth Vital Sign, she flashed the 10-point pain scale of emojis ranging from beaming to grimacing. The only mention-worthy pain was an occasionally aching meniscus from a forgettable high school football career.

It was refreshing that she didn’t ask about burnout. Everyone else was. Why not the PCP’s office? It was easy to imagine a frowny-face burnout score triggering the PCP to prescribe resiliency training – yoga, Soul Cycle™, and of course, mindfulness sessions.

Déja vu. This trendy to-do about burnout is a reprise of the war on pain a decade ago, in which clinicians were admonished to leave no ache or pain untreated. But that fundamental misunderstanding of pain and its profit-driven treatment created a disastrous opioid epidemic.

Nationally, the National Academy of Medicine (NAM)  has again weighed in, detailing the costs, patient-safety concerns, and workforce issues. Celebrity speakers offer their patented, packaged solutions. Some measures show burnout scores declining nationwide. Most clinicians have not experienced a drop in distress and suspect that any decrement in scores represents the most troubled individuals’ departure.

No one denies the widespread distress among clinicians, its link to a physician suicide rate exceeding even that of military personnel, and its adverse effects at the bedside. But having treated a presumptive diagnosis of burnout for a decade and failed, it is time to rethink the paradigm, to double-check the diagnosis before dispensing more therapy?

Recognizing that most clinicians reject the diagnostic label of burnout, Dean and Talbot have refocused the diagnosis away from an individual’s failure to withstand the rigors of a chosen career and reframed the situation as a systemic malady with personal consequences. Moral injury describes a dedicated professional’s predicament caught in an ever-larger, corporatized health care system, who is often asked to compromise that profession’s principles in daily work. Others have labeled these tensions as professional dissonance. Danielle Ofri indicts medicine itself – “It is a betrayal of trust, the trust we gave to our own profession….They are not burned out—they love patient care… they are heartbroken.”

With the diagnosis off-target, the therapy is misdirected. Mindfulness programs to remedy clinician burnout are proliferating like pain centers in the early 2000s. Mindfulness and resilience training, often the dual centerpieces of institutional burnout remediation programs,  borrow solutions from other industries but fail to recognize the uniqueness of health care—such as clinicians who are significantly more resilient than employees in other industries. In McMindfulness, Ronald Purser postulates that corporations, especially those in tech-intense industries, use mindfulness programs to improve worker performance while distracting them from “the structural problems in the workplace that are causing the epidemic of stress in the first place.”

We don’t tell patients with a torn meniscus to take Oxycontin to attain a smiley-face pain scale rating and ski to their heart’s content. Neither should we clinicians accept a prescription to boost one’s endorphins with mindfulness to get through a day full of repetitive trauma.

Wading with our patients through the dumpster dive that comprises our EHRs, our neuronal overload is an incessant reminder that our EHRs have earned a grade of “F” from national usability experts. Our families suffer from our workplace wounds, especially as the workload engulfs our nights and weekends.

At work or home, the tech-mediated trauma of each visit is compounded by moral injury, as the autonomy, mastery, respect, and fulfillment that define us as clinicians are subordinated to administrative and financial priorities encoded in the EHR and enforced by its 24/7 institutionally sanctioned cyberbullying.

At its height, the COVID-19 pandemic revived a sense of common purpose and teamwork among clinicians and administrators. However, as the tidal wave of cases receded and telemedicine remains ascendant, the wounds have reopened, unsolaced by personal contact.

The COVID crisis also demonstrated how non-profit health care has become nearly indistinguishable from the for-profit sector, with its relentless cost-cutting, staffing reductions and lavish executive pay, and aggressive bill collection practices towards its traditional core constituency, the poor.  Clinicians feel trapped and morally injured daily in a system that forces them to elevate corporate priorities over those of their patients. Unsurprisingly, the business solution to worker distress is the same in both sectors – the numbing nostrums of mindfulness programs.

Some leaders in health care quality and safety have acknowledged the need for deep diagnostics and systemic intervention, adding a Fourth Aim on which a health care system should be graded – “improving the work-life of those who deliver care.”  So, where to start? Cognizant of the tyranny of metrics that bedevil modern health care, we propose that clinicians and administrators rebuild their teamwork by wielding a mere three questions and one measure.

ADVERTISEMENT

First, the meaningful metric. How much time outside of office hours does the clinician spend on EHR work per week? This “work after work” has recently been highly correlated with burnout measures and readily measured from EHR vendor-programmed reports without custom reports or surveys. Institutional commitment to reducing that number as an executive metric is a start toward meaningful change.

And the mini-survey? Administrators should solicit regular feedback on work-life from their clinicians, and vice versa, based on the questions of Paul O’Neill, “Are you treated with respect by everyone that you meet every day? Do you have the tools and support to do your work? Does anyone notice, and thank you?” Such a bidirectional assessment echoes Uber, which iterated its rating system to foster respect between drivers and customers and to improve quality for both.

Bringing administrators and clinicians together to improve the results of these pithy measures would be an encouraging start in remedying the root causes of clinician distress. But we can only rehabilitate clinicians, patients, and administrators’ working environment if we first abstain from the narcotic allure of mindfulness prescriptions. Suffering clinicians and their patients deserve solutions, not smiley-face sedation.

Walter J. O’Donnell is a pulmonary physician. Wendy Dean is a psychiatrist.  Simon G. Talbot is a plastic surgeon. 

Image credit: Shutterstock.com

Prev

The confluence of coronavirus and chronic illness

November 1, 2020 Kevin 0
…
Next

Election anxiety? Here’s a guide to practicing medicine in Canada.

November 1, 2020 Kevin 1
…

Tagged as: Hospital-Based Medicine, Psychiatry

Post navigation

< Previous Post
The confluence of coronavirus and chronic illness
Next Post >
Election anxiety? Here’s a guide to practicing medicine in Canada.

ADVERTISEMENT

Related Posts

  • The other opioid epidemic that we ignore

    Hans Duvefelt, MD
  • Chasing numbers contributes to physician burnout

    DrizzleMD
  • Marijuana will not fix the opioid epidemic

    Kenneth Finn, MD
  • Market-based approaches solving the opioid epidemic

    Julie Craig, MD
  • How hospitals can help with the opioid epidemic

    Richard Bottner, PA-C and Christopher Moriates, MD
  • The pandemic’s epidemic: opioid use disorder and subpar suboxone access   

    Jonathan Staloff, MD and Claire Simon, MD

More in Physician

  • Why more doctors are choosing direct care over traditional health care

    Grace Torres-Hodges, DPM, MBA
  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [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

Leave a Comment

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

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [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

Leave a Comment

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

Loading Comments...