Tackling Physician Burnout Requires Unprecedented Leadership
By Robert D. Morton, CPHRM, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management, The Doctors Company
Recent actions by the World Health Organization seem to further legitimize what many physicians are experiencing: a chronically stressful healthcare system that makes connecting with patients and providing quality care more challenging.
The term “burnout” has been questioned as a labeling error—and rightfully so. What many healthcare professionals on the frontlines are experiencing is a normal response (symptoms) to an abnormal situation (cause), like sick fish in a tank of toxic water. A diagnosis of burnout suggests that the solution is to medicate the fish. A more holistic view is to say, “There’s really nothing wrong with you; let’s clean the tank.”
The World Health Organization (WHO) announced plans to label “burn-out” as an occupational phenomenon in the International Classification of Diseases (ICD-11). The syndrome, which results from chronic workplace stress, is characterized by feelings of exhaustion, increased mental distancing from one’s work or cynicism about work, and reduced professional efficacy. The WHO’s actions seem to further legitimize what many are experiencing: a chronically stressful healthcare system that makes connecting with patients and providing quality care more challenging and contributes to burnout, healthcare professional distress, or to what some have even labeled moral injury or human rights violations.
Drs. Simon Talbot and Wendy Dean, who co-founded the nonprofit organization MoralInjury.healthcare, borrowed the expression “moral injury” from Jonathan Shay, MD, PhD, a clinical psychiatrist who coined the phrase. Briefly, it is (1) a betrayal of what’s right, (2) by someone who holds authority, (3) in a high-stakes situation. Discussions of moral injury include the view that repeated daily betrayals by authorities within the system are manifest. These types of betrayals run counter to patients’ best interests—which pains doctors, whose unifying creed is that patients come first.
While other physician thought leaders like Dr. Dike Drummond (thehappymd.com), Dr. Paul DeChant (author, Preventing Physician Burnout), Dr. Zubin Damania (aka ZDoggMD), and Dr. Pamela Wible (idealmedicalcare.org) may differ on the terminology, each makes a similar call for leadership and action equal to the severity and scope of the dilemma. They all call for partnering with enlightened leaders to change the systemic and institutional patterns that inflict betrayals on the practice of good medicine.
Dr. Howard Marcus, an internist in Austin, Texas, responded, “Most of us do not see our administrators as oppressors but, rather, as stuck along with the rest of us in a system that has piled on time-consuming burdens—which saps us of the time and energy required to do the best we can for our patients in the time available.”
EHR rescue and optimization work is becoming more common to regain lost relationships with patients. Executive leaders who are desperate for help often contact firms like Medical Advantage Group (MAG), a subsidiary of The Doctors Company. MAG conducts system database audits, followed by workflow analysis, previsit planning, and redesign of work screens to make the EHR function better as a convenient, accessible clinical source of truth. Ironically, this improvement in EHR accessibility and usability makes the EHR function more like old paper charts when everything was at hand.
Like any meaningful change, improvements require leadership with a growth mindset that demonstrates a deep respect for people and for the nature of their work. This means exhibiting leadership behaviors such as deference to expertise and sensitivity to clinical operations—two characteristics of the continuous improvement mindset on the journey toward high reliability. Effective leaders meet physicians where they live—on the frontlines of care—and seek to understand what is getting in the way of connecting with patients and providing quality care. The best leaders then work tirelessly to remove the barriers.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
Reposted with permission. ©2019 The Doctors Company (www.thedoctors.com).
 Burn-out an “occupational phenomenon”: International Classification of Diseases. World Health Organization. https://www.who.int/mental_health/evidence/burn-out/en/. May 28, 2019. Accessed June 12, 2019.
 Swenson S. Esprit de corps: turning vicious cycle virtuous. Talk presented at: NEJM Catalyst event Essentials of High-Performing Organizations; July 25, 2018; Institute for Healthcare Policy and Innovation, University of Michigan. https://catalyst.nejm.org/videos/esprit-de-corps-vicious-virtuous-cycle/. Accessed March 4, 2019.
 Talbot SG, Dean W. Physicians aren’t ‘burning out.’ They’re suffering from moral injury. Stat website. https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/. Published July 26, 2018. Accessed April 30, 2019.
 Wible P. Not “burnout,” not moral injury—human rights violations. https://www.idealmedicalcare.org/not-burnout-not-moral-injury-human-rights-violations/. Posted March 18, 2019. Accessed May 10, 2019.
 Shay J. Moral injury. Psychoanal Psychol. 2014;31(2):182–191. https://www.law.upenn.edu/live/files/4602-moralinjuryshayexcerptpdf.