DR RAJ PERSAUD IS A CONSULTANT PSYCHIATRIST WORKING IN THE UK NHS AS WELL AS PRIVATE PRACTICE AND SEES IN HIS PRIVATE PRACTICE POSSIBLY MORE PHYSICIANS THAN ANY OTHER PSYCHIATRIST IN THE UK. HERE HE WRITES A SHORT SYNOPSIS BASED ON HIS CLINICAL EXPERIENCE ON PART OF THE SECRET OF HOW TO BE HAPPY AND FULFILLED MEDIC.
HOW TO BE A HAPPY DOCTOR
Raj Persaud FRCPsych Consultant Psychiatrist 117a Harley St London W1G 6AT
If you are a doctor reading this, take a guess at how many of your medical colleagues are quietly suffering from burnout? Got the figure in mind?
It might help to remind ourselves of the technical definition of burnout; an occupational stress syndrome characterized by declining enthusiasm for the job because of emotional exhaustion, depersonalizing your patients so they now appear to largely get in the way of the job, combined with deriving no sense of accomplishment from work.
An intriguing recent paper in the Journal of the American Medical Association (see references below), and accompanying editorial, quotes global studies indicating that approximately 1 in every 3 doctors is experiencing burnout at any given time. The study itself reports data that the figure could be as high as 2 in 3.
While Whitehall Mandarins as well as our own beloved GMC and BMA don’t appear at present overmuch bothered by doctors being destroyed by their work, perhaps the fact burnout leads to much poorer care for patients should jolt everyone awake to the fact this is a problem with repercussions way beyond the boundaries of the profession. Hospital Managers may want to take note that the accompanying Editorial quotes a study where a stress reduction program for hospital employees generated a 70% reduction in malpractice claims over the ensuing year, compared to a 3% drop at control institutions.
This study, conducted by doctors from across various specialties at the University of Rochester Medical Centre in New York, proposed a novel approach to addressing burnout. They argued that for doctors much occupational stress is really about a loss of meaning and lack of control in clinical practice. The antidote they suggest is to develop greater mindfulness—which they describe as the quality of being ‘fully present and attentive in the moment’ while doing the job.
Research not mentioned in these papers but from the area of positive psychology has found that the two key predictors of job satisfaction are having enough variety as well as autonomy at work. In my private practice as a psychiatrist I see many doctors and it has become clear to me that we can always improve how we look after ourselves and each other. What does it say about a caring profession which doesn’t actually care overmuch for colleagues? But the first hurdle for us might be appreciating that becoming more aware of our flaws and vulnerabilities makes us in the end much better doctors, compared to remaining heroically and resolutely blind to them.
Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians
Michael S. Krasner et al JAMA. 2009;302(12):1284-1293.
Enhancing Meaning in Work: A Prescription for Preventing Physician Burnout and Promoting Patient-Centered Care
Tait D. Shanafelt JAMA. 2009;302(12):1338-1340.