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Tuesday Jul 12, 2016

Try PROBE Tool to Help Stave Off Burnout

When a friend of a friend of mine committed suicide recently, it hit me harder than I would have imagined. I didn't know the man and knew little about him other than that he was an emergency medicine resident and a member of the gay, lesbian, bisexual and transgender community.

When I learned of his tragic passing, I went back and read something he had posted on social media a couple of years ago that stood out as particularly poignant: He wished he could be more proud to be a gay physician and support others who struggle with self-doubt.

Roughly twice as many physicians experience emotional exhaustion as do adults in the general working population.

The pressures of our profession can be stifling, especially for folks who are hesitant to be open about who they really are. Although each of us faces our own set of circumstances and personal needs, the rate of emotional exhaustion among physicians is about twice that of the general working population. Some theorize that too much empathy can induce compassion fatigue, leading to irritability and uncompassionate treatment of those closest to us. Unfortunately, the consequences of burnout are steep. We lose a doctor a day to suicide. But with proper tools and vigilance, we can help foster wellness and prevent medical student and resident burnout, depression and suicide.

Simultaneously, we can't ignore the many systemic failures that contribute to burnout, including disrespectful behavior that erodes empathy, curricula that don't emphasize social responsibility and engagement, and the unwieldy demands of electronic and paper nuisances.

As our vernacular shifts from a mutually exclusive "work-life balance" to a more holistic "work-life harmony," future physicians can find ways to mediate and integrate multiple commitments while bolstering our resolve. One of the paradigms I came up with recently is the acronym PROBE, which stands for Prioritization, Reflection, Organization, Burnout prevention/mitigation and Expectations. The elements of PROBE may help physicians recognize mild to moderate burnout and do better for themselves, their colleagues, and their patients by exploring some of the suggested tools. However, I would implore anyone who is experiencing severe burnout to set aside any perception of the condition as "a weakness" and to promptly seek the help of other professionals.

  • Prioritization -- Pamela Vaccaro, M.A., outlined the idea of the 80/20 rule, which states that 20 percent of your efforts provide 80 percent of the results, in a 2000 Family Practice Management article. She recommended engaging in activities that advance your overall purpose in life. I would suggest this includes developing a shared vision of the future with those closest to you.
  • Reflection -- Simply by checking in, you can bring awareness to a difficult moment. Apps such as Headspace may help with increasing the regularity of this process, and the MySelfCare.org quiz might help you gauge compassion fatigue. My fellow AAFP Board member Lynne Lillie, M.D., wrote an excellent post on mindfulness meditation a few weeks ago. Progress can be made by monitoring and measuring what you're doing. Debriefing with fellow residents, a partner and/or faculty are great ways to decompress after tough situations. My residency holds monthly sessions (based on Balint group structure) during which residents share patient stories and tips for dealing with stressful situations. Surgical residents at Stanford University developed a comprehensive Balance in Life program that includes faculty mentors, healthy food, stress management and social events.
  • Organization -- One's (digital) house is a reflection of one's inner mind, so working to relieve a cluttered inbox, keeping a repository of readings (e.g, on Google Drive, Dropbox, or using the free AAFP app for podcasts and FP Essentials issues), and learning time-saving tricks to use in your electronic health record system can all help you to be more efficient in your day-to-day tasks. This, in turn, may have the egosyntonic effect of giving you more time to enjoy the pleasures in your life.
  • Burnout prevention and mitigation -- The Resident Doctors of Canada recently released a Mental Health Continuum pocket card for personal burnout awareness and mitigation that details a spectrum -- healthy > reacting > injured > ill -- with each category listing actions to take and coping skills (e.g., visualization, goal setting, positive self-talk, tactical breathing) to use. The AMA's STEPS Forward collection has an online module highlighting six key aspects for resident wellbeing and the AAFP maintains a list of burnout resources. Finding what works for you in the moment is crucial to avoiding pent-up frustrations that can inevitably release in very unhealthy ways.
  • Expectations -- These can be set unreasonably high, leading to unattainable goals. Talking with those with experience in this area may help in setting reasonable expectations, and you may uncover some wise advice for how to avoid pitfalls. It's also important to guide expectations of family members and friends so you don't disappoint them. Whether it's a new job, a new rotation or a new project, setting your own goals can help you come away with a sense of self-growth.

Hopefully, this acronym will help you PROBE the issue of wellness in a systematic way and lead you to contentment in this healing profession. We have a long way to go to prevent the devastation of burnout in our profession; let's work together and take care of our own.

Richard Bruno, M.D., M.P.H., is the resident member of the AAFP Board of Directors.

Comments:

Great thoughts Richard! These are essential to better physician health, though I fear that most of what we focus on in burnout is teaching physicians to deal with a terrible system instead of fixing it. If that's even possible, it will take so long that we will lose thousands more physicians to suicide and other careers in the meantime.

Posted by Kyle Jones on July 13, 2016 at 05:24 PM CDT #

You raise great points about what individuals can do to decrease the risk of burnout, and your article is a good starting point. What we need now are solutions to a system which expects the quality of 30 minute to 1 hour appointments but only wants to pay for 10-15.

Posted by Natalie Marino on July 14, 2016 at 11:20 AM CDT #

Thank you for writing about physician burnout recognition. In addition to recognizing it, we need to provide a "toolkit" of resources for preventing and treating burnout. I highly recommend the " Heart of the Healer" workshop and retreat held in Seattle. The next course is 9/11-9/14/16 and information can be found on theHappyMD website. There are other resources available, as well but unless we all put into practice the preventative medicine we are so good at, it will take too long to change the system that breeds the risks of burnout to begin with. I am proud that our Academy is out in front helping to recognize and treat this serious threat to our health

Posted by Douglas Spotts MD < FAAFP on July 15, 2016 at 10:29 AM CDT #

"PROBE" will not help those of us that: do 2-3 hours of extra documentation a day, loose precious time with our friends and family, Fill out Health assessments that make money for the INS company that is non-reimbursable (they do not improve quality care), hear the disrespect in the voices of our patients we serve propagated by the Insurance and Hospital industry. Told by CMS that if you do this you will be sanctioned, If you do that you will be investigated by the "RACK" and the OIG. Physicians are made out to be criminals via the Sunshine act, yet politicians take billions from lobbyists to destroy our country. The real fraud is Big Pharma and Hospitals that are raiding the coffers of Medicare and leaving future generations without. And you wonder why physicians are burning out? So you offer a pneumonic?

AAFP get a clue! Unless AAFP= Big Pharma = Big Hospitals = CMS.

The AAFP has failed to stand up for the solo and small group physicians (Bulk of the physician work force) and has helped to put a big computer system between the patient and the physician. The AAFP has helped to destroy the sacred Doctor-Patient relationship. Knowingly or unkowingly, I do not know?

Posted by Dr Sanchez on July 16, 2016 at 07:09 PM CDT #

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