by Alexandra Brown.
Burnout is a popular discussion topic in healthcare today and has been part of the conversation for over a decade. Although applicable to all industries, Dr. Audrey Lyndon defined burnout within the context of healthcare as such:
“The emotionally exhausted clinician is overwhelmed by work to the point of feeling fatigued, unable to face the demands of the job, and unable to engage with others. The burned out clinician may develop a sense of cynical detachment from work and view people—especially patients—as objects.”
– Dr. Audrey Lyndon (Lyndon 2016)
Burnout Causes Deterioration of Physician-Patient Relationship
It is evident that burnout not only affects providers but also has a significant impact on patients by affecting both their interaction with the provider and the quality of care they receive. Dr. Lyndon further clarifies that providers suffering from burnout “are more likely to subjectively rate patient safety lower in their organizations and to admit to having made mistakes or delivered substandard care at work” (Lyndon 2016). Providers may subconsciously reduce patients to “objects” to protect themselves from further emotional exhaustion, depersonalizing the physician-patient relationship, and ultimately resulting in a provider “[curtailing] performance to focus on only the most necessary and pressing tasks” (Lyndon 2016). As such, unintentional errors may result, decreasing the quality of patient care.
Physician Decision-Making is Impaired
With regard to decision-making itself, Lyndon states that clinicians suffering from burnout “may also have impaired attention, memory, and executive function that decrease their recall and attention to detail. Diminished vigilance, cognitive function, and increased safety lapses place clinicians and patients at higher risk for errors.” This presents a huge concern with the emotional burnout affecting a physician’s clinical judgment and affecting the quality of care. Ultimately, burnout prevents a clinician from performing his or her responsibilities properly to care for patients effectively.
Burnout is Correlated with Increased Risk of Racial Bias
Quite possibly more distressing than the link to decision impairment, a recent article in JAMA correlated burnout in a cohort study of resident physicians with increasing rates of both explicit and implicit racial biases (Dyrbye et al, 2019). As such, burnout and the resultant racial biases may cause physicians to become less invested in their patients and clinical outcomes, perpetuating and exacerbating racial disparities in healthcare, ultimately decreasing the quality of care that patients receive. It’s apparent in current literature that burnout is affecting every aspect of patient care, none of which bodes well for the patient.
How Can We Combat the Symptoms of Burnout?
There have been some promising studies investigating potential remedies for burnout, including a 2015 Health Work Place (HWP) study investigating the effect of improving work conditions on physician satisfaction. The study concluded that workflow interventions and targeted quality improvement initiatives based on physician concerns may help alleviate burnout symptoms (Linzer 2015).
In a recent study with data from 2011, 2014, and 2017, the authors suggest the rate of burnout has decreased since 2014 due to improvements in work-life integration (Shanafelt, Hasan, Dyrbye et al. 2017). The authors recognize that the prevalence of burnout is still high; skewed with higher rates in healthcare as compared to the general US working population. However, the authors are optimistic that if given the necessary focus, these rates can and will improve. This should give us hope, as it is possible to reduce rates of burnout in physicians with specific initiatives geared at improving job satisfaction.
One Thing is for Certain:
Until conditions are improved for healthcare providers, burnout will continue to be at the forefront of discussions as we seek to improve the lives of physicians to ensure that patients receive the highest quality of care possible.
by Alexandra Brown
School: Temple University School of Podiatric Medicine
- Lyndon, A. Burnout among health professionals and its effect on patient safety: Annual perspective 2015. Agency Healthc Res Qual. 2016;(February):1-8.
- Dyrbye, LN; Massie, FS; Eacker, A; et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA – J Am Med Assoc. 2010;304(11):1173-1180. doi:10.1001/jama.2010.1318
- Linzer, M; Poplau, S; Grossman, E; et al. A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study. J Gen Intern Med. 2015;30(8):1105-1111. doi:10.1007/s11606-015-3235-4
- Shanafelt, TD; West, CP; Sinsky, C; et al. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017. Mayo Clin Proc. 2019. doi:10.1016/j.mayocp.2018.10.023
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