Read on Twitter
1/ Welcome to another edition of West’s #Wellbeing Wednesday! This week, #burnout with quotes from The Princess Bride. #wellbeingwednesday #medtwitter
2/ I’ll walk through selected topics within #burnout and #wellbeing, with links to related scenes or quotes from The Princess Bride. (possible fans: @drjessigold @RanaAwdish @arghavan_salles @Future_Docs @colleenmfarrell @gabrieldane)
3/ Fair warning – this is a T.O.U.S (Thread Of Unusual Size)!
4/ First up, let’s review #burnout definitions. How this term is used really does matter! I linked to a thread on this last week: https://twitter.com/ColinWestMDPhD/status/1291020224339357703?s=20
5/ So what is #burnout? From @CMaslach, “Burnout is a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job. …” (cont’d)
6/ “… The three key dimensions of this response are an overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911781/
7/ These 3 dimensions can be expanded, but essentially they are work-related:
Emotional exhaustion
Depersonalization
Sense of low personal accomplishment
Emotional exhaustion Depersonalization Sense of low personal accomplishment
8/ Understanding this is crucial, because the term “burnout” has been tossed around quite loosely. There is overlap between #burnout and other experiences such as depression and moral injury, but they are not the same thing.
https://twitter.com/ColinWestMDPhD/status/1318970460990853120?s=20
https://twitter.com/ColinWestMDPhD/status/1318970460990853120?s=20
9/ These terms share common drivers (though not entirely), so they are related. One may certainly contribute to the other, and I can absolutely see how moral injury would contribute to burnout, for example.
10/ But, as one illustration, suggesting that “burnout” is uniformly mislabeled and is really moral injury?
11/ This sort of definitional laxity from well-intentioned authors leads to additional confusion around all of these important terms, serving none of them well.
12/ While I’m making friends, here’s another point: the term “burnout” in no way blames the individual. It is an occupational phenomenon. This has been clear from the beginning of @CMaslach @workengagement research. https://twitter.com/ColinWestMDPhD/status/1175855918950572033?s=20
13/ All right, moving on. If burnout is an occupational phenomenon, what about the old-fashioned go-to points about medicine being hard, and we knew what we were getting into, and what did any of us expect, etc.?
14/ Is it acceptable that each year of arduous training and practice can feel like …
15/ I mean, doctors are privileged and better equipped to cope with stressors than other workers, right?
16/ Some of this is true – the rigors of training demand growth, and we know from Chantal Brazeau @Rutgers_NJMS @dyrbye and colleagues that medical students begin training with better wellbeing than peer college graduates. @AcadMedJournal https://pubmed.ncbi.nlm.nih.gov/25250752/
17/ We also know that physicians have greater resilience than the employed general population. Resilience is important, but physicians overall do not have a deficit in resilience.
https://twitter.com/ColinWestMDPhD/status/1278796456468647936?s=20
https://twitter.com/ColinWestMDPhD/status/1278796456468647936?s=20
18/ Despite these advantages, physicians experience higher burnout rates than the general public, even those in other demanding professions. @theNAMedicine @theNASEM https://www.nap.edu/catalog/25521/taking-action-against-clinician-burnout-a-systems-approach-to-professional
19/ In addition, physicians’ self-awareness of our well-being levels relative to our peers is poor! https://twitter.com/ColinWestMDPhD/status/1303690033053003778?s=20
20/ Thinking we are doing better than we actually are may seem like a coping strategy (the power of positive thinking!), but in reality …
21/
22/ There is a better way, though, if we shift our focus in #wellbeing to optimizing performance! Check out the thread for more on this, including how the Yerkes-Dodson Law is involved. https://twitter.com/ColinWestMDPhD/status/1306253272425037824?s=20
23/ As I wrote then, we need to shift focus from myopically fixing impaired individuals, workplaces, and systems to broadly optimizing performance across each of these levels. All aspects of our individual and organizational environments should be scrutinized through this lens.
24/ The case for change has been made clearly. The aforementioned @the NASEM report covers this in depth, and the @JAMA_current Charter on Physician Well-Being provides a path forward. http://ja.ma/2pMqDfE
25/ More on the Charter here: https://twitter.com/ColinWestMDPhD/status/1296088577479237632?s=20
27/ To be a part of the Charter movement, linked
@AmerMedicalAssn
: https://ama-assn.org/amaone/charter-physician-well-being……. Has your organization or society signed on? You can do so today, and every voice matters!
@AmerMedicalAssn
: https://ama-assn.org/amaone/charter-physician-well-being……. Has your organization or society signed on? You can do so today, and every voice matters!
28/ There are so many key advocates in this area, and #COVID19 has only made the need for these efforts more apparent. I can’t name everyone, but my closest collaborators have included @dyrbye @ChristineSinsky @LarissaThomasMD @StanfordWellMD. QT/link others to spread the word!
29/ We need system improvements to benefit not just ourselves and our colleagues, but our patients and our communities. The clamor for change is steadily growing, and I believe we are on the cusp of a better future in medicine.
30/ In closing, we have an obligation to make things better. To paraphrase the amazing @TheAmandaGorman:
“Being a physician is more than a pride we inherit,
it’s the past we step into
and how we repair it.”
“Being a physician is more than a pride we inherit,
it’s the past we step into
and how we repair it.”
31/
32/ Again, the @theNASEM @theNAMedicine report is a great resource https://www.nap.edu/catalog/25521/taking-action-against-clinician-burnout-a-systems-approach-to-professional
33/ That’s all for this week! I’ll return next Wednesday with another edition highlighting papers, topics, questions, etc. related to healthcare professional #wellbeing. /fin
