Physicians' burnout: some necessary considerations

According to Dr. Robert Pearl, Burnout among doctors is not only caused by the crisis in the national health system, but by a conflict between medical culture and scientific progress.

Burnout among physicians is not only the cause of the crisis in the health system

According to a recent Harvard report, medical burnout is "a public health crisis that requires urgent action.'' Experts predict that, without a solution, burnout will further erode the mental health of physicians and radically undermine patient care. According to Dr. Robert Pearl, Burnout among physicians is not only caused by the crisis in the national health system, but by a conflict between medical culture and scientific progress.

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In conferences and on social media, physicians often discuss the subject of burnout. However, despite the sense of urgency and an abundance of opinion, the problem is still poorly understood and poorly defined. If there is one thing on which physicians agree, however, is its cause. Burnout, they say, is the result of crises in health systems. In fact, physicians always report the same problems that prevent them from working in peace: too many bureaucratic tasks, too much government interference, low salaries, too many work hours and too much time spent in front of the computer.

Without a doubt, health system issues are the main factors contributing to the physicians' dissatisfaction. But, according to Dr. Pearl, these are not the only factors that cause or exacerbate burnout. According to Dr. Pearl, burnout is also caused by an increasingly intense clash between the progress of medical science and stubbornness inherent in medical culture.

In the past, it was assumed that all physicians were extensively skilled. This idea began to change in the early 2000s when electronic medical records were adopted. Since then, health managers have been able to collect and analyze a large amount of data with the help of increasingly powerful computers. Not only clinical data but also data related to care management. These data revealed an uncomfortable truth: not all physicians work well. In fact, if there are physicians who are reducing patient mortality from stroke, heart disease, and cancer by 30% to 50%, there are physicians who are not doing so at all. And sometimes they work in the same department.

To highlight these fluctuations, the comparative performance monitoring (CPM), a system of analysis of the work of individual health professionals, was created. Physicians, therefore, began to receive regular input on their performance. 

Among physicians, these relationships have become a source of frustration, anxiety and dissatisfaction, all symptoms associated with burnout. As clinicians and scientists, physicians fundamentally understand that evidence-based data and feedback can improve the health and longevity of patients. However, CPM reports, which contain precisely evidence-based data and recommendations, generate unhappiness and resentment. First, because, according to many physicians, they dry up the profession. In fact, thanks to advances in science, physicians today have evidence-based approaches based on computer algorithms that produce superior clinical results and save patients' lives. However, medical culture has always appreciated the autonomy, personal experience, and creativity of the physician. On the contrary, achieving the best comparative performance scores is a matter of following a series of defined steps. Constantly following these guidelines seems robotic and humiliating for physicians.

A second problem is how physicians receive and perceive comparative performance data. On reports, each physician is ranked with a score. For many physicians, brilliant students at university, perhaps being in the middle of this ranking, considered simple performers of medium quality, can have a strong discouraging effect. According to Dr. Pearl, comparative reports (monthly or quarterly) do not induce physicians to improve for the sake of their patients. Rather, they cause them to compete with others in their specialty, thus encouraging physicians to see their colleagues as threats.

Some say we should stop measuring physicians' performance. According to Dr. Pearl, however, we need to stimulate collaborative performance. Instead of pitting physicians against each other, they should be encouraged to work together to improve everyone's performance. The time has come, Pearl writes, to redefine the approach of medicine regarding performance metrics.

We start by recognizing the difficult reality that half the physicians don't reach good enough standards. This makes many physicians feel ashamed and disappointed, but it could also be a stimulus for improvement. Almost all physicians have a professional aspect in which they are very good, while in others they fail to meet expectations. Health managers can use the data to identify the strengths of each physician. They can, therefore, encourage those with more skills to help others improve.

Health managers have the opportunity to embrace a "growth mentality" and, as a result, to strengthen collaboration against competition mindsets. By emphasizing the enormous impact these parameters have on patient health, while also facilitating overall group improvements, health managers can bring physicians back to the fundamental mission of medicine.

When culture collides with science, the only way to protect patients is to change the culture. Physicians have the opportunity to radically change the culture of medicine. By using performance measurements as an educational tool and working together to strengthen collective performance, today's physicians can improve patient health, increase clinical team spirit and decrease burnout symptoms.

Pearl R. The Unspoken Causes Of Physician Burnout. Forbes. Jul 8, 2019