Let’s imagine a screening test that can detect cancer X and stage it.
Now, let’s suppose that we run this test on every living being in community Y. In this story, we discover that 50 %–one out of every two people–has cancer X. Cancer X has dire effects on people’s health, and can be fatal. To make things more dramatic, let’s assume that all of the afflicted people are at stage IIIb or IV.
With half of the people in community Y having cancer X (Stage IIIb or IV): What do you do?
Now, imagine that this scenario is true. Well, you do not have to imagine. It is! If we remove the hypothetical names and replace them with real ones, Cancer X becomes burnout. Community Y becomes the medical community. 50 % of physicians have burnout (Advanced stage).
Now, what do you do?
There is an overwhelming body of literature that discusses not only the phenomenon of physician burnout, but its consequences on their health and effects on patients and healthcare. The past few years have seen a tremendous increase in discussions of this problem that is slowly taking center stage. Burnout is defined as feelings of lack of personal development, becoming cynical, and gradual erosion of enthusiasm for work.
The effects of burnout on a personal and professional level can best be summarized in this table published in an article in the Archive of surgery in 2009 by Balch et al.
Burnout is an indolent process, and I liken it to a malignancy that starts early and continues throughout the life of the medical student, resident, and practicing physician. Knowing what we know about the risk factors and the contributors of burnout, the better visualization/definition of burnout is that at any given time, burnout is a contagious malignant existence that sways between minimal to extreme, pushed by personal, professional, emotional, psychosocial and environmental factors. It has extreme morbidity and mortality consequences on physician and patient alike.
At the DNA/Genotype level, burnout is a disease of emotions. At the Phenotype level, it manifests physically, emotionally, mentally and psychosocially:
The malignant transformation occurs because of the following:
According to Moreno-Jimenez et al in 2012, the best possible model for burnout along with the best targets for intervention are the following:
Risk Factors: The very nature of the physician’s profession places him or her at risk for burnout.
Documented risk factors include:
- Hours worked
- Too many bureaucratic tasks
- Impact of the Affordable Care Act
- Stress during medical school
- Lack of control over time management
- Work organization and planning
- Interpersonal relationships
- Low decision authority, supervisor support, and peer support
- Dissatisfaction with doctor-patient relationship
- Inability to balance work and personal life
- Electronic records
- Documenting among others
These reasons, along with the following standards combine to place the physician, no matter the stage of practice, at the highest risk of burnout among all professions.
- Work hard and long hours
- Deal regularly with life-and-death situations with their patients
- Make substantial personal sacrifices to practice in their field
- Share an unwritten but understood code of rules, norms, and expectations, including coming in early and staying late, working nights and weekends, meeting multiple simultaneous deadlines, never complaining, and more importantly, keeping emotions or personal problems from interfering with work
Burnout is a malignancy of emotions. A reasonable approach would be to better understand our emotions and know how to protect them and manage them. An emotionally intelligent approach sounds like a very viable option as definitive therapy. And it is! By raising awareness of our own emotional intelligence, we make sure we are better protected with different treatment options against burnout.
Emotional Intelligence (EI) refers to a set of abilities that are inherent, measurable, and perhaps most important of all, modifiable. These abilities help us perceive, understand, regulate and manage our emotions as well as those of others. They provide us with the necessary tools to become aware of ourselves and others so we can better manage ourselves and others. Review of the literature shows a marked increase in the interest to study and possibly apply the concept of EI in the field of medicine.
There are 15 realms of emotional intelligence, as illustrated in the diagram below:
From 2010 until 2014, there had been an explosion of reviews and studies looking at EI in the field of medicine, and at physician burnout in particular. There seems to be a more focused approach to linking the concepts of EI and their relevance on burnout. Research on physicians and EQ/EI shows them to have lower than average scores and higher than average IQ scores. In general, physicians are highly technical in their respective areas but seem to lack communication skills, empathy, and the intercommunication skills that are needed to provide exceptional patient-centered medical practice.
Review of literature shows that EI is paramount to providing health care professionals the necessary and much needed skills they require to help them be successful at managing the many roles they often need to play. Research also shows that these skills are often not taught. They often aren’t the focus of educational programs, and certainly not the focus of training forums or courses.
A study of 2800 physician “star performers” showed that 75% of a high achiever’s success is a function of emotional intelligence–only 25% of success reflects technical competency (Harvard & Rutgers, 2002). The results of this study have been duplicated. The wonderful things about EQ is unlike IQ, which is generally fixed at a certain age, EI competencies can be learned and EQ skills can be developed.
The practice of medicine, as well as the interaction of physicians with patients, health care organizations, new laws, and corporate medicine necessitate the development of a new skill that is dependent on physicians’ ability to collaborate care. The inability for collaboration will produce stress and further burnout among physicians. This new ability and the new demands are not taught in the medical schools or in graduate medical education. They are dependent on core competencies that are measured, studied and improved upon by EI.
Using coaching techniques that focus on improving self-awareness, self-care, self-compassion and boundary setting have led to behavioral changes among physician and improved patient care. Both MCAT and ACGME are advocating the incorporation of EI curricula for the development of physicians.
Our emotions are under assault because of our profession. We need to recognize that, understand it, and deal with it. The best approach that has worked in my experience has been what I label as the AAA approach:
Awareness, Acknowledgment and Action.
Screening for burnout is essential with several questionnaires available for that. By learning about ourselves and our emotions, understanding their strengths and weaknesses, and by knowing how to protect and treat, approaches using Emotional Intelligence techniques (which have been in practice for over 30 years) are an extremely viable and proven way to not only combat burnout, but prevent it.
Dr. Naim El-Aswad is American Board Certified in Internal Medicine. He has specialized in Internal Medicine and Emergency Medicine for over 15 years. He practices both disciplines in Houston Texas. Dr. El-Aswad has been involved in the care and wellness of patients, but has also been very active in teaching and training other healthcare workers including physicians, paramedical personnel and nurses. Dr. El-Aswad, along with his coaching partners, has created a program that utilizes emotional intelligence for physician burnout, leadership and management skills and wellness. Some of his clients include McGill University, Methodist Hospital systems in Houston, and the Sullivan Group.
Phone: (936) 662-9068