The current medical crisis is an unexpected global challenge. We have been forcibly evicted from comfortable routines. A novel virus, SARS-CoV-2, confounds established approaches. Confusion, anxiety and uncertainty abound. More than an intensive care phenomenon, this disaster is a crisis — public health and humanitarian. Pandemic solutions require the entire population to engage. Clinicians and physicians must assume a broad leadership that includes self-care with the care of others. This perspective embraces COVID-19 patients without forgetting those having other medical needs. Wellness thus scales upward and becomes inclusive. Physician wellness is rooted in personal accountability (e.g., autonomy, humanely practicing in competent ways, and social-emotional relatedness to the healthcare organization and its demands) and renewing physician engagement.
Burnout is an experience of emotional exhaustion, depersonalization, and feelings of low achievement and decreased effectiveness. Although the focus of this blog is physicians, burnout is also a serious problem for nurses and other health care workers. National studies indicate that burnout is more common in physicians than U.S. workers in other fields and that the gap between physician burnout and other workers’ experience is increasing. This difference is not because of physician shortcomings. The physician selection process is rigorous and eliminates those unable or unwilling to accept this lifestyle. Most physicians are altruistic and committed to their profession. They are taught to address complex problems and to embrace challenges, including grueling training, ongoing night call, and long work hours.
The spike in reported burnout is directly attributable to loss of control over work, increased performance measurement (quality, cost, patient experience), the increasing complexity of medical care, the implementation of electronic health records (EHRs), and profound inefficiencies in the practice environment, all of which have altered work flows and patient interactions. The result is that many previously well-adjusted and renewing physician engagement have been stressed to the point of burnout, prompting them to retire early, reduce the time they devote to clinical work, or leave the profession altogether.
For clinicians, the burnout syndrome has been a developing phenomenon marked by demoralization and ultimately self-sabotaging trajectories. Exhaustion, depersonalization, and feelings of professional inadequacy make up its hallmarks. What had been prevalent as indolent distress now is exacerbated by real-life, overwhelming challenges now and coming. Depression and PTSD from COVID-19, distinct from burnout, can superimpose themselves and further impair one’s functioning.
The burnout syndrome shows itself with exhaustion as physical fatigue and emotional depletion. A lack of enthusiasm makes a recovery difficult. Depersonalization takes over when overwhelming stress leads to physical and emotional withdrawal. Cynicism about the sincerity of others and one’s competence organize into numbing attitudes. Feeling this avalanching depletion and inability to recover numbs reason and clear thinking. Doctors now seriously doubt their skill, competence, and effectiveness. Mindfulness counters burnout.
Mindfulness is a concept, practice and mindset. To some, it is merely relaxed meditation; to others, it is a focused concentration. As the ancient Greek philosopher Heraclitus said of opposite tensions: the truth is simple-difficult. Putting the enormity and complexity of mindfulness in a few words might read: present moment awareness, even amid ambiguous uncertainty.
