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The past decade has been a time of great change for US physicians. Many physicians feel that the care delivery system has become a barrier to providing high-quality care rather than facilitating it. Although physician distress and some of the contributing factors are now widely recognized, much of the distress physicians are experiencing is related...
Context in source publication
Context 1
... Mature cultures, such as the culture of medicine and the culture of most health care organizations, typically must unlearn some old habits and ways of thinking before new ones can be incorporated. Once we have defined the ideal future state, we can then evaluate how it differs from the present state and identify gaps and barriers that need to be addressed to make progress (Table 2). This comparison helps us define the old beliefs and habits we need to unlearn as well as the new things we need to learn, thereby allowing us to plan and manage the change. ...Citations
... Prior to the COVID-19 pandemic, there was a growing awareness that clinician burnout was not due to a lack of individual resilience, but rather the result of a health care delivery system and culture of medicine that was eroding clinicians' sense of purpose, meaning, and altruism. 5 The COVID-19 pandemic added moral injury to widespread clinician burnout by placing extreme and excessive demands on frontline clinicians. Emotional exhaustion has increased for all health care professionals since the onset of the pandemic. ...
... 1). The healthcare culture assumes the values of beneficence and non-maleficence and adheres to the Hippocratic Oath (Shanafelt et al., 2019). At the center of the Canadian healthcare system is the physician-patient relationship. ...
... Despite the beneficial qualities of compassion, the professional and organizational cultures of allopathic medicine have increasingly adopted policies and positions that create barriers to compassionate care, rather than facilitating it (Shanafelt et al., 2019). Excessive preauthorization and documentation, staff shortages, focus on relative value units and patient volume, and limited appointment lengths contribute to disturbing rates of provider/physician depression, substance abuse, and even suicide, all of which likely disturb a provider's capacity for compassion (Sprang et al., 2007;Lancet, 2019;Shanafelt et al., 2019; The National Academy of Medicine, 2019; Trzeciak and Mazzarelli, 2019). ...
... Despite the beneficial qualities of compassion, the professional and organizational cultures of allopathic medicine have increasingly adopted policies and positions that create barriers to compassionate care, rather than facilitating it (Shanafelt et al., 2019). Excessive preauthorization and documentation, staff shortages, focus on relative value units and patient volume, and limited appointment lengths contribute to disturbing rates of provider/physician depression, substance abuse, and even suicide, all of which likely disturb a provider's capacity for compassion (Sprang et al., 2007;Lancet, 2019;Shanafelt et al., 2019; The National Academy of Medicine, 2019; Trzeciak and Mazzarelli, 2019). Moreover, even though they are buffered from the burden of clerical medicine, there is a measurable atrophy of compassion among medical students (Hojat et al., 2009). ...
... Moreover, studies examining the root causes of both the increase in mental distress and the decline in compassion point to the larger culture of medicine and have done so for decades (Pence, 1983;Neumann et al., 2011; The National Academy of Medicine, 2019). Rather than promoting the individual and collective benefits afforded through the expression of compassion, medical students are quickly inculcated with a mindset of "perfectionism, lack of vulnerability, and low self-compassion" (Shanafelt et al., 2019). ...
Background
Compassion is considered a fundamental human capacity instrumental to the creation of medicine and for patient-centered practice and innovations in healthcare. However, instead of nurturing and cultivating institutional compassion, many healthcare providers cite the health system itself as a direct barrier to standard care. The trend of compassion depletion begins with medical students and is often attributed to the culture of undergraduate medical training, where students experience an increased risk of depression, substance use, and suicidality.
Objectives
This qualitative study aims to develop a more comprehensive understanding of compassion as it relates to undergraduate medical education. We used focus groups with key stakeholders in medical education to characterize beliefs about the nature of compassion and to identify perceived barriers and facilitators to compassion within their daily responsibilities as educators and students.
Methods
Researchers conducted a series of virtual (Zoom) focus groups with stakeholders: Students ( N = 14), Small Group Advisors ( N = 11), and Medical Curriculum Leaders ( N = 4). Transcripts were thematically analyzed using MAXQDA software.
Results
Study participants described compassion as being more than empathy, demanding action, and capable of being cultivated. Stakeholders identified self-care, life experiences, and role models as facilitators. The consistently identified barriers to compassion were time constraints, culture, and burnout. Both medical students and those training them agreed on a general definition of compassion and that there are ways to cultivate more of it in their daily professional lives. They also agreed that undergraduate medical education – and the healthcare culture at large – does not deliberately foster compassion and may be directly contributing to its degradation by the content and pedagogies emphasized, the high rates of burnout and futility, and the overwhelming time constraints.
Discussion
Intentional instruction in and cultivation of compassion during undergraduate medical education could provide a critical first step for undergirding the professional culture of healthcare with more resilience and warm-hearted concern. Our finding that medical students and those training them agree about what compassion is and that there are specific and actionable ways to cultivate more of it in their professional lives highlights key changes that will promote a more compassionate training environment conducive to the experience and expression of compassion.
... Ultimately, hospitals and their staff would benefit from a culture where discussing mental health issues is normalized. This might be complex, as it requires stepping away from professional and social norms currently present in hospitals, such as a focus on high performance, self-reliance, and not burdening others [54]. In addition to the aforementioned normative pressures surrounding workplace mental health, this culture makes it particularly challenging for staff working in health care to disclose mental health issues, which in turn can exacerbate the issue [54]. ...
... This might be complex, as it requires stepping away from professional and social norms currently present in hospitals, such as a focus on high performance, self-reliance, and not burdening others [54]. In addition to the aforementioned normative pressures surrounding workplace mental health, this culture makes it particularly challenging for staff working in health care to disclose mental health issues, which in turn can exacerbate the issue [54]. However, fostering a caring work environment could serve as a possible solution [55]. ...
Background
Psychosocial support programs are a way for hospitals to support the mental health of their staff. However, while support is needed, utilization of support by hospital staff remains low. This study aims to identify reasons for non-use and elements that are important to consider when offering psychosocial support.
Methods
This mixed-method, multiple case study used survey data and in-depth interviews to assess the extent of psychosocial support use, reasons for non-use and perceived important elements regarding the offering of psychosocial support among Dutch hospital staff. The study focused on a time of especially high need, namely the COVID-19 pandemic. Descriptive statistics were used to assess frequency of use among 1514 staff. The constant comparative method was used to analyze answers provided to two open-ended survey questions (n = 274 respondents) and in-depth interviews (n = 37 interviewees).
Results
The use of psychosocial support decreased from 8.4% in December 2020 to 3.6% by September 2021. We identified four main reasons for non-use of support: deeming support unnecessary, deeming support unsuitable, being unaware of the availability, or feeling undeserving of support. Furthermore, we uncovered four important elements: offer support structurally after the crisis, adjust support to diverse needs, ensure accessibility and awareness, and an active role for supervisors.
Conclusions
Our results show that the low use of psychosocial support by hospital staff is shaped by individual, organizational, and support-specific factors. These factors can be targeted to increase use of psychosocial support, whereby it is important to also focus on the wider hospital workforce in addition to frontline staff.
... Despite being at least as satisfied in their work as their male counterparts, women physicians self-reported high rates of burnout both pre- (McMurray et al., 2000) and post-COVID (The Physicians Foundation, 2021). In other studies, no sex differences in burnout were detected (Shanafelt et al., 2019). Perceived lack of support at home has been associated with both a high risk for burnout and burnout syndrome (Afonso et al., 2021); conversely, having a supportive spouse or colleague buffered the effects of burnout (McMurray et al., 2000). ...
Burnout in health care has received considerable attention; widespread efforts to implement burnout reduction initiatives are underway. Healthcare providers with marginalized identities may be especially at risk. Health service psychologists are often key members of interprofessional teams and may be asked to intervene with colleagues exhibiting signs of burnout. Consequently, psychologists in these settings can then find themselves in professional quandaries. In the absence of clear guidelines, psychologists are learning to enhance their scope of practice and navigate ethical guidelines while supporting colleagues and simultaneously satisfying organizational priorities. In this paper we (a) provide an overview of burnout and its scope, (b) discuss ethical challenges health service psychologists face in addressing provider burnout, and (c) present three models to employ in healthcare provider burnout and well-being.
... Yes 249 (31.5) [6]. Further understanding of this phenomenon is critical in creating a culture of medicine that supports selfcare, boundary setting, and a sustainable, healthy work environment [38]. In addition, the identified communication domain may have implications for understanding psychological safety, an emerging important construct in understanding and addressing group dynamics in healthcare [15,39]. ...
Background
Measurement is one of the critical ingredients to addressing the well-being of health care professionals. However, administering an organization-wide well-being survey can be challenging due to constraints like survey fatigue, financial limitations, and other system priorities. One way to address these issues is to embed well-being items into already existing assessment tools that are administered on a regular basis, such as an employee engagement survey. The objective of this study was to assess the utility of a brief engagement survey, that included a small subset of well-being items, among health care providers working in an academic medical center.
Methods
In this cross-sectional study, health care providers, including physicians and advanced clinical practitioners, employed at an academic medical center completed a brief, digital engagement survey consisting of 11 quantitative items and 1 qualitative item administered by Dialogue™. The emphasis of this study was on the quantitative responses. Item responses were compared by sex and degree, domains were identified via exploratory factor analysis (EFA), and internal consistency of item responses was assessed via McDonald’s omega. Sample burnout was compared against national burnout.
Results
Of the 791 respondents, 158 (20.0%) were Advanced Practice Clinicians (APCs), and 633 (80.0%) were Medical Doctors (MDs). The engagement survey, with 11 items, had a high internal consistency with an omega ranging from 0.80–0.93 and was shown, via EFA, to have three domains including communication, well-being, and engagement. Significant differences for some of the 11 items, by sex and degree, in the odds of their agreement responses were found. In this study, 31.5% reported experiencing burnout, which was significantly lower than the national average of 38.2%.
Conclusion
Our findings indicate initial reliability, validity, and utility of a brief, digital engagement survey among health care professionals. This may be particularly useful for medical groups or health care organizations who are unable to administer their own discrete well-being survey to employees.
... The culture of medicine often rewards physician attitudes and behaviors that detract from wellness. 31 Physicians internalize the culture of medicine that promotes perfectionism and downplays personal vulnerability. 32 Physicians are reluctant to protect and preserve their wellness, believing selfsacrifice makes them good doctors. ...
Physician burnout is increasing, but navigating its prevention involves a complex intersection of physical, psychological, social, and organizational strategies.
... The hidden curriculum [43] describes certain informal, often unspoken norms that make it difficult for the doctor to expose emotions, weakness, and illness or to admit mistakes in a professional medical setting. The conclusion of a paper by Tait Shanafelt and Schein that discussed several of these elements is that change is necessary to "heal the professional culture of medicine" [44]. ...
... Some researchers argue that psychological safety of employees, such as valued feed-back and openly admitting to mistakes, is not part of the organizational tradition in the field of health care [44,60]. To create psychological safety, Schein suggests several activities that can be implemented including a focused dialogue with the goal of helping participants to relax sufficiently to examine their own assumptions and to be able to consider other assumptions as equally valid or true. ...
... Several topics emphasized in peer support conversations are known drivers of burnout among doctors: lack of support, fear of voicing concerns at work, excessive workloads, work-home conflicts, negative leadership culture and a lack of comfort with their amount of responsibility at work [3,4,8,44,[61][62][63][64][65][66]. In the interviews, explicit statements were made indicating that speaking up at work entails taking a personal risk and that some of the interviewees did not know where else to turn for help with their workrelated problems. ...
Background
Doctors’ health is of importance for the quality and development of health care and to doctors themselves. As doctors are hesitant to seek medical treatment, peer support services, with an alleged lower threshold for seeking help, is provided in many countries. Peer support services may be the first place to which doctors turn when they search for support and advice relating to their own health and private or professional well-being. This paper explores how doctors perceive the peer support service and how it can meet their needs.
Materials and methods
Twelve doctors were interviewed a year after attending a peer support service which is accessible to all doctors in Norway. The qualitative, semi-structured interviews took place by on-line video meetings or over the phone (due to the COVID-19 pandemic) during 2020 and were audiotaped. Analysis was data-driven, and systematic text condensation was used as strategy for the qualitative analysis. The empirical material was further interpreted with the use of theories of organizational culture by Edgar Schein.
Results
The doctors sought peer support due to a range of different needs including both occupational and personal challenges. They attended peer support to engage in dialogue with a fellow doctor outside of the workplace, some were in search of a combination of dialogue and mental health care. The doctors wanted peer support to have a different quality from that of a regular doctor/patient appointment. The doctors expressed they needed and got psychological safety and an open conversation in a flexible and informal setting. Some of these qualities are related to the formal structure of the service, whereas others are based on the way the service is practised.
Conclusions
Peer support seems to provide psychological safety through its flexible, informal, and confidential characteristics. The service thus offers doctors in need of support a valued and suitable space that is clearly distinct from a doctor/patient relationship. The doctors’ needs are met to a high extent by the peer-support service, through such conditions that the doctors experience as beneficial.
... Supporting network: As the health care system becomes more complex, physicians are increasingly employed by large health care organizations. 76 Physicians within these complex health care systems have a decreased sense of autonomy and control over their work. 77 Many physicians feel they are just "cogs in the wheel" at their institutions. ...
Surgical complications remain common in health care and constitute a significant challenge for hospitals, surgeons, and patients. While they cause significant physical, financial, and psychological harm to patients and their families, they also heavily burden the involved physicians. This phenomenon, known as the “second victim,” results in negative short and long-term physical, cognitive, and psychological consequences on the surgeon. In this review, we explored the intricate connections between the surgeons' emotional response to adverse events concerning the patient outcome, perceived peer reaction, and existing social and institutional support systems. Using a selective literature review coupled with personal experiences, we propose a model of this complex interaction and suggest specific interventions to ameliorate the severity of response within this framework. The institution of the proposed interventions may improve the psychological well-being of surgeons facing complications and promote a cultural shift to better support physicians when they occur.
... It has been hard to miss an immodesty in public health leaders who are clinicians, which tracks with long-standing concerns that physicians have "some blind spots and unhealthy norms," including "assum[ing] the role of a hero" and implying that "to err is human, but … [they] are superhuman." 30 People speak grandly of "following the science" when what they actually follow is a narrow epidemiological slice of available knowledge about human health behavior. Growing recognition of the essential value of humility in patient care 31 should extend to those working in public health leadership as well. ...
Under-resourced and fragmented public health infrastructure has contributed to a poor pandemic response in the United States. There have been calls to redesign the Centers for Disease Control and Prevention and to increase its budget. Lawmakers also have introduced bills aiming to change public health emergency powers at the local, state, and federal levels. Public health is ripe for reform, but reorganization and enhanced funding will not address an equally pressing problem: chronic failures of judgment in the definition and implementation of legal interventions. Without a more informed and nuanced appreciation for the value and limits of law as an instrument of health promotion, the public will remain at unnecessary risk.
