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Promoting joy in medicine: Dean Lloyd Minor and fellow leaders offer insights

Dean Lloyd Minor, MD, vividly recalls when he first realized the full scope of physician burnout. It was five years ago, the fall of 2012, and he had just been selected as the new dean of Stanford's medical school. While meeting with numerous Stanford Medicine leaders, he heard how burnout was taking a daily toll and what they were trying to do to address it.

"The reason it was such an eye-opening experience was that it had been in front of me for years," Minor told several hundred attendees of the first American Conference on Physician Health: Creating an Organizational Foundation to Achieve Joy in Medicine, which was held in San Francisco last week and hosted by Stanford Medicine, the American Medical Association and the Mayo Clinic.

As a department chair at Johns Hopkins University School of Medicine, he had known colleagues whose productivity dipped as they struggled. As provost there, he had to intervene in cases where behavior was so severe the institution needed to act.

"I put it all together. This is not just individuals acting out, this is really a systemic issue we face as a profession and it's affecting our ability to deliver the very best care to our patients," Minor said. Now, at the helm of Stanford Medicine, he had the opportunity to do something about it.

Minor joined other health care leaders -- Sarah Krevans, president and CEO of Sutter Health; Steve Strongwater, MD, president and CEO of Atrius Health; and Tina Shah, MD, a former white house fellow at the U.S. Department of Veterans Affairs --  in a panel discussion that concluded the conference on Friday.

Panel members addressed the challenges encountered and lessons they had learned leading organizations that are working to improve conditions for physicians.

At Stanford, the first step was to work to understand the problem, Minor said. So in early 2013, leaders conducted a wellness survey of physicians. The results clarified the problem: burnout was widespread.

"We realized quickly that this was an issue we needed to address. And not just that we wanted to address, we wanted to lead," Minor said.

Krevans urged health care leaders to carefully craft communication addressing widespread institutional change. "Out in your organizations, there are a lot of people who feel they have a lot of needs that need to be met," she said. When implementing strategies to help physicians, ensure that all employees feel supported, she suggested.

That is the goal at Stanford Medicine, Minor told attendees. Although initial efforts focus on physicians, the organization intends to promote health well-being and wellness broadly throughout its health care workforce.

Strongwater said his organization, which has 900 physicians in Massachusetts, trained all of its workers in empathy. The effort sparked an ongoing joke of sorts -- co-workers chided one another whether an action "is joyful" or "added joy" -- but one with the capability to bring about cultural change.

Enhancing empathy is part of a multi-tiered strategy to address burnout. The electronic health record, however, in its current form, is a driver of burnout, Minor said.

"How can we improve the ability of the EHR to interface with patients and with providers in a much more engaging and user-friendly way than it does today?" he asked. Completely scrapping existing systems is not a likely option, given the hundreds of millions of dollars already invested. However amending the design experience by developing more efficient portals is possible, Minor said. "It can't come soon enough."

Regulatory policies could also be revised to ensure they are benefitting patients, the panelists agreed.

Moderator Andrea Sikon, MD, asked the panelists to share parting tips for restoring the joy in medicine. Minor responded:

I think compassion and empathy are things that all of us in leadership need to keep in mind and demonstrate in our interactions.

[We should] always remember why we do what we do, because we are as health care professionals entrusted with this incredibly awesome responsibility to provide care for patients. For me, remembering that has helped me to deal with really challenging situations and to see a broader perspective. It's a real privilege.

The 2018 conference will be held in Toronto.

Previously: Boosting physician wellness: Lessons from Stanford at Medicine XCountering the problem of physician burnout and Dean Lloyd Minor shares leadership lessons at Stanford Medicine X
Photo by Paul Sakuma

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