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Attitude toward mistakes — and lack of self-care — harm physicians’ well-being

A survey shows there's nothing inherent about being a physician that leads to burnout. The problems are long hours and shame about errors.

Physicians experience burnout more than most workers, but the problem isn't inherent to the medical profession, according to Stanford Medicine psychiatrist Mickey Trockel, MD, PhD.

Rather, it's the long hours doctors often work and a culture that leads them to castigate themselves for mistakes, he said. A study Trockel and his colleagues conducted, comparing physicians' self-compassion with those of people in other professions, pointed to the causes of physician burnout.

In fact, the study, published in Mayo Clinic Proceedings, found that physicians who view errors as a learning opportunity and who work a healthy amount are less likely to burn out than their non-doctor peers.

"We've been talking about how physicians are more susceptible to burnout for a decade," Trockel said. "What this research shows is it has nothing to do with being a physician. It's about predictable attitudes and behaviors when physicians are immersed in a culture that perpetually defers self-care and responds to errors with shame and blame."

Attitude survey

The researchers surveyed 832 physicians along with 5,182 people in other fields. They asked the respondents how they reacted when they made errors, as well as how often they neglected their own health because of work.

They found that 30% of physicians often or always condemned themselves when they made an error instead of encouraging themselves to learn from it. Twenty percent of people in other fields reacted the same way.

"Physicians are harder on themselves than the average person," Trockel said. "What leads them to those feelings are likely cultural. It starts in medical training and continues into the medical practice environment."

More starkly, 52% of physicians said they often or always put off self-care because of time pressure, while only 15% of workers in other fields said the same.

"It's necessary to defer sleep to be on call, and putting others' needs first saves lives," Trockel noted. "The problem is when that's exacerbated by extra work, factors like regulatory policies and insurance requirements that drive unnecessary workloads and lead to a deferment of self-care."

A healthy attitude

The researchers found that when they controlled for a self-compassionate mindset and work hours, being a physician was associated with lower risk of job burnout. The medical profession's stable employment, high pay and meaningful work is likely part of the reason, Trockel said.

The study suggests steps the medical profession can take to help physicians avoid burnout, Trockel noted. More reasonable work hours -- including time off after intense and lengthy shifts -- can go a long way toward keeping physicians refreshed, he said.

On a personal level, physicians can work with a coach or therapist to reframe their attitudes about errors, viewing them as learning experiences, he suggested. And health system leaders can avoid casting blame on individual doctors for errors and instead focus on system failures -- an approach that not only helps physicians' mental wellness, but also frequently reduces mistakes.

"Physicians will always be human, and mistakes will always be with us," he said. "But we can design systems to better prevent human errors."

Photo by fernandohiminaicela

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