Clinician burnout endangers quality of care

Clinicians know that burnout – emotional, physical, and mental exhaustion caused by excessive and prolonged stress – makes it much harder to take care of patients.the culture of medicine can be brutal – doctors are supposed to be superhuman, not susceptible to human emotional or physical demands. But it’s almost impossible to be an empathetic, patient, and careful professional when you are going weeks without a full night’s sleep, you have no opportunity to express your emotions, and you  spend more time caring for the computer than caring for patients.

It makes sense that burnout would be detrimental to patients as well as clinicians, but do the data support this theory? The answer is a resounding yes, according to new meta-analysis in JAMA Internal Medicine. Researchers compiled results from 47 studies surveying 42,473 physicians to quantify the associations between burnout symptoms and patient safety, quality of care, and patient satisfaction. Physician with symptoms of burnout, such as depression, exhaustion, and emotional distress, had a 96% greater risk of patient safety incidents, and more than double the risk of poorer quality of care and reduced patient satisfaction.  

Burnout is known to be epidemic amongst clinicians – with more than half experiencing at least one symptom of burnout. To make matters worse, there are “few funders who have entered this field in a substantive manner,” Dr. Mark Linzer from the University of Minnesota Department of Medicine writes in an accompanying commentary in JAMA. So far, most of the efforts to address burnout have been small-scale interventions, such as offering doctors mindfulness sessions, despite evidence that systems-level interventions such as changing institutional structure and standards are more effective.

Linzer suggests quality improvement initiatives, workflow redesign, and organizational culture as ways address burnout. However, these are only a few pieces of the puzzle. Many clinicians are questioning their career in medicine not just because their work is stressful, but because their work is futile. As medical student Leo Eisenstein wrote in NEJM last month, “A source of burnout that receives insufficient attention is the experience of caring for patients when you know that their socioeconomic and structural circumstances are actively causing harm in ways no medicines can touch.”

We can’t simply just focus on workflow and EMR issues to fix burnout (although those are important). We have to address the systemic problems in our health care system – inequality, lack of investment in social determinants, profit-based health care, etc – that are making clinicians feel powerless to help their patients.