Charter for Physician Well-being in JAMA

I missed this April, 2018 JAMA article and wonder whether you have too.

Authors Thomas, Ripp, and West propose a set of guiding principles to support physician wellness:

• Effective patient care promotes and requires physician well-being.
• Physician well-being is related with the well-being of all members of the health care team.
• Physician well-being is a quality marker.
• Physician well-being is a shared responsibility.

Link to abstract: https://jamanetwork.com/journals/jama/article-abstract/2677478

The problems are real. Conversations about this topic are becoming mainstream. Let’s all work together for change. We, our colleagues, our patients, our families, and our communities need healthier physicians.

Wellness Within the Culture of Medicine

We’ve looked at person wellness and institutional wellness. Now let’s turn our attention to wellness within the culture of medicine. This is the third level of our physician wellness framework. Western medicine has its own set of customs, traditions and values that are learned early in the course of medical training. The value of sound scientific methods, the importance placed on logic and reason, and the significance of professional integrity are examples. Hard work, sacrifice and commitment are also included. Unhealthy values include harsh judgment, shame, a sense of superiority, and perfection.

When examining physician wellness at the cultural level, we must also address discrimination within medicine. Overt racism, misogyny, ageism and discrimination based upon sexual orientation are everyday occurrences and affect everyone within the culture of medicine.  Think #metoo isn’t valid for medicine? Read “A Mother in the House” at this blog for another opinion. It’s difficult to experience wellness at the same time as discrimination.

At every level, physician wellness depends upon continuous, usually low-tech, activities and habits based upon individual and shared values. Identifying and shaping these shared values is not going to happen on its own. We all have an obligation to speak and act up. We need improved physician health. Our families, our communities, patients, and even the institution of medicine deserves better.

Physician Wellness at the Institutional Level

Over 50% of physicians report symptoms of burnout. This high level tells us that addressing wellness at the personal level is not enough. It speaks to a systemic rather than individual etiology. Organizations have begun to recognize it is in their best interest to keep their physicians happy. Losing even one physician to burnout is expensive. In addition, burned out physicians are liabilities. Mistakes increase. Productivity decreases. Patient satisfaction decreases. Ripple effects touch other members of the team, which leads to further burnout. If for no other reason, physician wellness at the organizational level matters since it affects the bottom line.

Fixes at the institutional level have primarily focused on time. Physicians have too little time to do what we need to do and to do it well. The EMR is regularly blamed as a time sink. Re-engineering the tools, environment, and systems of care delivery can help us save time. However, its not only a lack-of-time issue. What we do with our time also matters. We need systems that allow each person to work at the highest level of their training. Doctors can practice medicine while other team members do what they do best.

Finally, we  need to acknowledge the inherent conflict between the business of medicine and the practice of medicine—something physicians wear every day as we work with our patients.  Making these changes at the institutional level requires a change of institutional values to include physician wellness.