Physician distress and burnout is an international phenomenon. A comprehensive review of physician ill-being studies done worldwide shows that 30-60% of physicians are experiencing burnout and/or entertaining thoughts of leaving the practice of medicine.
This distress manifests quite early. In a large Australian study nearly one quarter of first-year medical students manifested suicidal ideation prior to exams. Numerous studies of medical students in the US find a high prevalence of psychological distress, surfacing as early as the first year of medical school.
Part of the burnout and stress syndrome suffered by physicians, housestaff and students is depersonalization, withdrawal, and loss of empathy. These carry a major toll for both doctor and patient, resulting in decreased patient satisfaction, prolonged recovery time and an increase in medical errors.
Burnout in doctors begins as early as the middle of the first year of medical school and some of the causes are known. An in-depth exploration of causation revealed the rate of abuse and bullying reported of and by medical students, residents and faculty approaches 70-80% in most medical schools and teaching hospitals. Although this primarily takes the form of verbal bullying, abuse includes physical and sexual abuse.
Another alarming reality is the medical school curriculum which is focused primarily on pathology and disease. The first year is focused on basic science and taught in an impersonal, competition-encouraging atmosphere. This encourages mistrust and isolation and replaces the naïve first year medical student’s desire to relate warmly and effectively with others.
Looking specifically at burnout in medical school faculty, 62% of internal medicine clerkship directors in the US met criteria for burnout in a 2009 study, and those with burnout demonstrated associated lack of empathy toward their students. In another study, 21% of faculty was considering leaving academic medicine due to dissatisfaction. Their primary source of dissatisfaction was the non-relational and unethical nature of their workplace. They felt a low sense of engagement with others, and a lack of alignment of personal and institutional values.
A proactive strengths-based approach
A problem-based approach to these issues has failed to address them effectively in over 30 years of active study of physicians’ health and impairment.
I propose instead a proactive strengths-based approach by teaching the skills of positive health, resilience, and professionalism to medical students and practicing physicians.