Each Healthcare Clinician's Burnout Is Unique

Generic Approaches Are Not Only Unhelpful, They're Counter-productive

Yes, there IS an epidemic of burnout. And there’s a veritable universe of potential contributors. Take any two healthcare clinicians who are grappling with burnout - say who scored identically in the Maslach Burnout Inventory (MBI) or any of the other instruments out there. You’ll find that their burnout is not caused by the same things. Yet they both experience the same manifestations of burnout, at least as measured on the coarse instruments available.

But drill down on what each of them identifies as the leading contributors and you’ll find that they’re different. And even if they had the very same three issues, you’d find that they each have a different weighting.

Thus, each person’s burnout is truly a unique assemblage of contributors. Now, that doesn’t mean they’re all such uniquely different compositions. Indeed, there are common contributors that just about everyone agrees on, e.g. the electronic medical record, litigation stress, crazy workload, etc.

So, in this example, Doc A is beaten down by excessive workload; Doc B is going crazy with the EMR; and Doc C is overwhelmed by litigation stress.

Applying a general nostrum like deep breathing or training in having a kinder bedside manner is not going to address their burnout as it’s not addressing the primary contributor for each of them.

What you find when talking with docs about their burnout is that the causes of each of their burnout is really a stress array. It’s a constellation of things. And its composition and the weighting of each stressor are variable, and in fact, unique to each individual.

So, let’s expand the “Stress Inventory” and show each doc’s self-assigned score (this is a fictional assessment):

(“pt” = patient)

That’s a truckload of stressors. And each doc has some of them in varying intensity.

But even more striking is when you highlight the self-ranked most severe stressors:

Wow! Each doc has their own stress truckload, each with MULTIPLE severe stressors!

How Many Burnout Flavors Are There?

Simply on possible permutations … I’m no mathematician but I do recall something about calculating possible combinations and - well, all I remember right now is it’s gargantuan. Take a portion of the stress table of contents, say the 15 items above, and let each person have an assigned impact rating of between 0 and 4, and how many possible configurations do you come up with?

So, what’s that say about how to approach this?

Doc A is dealing with workload and a medical board investigation into a patient complaint.

Doc B is - and probably was already - dealing with EMR hassles, and is also seeing a high ratio of complex patients, is caught in a documentation nightmare and not completing charts on time, and is getting shamed by his administration for allegedly not handling a patient encounter correctly.

And Doc C is being sued for negligence and wrongful death, is in a high-risk specialty already dealing with complex patients, perhaps dealing with marital or family issues (or their own mental health issues), and is traumatized by recent threats from a violently angry patient.

First, let’s realize the complexity of the causal matrix. And for those who are not clinicians, let’s recognize the immensity of these stressors, not to mention the entire composite for each doc.

Second, we’ve got to recognize that this stress takes a toll and is going to show up somewhere.

Third, each doc has got to have the availability of a coach / therapist / counselor who is exquisitely attuned to the stress array facing clinicians and who provides competent and tailored services in an utmost safe environment. And that means sacrosanct confidentiality.

And fourth, each doc needs to have the space and time to process what they’re going through and to access whatever resources are needed to help them navigate this particular concern.

Simply telling docs (and all other clinicians) to practice mindfulness or be more compassionate is not going to cut it.

Now, this may seem paradoxical.

There ARE significant benefits in offering broad-spectrum antidotes - practices if you will - to the clinician community as a whole.

All of us can use guidance in, and reminders to implement, practices that help us manage stress better. And it is great that some hospitals are offering these.

But don’t mistake that offering as a sufficient response to the burnout epidemic.

The Matrix of Clinician Distress Is Larger Than Burnout

Burnout is only one stress syndrome in the universe of clinician distress.

While there is finally a recognition among healthcare leaders of the immensity of the burnout epidemic, I fear that everything that’s causing physician - and more broadly all clinician - distress is being clustered under the “burnout” rubric.

Well-meaning, no doubt. But both inaccurate and unhelpful. And not only not helpful, but dangerous in its false diagnosis and counterproductive in its application of generic burnout remedies to very impactful stress syndromes and complex contextual situations which demand special approaches.

In the next piece, we’ll re-examine the components of the matrix of clinician distress (read or listen to the full seven-part series which can be found on the main Physician Interrupted archive page), see how each is different from burnout, and explore what approaches ought to be taken.

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