Tuesday, August 23, 2016
by Arif Kamal
On the topic of palliative care clinician wellness, we are starting to recognize that there is some good news to counter all the bad. First, the bad news. If you’re reading this, and you believe that burnout has not touched your professional life, then it is likely that the colleagues sitting to the immediate left and right of you are not so lucky. Recent survey data of over 1300 palliative care clinicians highlight a sobering statistic: almost two-thirds of our colleagues report burnout (Kamal JPSM 2016). This is among the highest rate of all medical disciplines, and significantly higher than the 45% average burnout rate of physicians outside our specialty (Shanafelt JAMA IM 2012). Burnout, explicitly stated, is a leading cause of palliative care clinicians opting to leave the field, second only to usual retirement. Those reading these statistics are likely not surprised; compassionately caring for persons with serious illness often on the worst days of their life can take a toll on our emotional health. A growing appreciation of the downstream effects of unchecked burnout on the ability to deliver timely, high quality palliative care has elevated the issue to nothing short of a crisis for our field.
But there’s also good news. Enter resilience, stage left. Resilience is the “capacity to meet challenges, recover from difficulties, and thrive at work; built from skills, not reflective of traits.” Of that definition, the last part is the most important. The idea that certain people are more capable of handling challenges at work is not new; we all know someone who seems to handle difficulties with grace, and an increasing workload with enthusiasm. When the pager goes off, she skips to the phone. All while I worry about making it home in time to read my four-year old “three books, Daddy, you promised three books” before bed. What makes my colleague different?
There are a few potential explanations for this seemingly-odd behavior by my colleague. One explanation is that of self-selection; clinicians who stick around in palliative care are the ones who can cut it, the burnt out ones got out a long time ago. “Crispiness” creeps up on some, and silently ushers the unlucky ones out of palliative care, or maybe even out of medicine. For the lucky few, a retirement party and adoration for the lengthiness of a career in the trenches awaits. Another explanation is that the upbeat clinician has the right personality: upbeat, optimistic, never fazed. She was born with something I was not, a set of traits missing in my family’s gene pool. Like missing the gene for being tall, an Olympics Gold Medal for basketball is no more in my future than a long, healthy career as a palliative care clinician.
Summatively, these two explanations reflect a “trait-based” approach to resilience; those who’ve got it win, and those who don’t, leave. In truth, the clinician I reference has developed, practice, and refined her own set of resilience skills – this has nothing to do with her personality, genetics, or “makeup”. Like leadership skills and communication skills, resilience skills are not inherited or accidentally found. Diligent, intentional, and regular learning and practicing of resilience skills is the main way for persons to build the capacity to thrive in the midst of challenges.
During our Tweetchat on Wednesday, August 24 at 9PM ET, we will discuss the following topics:
T1: We are asserting that resilience is a skill, and not a trait, is that surprising? What skills have you seen others use to help deter burnout?
T2: How can employers/leaders assist clinicians in building resilience skills?
T3: What roles, if any, should specialty societies (e.g. AAHPM, HPNA, NHPCO) play in building resilience skills within the field?
Arif Kamal MD, MBA, MHS is the Physician Quality and Outcomes Officer at Duke Cancer Institute, a palliative medicine physician and oncologist, and dreads the longwindedness of “Green Eggs and Ham” selected as part of the “three books, Daddy, three books” bedtime routine.
What: #hpm (hospice and palliative med/care) chat on Twitter
When: Wed 08/24/2016 - 9p ET/ 6p PT
Host: Dr. Arif Kamal Follow @arifkamalmd on Twitter
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Kamal, A. H., Bull, J. H., Wolf, S. P., Swetz, K. M., Shanafelt, T. D., Ast, K., Kavalieratos D, Sincalir CT, Abernethy, A. P. (2016). Prevalence and Predictors of Burnout Among Hospice and Palliative Care Clinicians in the U.S. Journal of Pain and Symptom Management, 51(4), 690–6. http://doi.org/10.1016/j.jpainsymman.2015.10.020
Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., reskovich, M. R. (2012). Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of Internal Medicine, 172(18), 1377–85. OPEN ACCESS PDF http://doi.org/10.1001/archinternmed.2012.3199
Image Credit: "Burnt Toast" by Christian Sinclair via Canva - Creative Commons-BY-SA