“You can teach a canary in a coal mine to meditate, but it is still going to die.”
I have seen this canary sentiment as a metaphor for health care and burnout pop up a few times on Twitter recently, attributed to a couple different thoughtful doctors, including Dr. Jenny Ramsey (at Hospital Medicine 2018), Dr. Lucy Kalanithi (of When Breath Becomes Air fame), and Dr. Stuart Slavin.
To be honest, I am rather burned out on reading about physician burnout at this point. Nevertheless, I love the canary idea; it is such a perfect visual of the current problem facing physicians.
I was thinking about the meditating canary when I read the new “Charter on Physician Well-Being,” published this week in JAMA, and already endorsed by most major medical organizations/acronyms, including SHM, ACP, SGIM, AMA, AAMC, AAIM, ABIM, ACCME, APA, and the IHI. The physician well-being charter was created by the Collaborative for Healing and Renewal in Medicine (CHARM), a group that includes leading medical centers and organizations.
What makes this different from previous attempts at addressing burnout? The charter takes a systems-based approach to physician well-being. Aha, of course! Just as the patient safety movement realized more than two decades ago, real progress would only be made when we stop focusing our attention, blame, and interventions on individuals and instead look at systems, now the physician well-being movement has officially made the same bold proclamation. It is not the fault of the burned-out physician who just needs to be hammered over the head with better coping skills – same as the majority of medical errors would not be fixed by continuing to tell physicians that they screwed up and should figure out how not to do that again!
We need to make real changes to the system. For example, one of the charter’s authors, Dr. Colin P. West, highlights why it is important that organizations commit to optimizing highly functioning interprofessional teams: “Can you imagine @KingJames [LeBron James] or @Oprah applying their unique skills AND personally seating the crowd, collecting stats, assessing satisfaction, etc.? So why do we?”
The authors also call for organizations to commit to reducing time spent on documentation and administration. Hallelujah!
Now the question is whether this charter will actually have any teeth, or will it have the same fate as our canary, slowly fading away never to be heard from again?
Physician burnout has certainly reached a burning platform status. As we prepare to welcome the newest crop of interns – who will arrive as excited, proud, and anxious as any of us were to put on that long white coat for the first time and join this noble profession – I can easily see them in my mind’s eye as fluttering, cheerful, colorful canaries flying head first into the mines. Perhaps, the intense public scrutiny on the issue will fan the flames of the burning platform to keep this charter relevant. It will require nothing less than persistent attention and focused pressure, particularly on hospital systems, to make these recommendations become reality.
In one promising sign that this could actually stick this time around, an article in the New England Journal of Medicine earlier this year reported that chief executives from 10 major health care organizations had committed to 11 actions to combat physician burnout, including supporting team-based models of care. They also pointed to a success story from the Department of Family Medicine at the University of Colorado, where they introduced a new team-based care model in their ambulatory care clinics, which required significant investment from the health system, and resulted in burnout rates among clinicians dropping from 53% to 13%. In addition, some quality metrics improved and productivity increased, reportedly making the program cost-neutral.
The AMA has recommended several systems-based approaches for reducing burnout.
While there is reason to remain skeptical that health systems will truly address burnout, especially when it comes to those of us in the hospital setting, the Charter on Physician Well-Being finally takes the first step by laying out a more comprehensive roadmap on how to tackle this problem. It recognizes that “physician well-being is a shared responsibility” between individual physicians and their organizations, requiring “partnerships among health care team members and medical organizations, local and national physician groups, and institutions and regulatory bodies/policymakers.”
Yes, this means there is also a role for promoting self-care, as the charter points out that “individual physicians who learn and incorporate self-care skills can enrich their own well-being.” They go on to state, “…physicians may benefit from opportunities to enhance emotional awareness, mindfulness, and self-reflections.”
So next time a hospital leader invites you to an art/yoga/meditation/therapy llama session, by all means you should go, but please – for me – also ask them what they are doing to change the damn coal mine!