#KEYLIMEPODCAST 332: For Every Action There is an Equal and Opposite Reaction. (Newton)

Reference

LaDonna K,. Wrestling With the Invincibility Myth: Exploring Physicians’ Resistance to Wellness and Resilience Building Interventions Acad Med 2021 Aug 10. Online ahead of print.

Reviewer

Lara Varpio (@LaraVarpio)

Background

• Despite it being a topic of conversation for us for over 9 years, it is still a real and serious problem.
• We know clinician burnout is REAL. We know that it affects up to half of the physicians in North America. We know that resilience and burnout interventions are now implemented in clinical contexts around the world. They are often individual focused – so yoga, meditation, mindfulness workshops aimed at building the resilience of individuals. They can also be focused at the organization level – there is some research about job redesigns, and about co-worker support efforts.
• And this this the heart of the burnout problem as I see it today: is burnout a problem with an individual or with an organization? Should remediation efforts be aimed at the individual or at organizations?

Purpose

• In this research, they set out to explore faculty physicians’ experiences of wellness and of burnout; they explore the perceptions those individuals hold of wellness initiatives, and about their experiences and perceptions influence their uptake of wellness strategies

Key Points on the Methods

• Using constructivist grounded theory, 21 full time physician faculty members were interviewed, asked about the factors that affect their wellness, their perspectives about their resilience, and why they perceived that physicians might resist initiative aimed at nurturing physician wellness.
• Interview questions evolved as the study progressed and insights were gained. Initial, focused, and theoretical coding was carried out. Constant comparison shaped the analytic processes till they had enough data to answer their questions.

Key Outcomes

• The participants acknowledged feeling overworked, but they also perceived that physicians have the constitution and training to handle stress
• However, they could not handle problematic organizational and professional values. Organization and profession are valuing flow, capacity, meeting budget targets. In this context, a physician’s achievement was measured by what they could bring to the organization, the prestige, the volume of work.
• Participants also described this invincibility in terms of the unrealistic expectations for both their work performances and personal behaviors.
• A taboo associated with seeking help for burnout. If they admitted to burnout, participants worried about appearing weak, about being dismissed, or even being ridiculed
• They described sacrificing everything for an organization that didn’t care about them, that didn’t recognize their efforts, that made everything about service to patients, and didn’t balance that with emphasis on support of clinicians

Key Conclusions

• The authors conclude that organizational processes and policies AS WELL AS the values of the medical profession itself are powerful contributors to the burnout experienced by individual clinicians.

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