A
Novel Thought?
Hospital turns toward service
Response prepared to national medical errors report
FINDING THE BALANCE
by: Lawrence M. S H U ER
Medicine is often an all-consuming profession. Many of us work extremely long hours and quite often the work follows us home either emotionally or physically. When my wife points out that I look troubled because I'm preoccupied with the condition of one or more patients, I'm reminded how vital it is to "find the balance" between work and family life Ñ not only for my sake but for my family's health and well-being as well.
An article in the April 2000 Modern Physician deals with this very issue, in part through the eyes of Peter Moskowitz, a former faculty member in the Department of Radiology. He recognized he had a problem when a successful career with "the perfect family life" disturbingly included a teenage son who began to abuse alcohol and drugs and the strain leading to a marriage separation.
Peter had an epiphany and took two months off from work. During this time he realized that as a physician he had dedicated himself to the care of his patients and neglected to take care of himself and his family. He changed his way of thinking and began to learn to say "no" and cut back on volunteer commitments. He organized his work schedule so that he could be home by 6 p.m.
Peter began to eat a healthier diet and to exercise regularly. He also set aside time for fun, which in his case involved hiking, classical music and fly fishing. He and his wife reconciled after nine months, and he was able to spend time alone with his son, repairing their relationship.
Now, after two years training at the Hudson Institute of Santa Barbara, Peter has founded his own institute in Palo Alto. His goal is to help other physicians and health care professionals experiencing job dissatisfaction, stress and burnout.
It's not surprising that people in the renewal industry see plenty of work ahead as increasingly physicians find their lives out of balance and ask for help. Practitioners, according to the article, see that stress is likely to increase for physicians in the current medical economic climate.
This same article quotes a January 1997 survey of the Sacramento El Dorado [California] Medical Society where 81 percent of 454 responding physicians considered burnout a significant problem in the medical profession. A full 67 percent said that burnout was a problem in their group or practice. Significantly, 43 percent of physicians agreed that they themselves were burned-out.
The five leading factors contributing to burnout are expectations of greater workload, loss of individual autonomy, loss of control over scheduling, pressure to decrease cost but increase "quality" and inability to balance personal and professional life.
Peter Moskowitz notes that early signs of burnout may include feeling chronically irritated, getting annoyed by minor issues or experiencing personal conflicts at work. If these go unaddressed they may lead to physical signs such as hypertension, gastrointestinal disorders and symptoms of coronary disease. Other signs of burnout may include exhaustion, both emotional and physical; cynicism, which manifests itself in distancing and anger; and ineffectiveness, when physicians lose their self-confidence and normal tasks become insurmountable.
There really is no quick fix for burnout. Often the problem will have been simmering for many years. To find a solution, each of us must recognize if we have a problem and be willing to admit that changes - often reconnecting with family and more rest, relaxation and exercise - are needed.
I found it interesting that the people who work in this area say consistently that it is important to have a plan for the future to work toward, rather than to dwell on how things were better in the past.
No doubt physician burnout does affect one's outlook and ability to work with others. If people sense that they may be having such a problem, it would be advisable to seek help to define the problem and reorder their priorities. Physicians can get help from "coaches," and the Physicians Well Being Committee of the Medical Staff can provide some guidance. Please contact the committee chair, Bob Matano, a faculty psychologist, (rmatano@ stanford.edu or 650-725-5716.
