Fostering wellbeing in your practice

Michael F. Myers: As a specialist in physician health, I know that a doctor's work setting is huge and its impact on their well being. In fact, I've had a decades-long career actually looking after doctors and my private practice and I've seen scores of them with a chief complaint of: 'I love being a doctor, but I hate my job. I hate where I work.'

So this is the lens I'm going to use this morning speaking with you. I've learned a lot over the years by listening to these unhappy folks. They talk a lot about stress at work, burnout, depression, PTSD, or they're sent to me because of disruptive behavior, they've been drinking too much; things like that. And what I want to do is just give you a few quotes, from my practice, just so you can get a flavor of this: 'I don't have a voice, no actual say in what would make this clinic a happier place.' Or another one, 'It's all about the bottom line here; metrics. This is treadmill medicine with no interest in what this kind of medical care is doing to my health.' Another one: 'It's so disorganized here, it's rudderless. No one is really in charge.' Another one: 'As a woman doctor, I'm invisible. I feel talked over all the time in meetings when we have.' And then finally: 'I'm the only black doctor here, when I used the term microaggression recently, no one knew what I was talking about.'

So these statements really get at the heart of how an unhealthy workplace can affect one's morality. In fact, you know, we now have this term moral injury that many of you I'm sure have heard of, thanks to doctors Wendy Dean and Simon Talbot, who have written extensively about this, and I urge you to take a look at their website. But also, a shout out of thanks to Dr. Tait Shanafelt, who currently is the chief wellness officer at Stanford University. For many years, he was at the Mayo Clinic and part of the major burnout research group in this country. And they've written extensively about the importance of making the business case for burnout prevention in the medical workplace. Because without it, you have attrition. You have lateness, you have trouble hiring, you've got a rapid turnover of your doctors, doctors make mistakes, there's lawsuits, there's sickness and paying out benefits to doctors on medical leave.

So there's a very strong argument, apart from the the moral and health promoting aspect of burnout prevention. The other one, of course, is the business case.

So let me turn now in the time I have left to talk about some solutions. The first point I want to make is in the whole area of inclusion, you need to have a diverse group of physicians in your group, and everyone, everyone, everyone has to have a sense of belonging, that they're kept informed, that they're part of decision making. That they not only have a voice but are welcome and expected to participate.

The second one is leadership. As you know, there's all kinds of leaders there's all kinds of bosses. But what a group is looking for is a leader who is at the helm, who takes action. And it's not just in the title, it's taking action, without necessarily being authoritarian.

And you can do all of this short of having a master's degree. An open door policy works too; it helps tremendously. So, the doctors feel that when and if they're having sort of an urgent situation, that you're accessible, and that you listen with an open heart and an open mind that that that you they have your back or your ear.

As alluded to above, in one of those examples, regular meetings are essential. And you know, especially now, so many people feel that they're meeting to death or meeting out to death, but it's important to have an agenda with a clear starting time and a clear ending time. You can do a lot in a 30 minute window or a 60 minute window or something like that.

Allowed jobs or manifesting some part of the clinic, where where doctors can go to just have a break, where they can talk about non-clinical phase. Or they can kind of see each other in person and get a clinical opinion or something like that, over a beverage, something like that those those breaks in the old fashioned doctor's lounge or the current equivalents really, really help.

I want to mention a few other things, staffing. Doctors can get to feel guilty really quickly, if they fall ill and they have to take a few days off or perhaps a little longer period of time, that they are relinquishing their work, and that the rest of the staff have to pick it up. So there needs to be a mechanism, whether this is being able to hire locums or physician extenders, or somebody who can step in, so that the individual who's feeling ill can just deal with that and not have to worry about this layer of guilt or responsibility that everybody at work is going to be disappointed and then they're going to be angry at them. Because they're already sort of working as hard as they possibly can but it also extends for larger things like maternity leave, paternity leave, compassionate leave, so that if a doctor is worried or needs to take care of an ailing family member, like a spouse, or a child, or elderly parent, if they could do this, and, again, still be part of the team.

You know, it's pretty basic, there needs to be an ethos, that good care of patients begins with a belief that doctors are human, and that they need to feel cared for to. And just this sort of sense that I feel cared for here that we're actually we're actually kind of a big family. And that feels really good to be working in a place like that. I've got one final piece of advice. If you're a non-physician, medical administrator, and many of you are, please try your best to put yourself in the doctor shoes by listening carefully to their struggles into their strengths, and what they can bring to the table here.

Also a word of advice to physician administrators who are no longer doing clinical work. Because I hear this too often from doctors, they say that, 'yeah, she's a physician, but you never know it', et cetera, et cetera, try to remember what it was like when you were in the trenches. And that will really help to keep that measure of empathy for the doctors and doing all the frontline work. You know, don't just don't mind hard work. Most thrive on it, actually. But they'll get unhappy very, very quickly. If they don't feel valued, or feel that they don't have a voice.