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The well-being of physicians

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Introduction

Although there has been tremendous progress in our understanding of disease and in interventions to restore health, many physicians have lost sight of their personal well-being. Physicians now confront the stresses of increasing government regulations, malpractice suits, the business aspects of medicine, increased clinical demands, less time with patients, a rapidly expanding knowledge base, rising student debt, and how to balance their personal and professional lives. Although many physicians acknowledge the existence of these stresses, it is difficult to fully understand their effect on health. After all, “Illness doesn’t belong to us. It belongs to them, the patients. Doctors need to be taught to be ill. We need permission to be ill and to acknowledge that we are not superhuman” (2).

Much has been written about the well-being and quality of life of patients in recent years (3), but although great strides have been made in the assessment of patient quality of life 4, 5, 6, 7, little attention has focused on the well-being of clinicians and how it might affect patients 8, 9, 10. It is important to understand the prevalence, causes, and consequences of physician distress; the factors that contribute to physician well-being; and the steps that academic medical centers, health maintenance organizations, and physician organizations can take to promote physician well-being and those that individual physicians may take to promote their own wellness.

Section snippets

Physician distress

The medical literature began to testify to the problem of physician distress 20 years ago 11, 12, 13. These studies reported “burnout” in a wide range of practicing physicians with 30% to 60% of specialists and general practitioners 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 experiencing burnout when measured with validated instruments 24, 25. Although the problem is common among academic faculty, among whom 37% to 47% experience burnout, it is, alarmingly, even more prevalent in

Causes of burnout

Although the factors that contribute to burnout are unclear, there is evidence that an important role is played by such factors as workload 8, 50, 51, 52, specialty choice 11, 50, 53, practice setting 11, 21, patient characteristics 50, 54, sleep deprivation (33), personality type 22, 55), methods of dealing with death/suffering (22, 56, methods of dealing with medical mistakes 57, 58, malpractice suits 58, 59, 60, lack of control over practice environment 16, 51, and problems with work-life

The well-being of physicians

In his famous address to the Harvard Medical School, Francis Peabody said, “The secret of caring for the medical patient is in caring for the medical patient” (65). Others (66) concur that Candib’s rephrasing, “The secret of the care of the patient is caring for oneself while caring for the patient” (67), may provide even greater insight.

But how do we care for ourselves? What is physician well-being and, more importantly, how do we get there? Although there is a large body of literature about

Practical suggestions for physicians

It is important for physicians to note that recovery from distress and burnout is possible 12, 38. The editors of the Western Journal of Medicine dedicated their January 2001 issue to physician well-being (77). One article by Weiner et al. explored physicians’ own wellness promotion practices by asking “How do you solve dilemmas related to your physical, emotional, and spiritual well-being?” (68). Study participants also completed a survey to measure well-being. The authors identified

Implications for academic medicine, health maintenance organizations, and physician organizations

The implications of the research cited here should be a strong call to action for academic medicine, health maintenance organizations, practice administrators, and physician organizations. Distress has been identified as an issue in nearly every group of physicians that has been studied, from interns in training 8, 9 to department chairs (20). Distress and well-being are intimately associated with factors essential to building an economically healthy 82, 83 and thriving health care

A call for research

Prospective, longitudinal studies that further explore the causes and ramifications of physician distress and new instruments to specifically measure physician well-being are needed. Prospective studies to identify individual and organizational interventions that can promote wellness and evaluate its effect on productivity, patient care, and patient satisfaction will be important. The well-being of female physicians may be dependent on variables distinct from their male counterparts and should

Conclusion

Being a physician carries with it the potential for both great joy and great distress. Sir William Osler distilled this dual potential: “The practice of medicine will be very much as you make it—to one a worry, a care, a perpetual annoyance; to another, a daily job and a life of as much happiness and usefulness as can well fall to the lot of man.” Physicians must identify, nurture, and defend their personal interests and values if they desire personal and professional satisfaction in life.

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References (103)

  • J.M. Bissonnette et al.

    Restructuring residency training in obstetrics and gynecology

    Am J Obstet Gynecol

    (1999)
  • W.K. Beatty

    Galen. Of Protecting the Health, book V

  • C. McKevitt et al.

    Illness doesn’t belong to us

    J R Soc Med

    (1997)
  • A. Leplege et al.

    The problem of quality of life in medicine

    Jama

    (1997)
  • A. Levorato et al.

    Communication with terminal cancer patients in palliative careare there differences between nurses and physicians?

    Support Care Cancer

    (2001)
  • D.A. Loblaw et al.

    Development and testing of a visit-specific patient satisfaction questionnairethe Princess Margaret Hospital Satisfaction With Doctor Questionnaire

    J Clin Oncol

    (1999)
  • C.M. Moinpour et al.

    Substituting proxy ratings for patient ratings in cancer clinical trialsan analysis based on a Southwest Oncology Group trial in patients with brain metastases

    Qual Life Res

    (2000)
  • M.L. Rothman et al.

    The validity of proxy-generated scores as measures of patient health status

    Med Care

    (1991)
  • T.D. Shanafelt et al.

    Burnout and self-reported patient care in an internal medicine residency program

    Ann Intern Med

    (2002)
  • L.M. Bellini et al.

    Variation of mood and empathy during internship

    Jama

    (2002)
  • A.J. Ramirez et al.

    Burnout and psychiatric disorder among cancer clinicians

    Br J Cancer

    (1995)
  • J. Lemkau et al.

    Burnout and career-choice regret among family practice physicians in early practice

    Fam Pract Res J

    (1994)
  • R. Goldberg et al.

    Burnout and its correlates in emergency physiciansfour years’ experience with a wellness booth

    Acad Emerg Med

    (1996)
  • J.D. McCue et al.

    A stress management workshop improves residents’ coping skills

    Arch Intern Med

    (1991)
  • L. Grassi et al.

    Psychiatric morbidity and burnout in the medical professionan Italian study of general practitioners and hospital physicians

    Psychother Psychosom

    (2000)
  • G.J. Deckard et al.

    The occurrence and distribution of burnout among infectious diseases physicians

    J Infect Dis

    (1992)
  • K.M. Kash et al.

    Stress and burnout in oncology

    Oncology (Huntingt)

    (2000)
  • K.K. Guntupalli et al.

    Burnout in the internist–intensivist

    Intensive Care Med

    (1996)
  • C. Maslach et al.

    Maslach Burnout Inventory Manual

    (1996)
  • J.P. Rafferty et al.

    Validity of the Maslach Burnout Inventory for family practice physicians

    J Clin Psychol

    (1986)
  • D.A. Whippen et al.

    Burnout syndrome in the practice of oncologyresults of a random survey of 1,000 oncologists

    J Clin Oncol

    (1991)
  • G. Deckard et al.

    Physician burnoutan examination of personal, professional, and organizational relationships

    Med Care

    (1994)
  • P.A. Parker et al.

    Burnout, self- and supervisor-rated job performance, and absenteeism among nurses

    J Behav Med

    (1995)
  • L. Doan-Wiggins et al.

    Practice satisfaction, occupational stress, and attrition of emergency physicians. Wellness Task Force, Illinois College of Emergency Physicians

    Acad Emerg Med

    (1995)
  • J. Firth-Cozens

    Emotional distress in junior house officers

    Br Med J (Clin Res Ed)

    (1987)
  • M.F. Myers

    The well-being of physician relationships

    West J Med

    (2001)
  • J.M. Colford et al.

    The ravelled sleeve of care. Managing the stresses of residency training

    Jama

    (1989)
  • D.H. Novack et al.

    Calibrating the physician. Personal awareness and effective patient care. Working Group on Promoting Physician Personal Awareness, American Academy on Physician and Patient

    Jama

    (1997)
  • C.E. Lewis et al.

    How satisfying is the practice of internal medicine? A national survey

    Ann Intern Med

    (1991)
  • B.H. Mawardi

    Satisfactions, dissatisfactions, and causes of stress in medical practice

    Jama

    (1979)
  • L.M. Koran et al.

    House staff well-being

    West J Med

    (1988)
  • J.W. Smith et al.

    Emotional impairment in internal medicine house staff. Results of a national survey

    Jama

    (1986)
  • D.E. Girard et al.

    A prospective study of internal medicine residents’ emotions and attitudes throughout their training

    Acad Med

    (1991)
  • K. Hsu et al.

    Prevalence of depression and distress in a large sample of Canadian residents, interns, and fellows

    Am J Psychiatry

    (1987)
  • V.U. Collier et al.

    Stress in medical residencystatus quo after a decade of reform?

    Ann Intern Med

    (2002)
  • P. Sullivan et al.

    Results from CMA’s huge 1998 physician survey point to a dispirited profession

    Cmaj

    (1998)
  • G.O. Gabbard et al.

    The psychology of postponement in the medical marriage

    Jama

    (1989)
  • A. Melville

    Job satisfaction in general practiceimplications for prescribing

    Soc Sci Med [Med Psychol Med Sociol]

    (1980)
  • R.A. Schmoldt et al.

    Physician burnoutrecommendations for HMO managers

    HMO Pract

    (1994)
  • M.R. DiMatteo et al.

    Physicians’ characteristics influence patients’ adherence to medical treatmentresults from the Medical Outcomes Study

    Health Psychol

    (1993)
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    Tait D. Shanafelt, Jeff A. Sloan, and Thomas M. Habermann are from the Mayo Clinic, Rochester, Minnesota.

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