New approach to fighting burnout

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Medical doctors in the United States are twice as likely to experience symptoms of burnout as other workers, which can compromise quality of care and place patients at risk.

In a study in JAMA Internal Medicine, Mayo Clinic researchers suggest a new approach to fighting burnout: external professional coaching.

Defined by the World Health Organization as “feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy,” burnout creates problems for both physicians and the patients they treat.

This study, led by Liselotte Dyrbye, M.D. and Colin West, M.D., Ph.D., investigates the use of external professional coaching – focused on professional goal setting, work choices, professional relationships, and influencing change at work – to reduce burnout.

Though researchers have previously studied coaching in other contexts, this is the first study specifically exploring its effects on physician burnout.

“Helping physicians navigate career decisions and manage the stress of their job is crucial,” says Dr. Dyrbye.

“While many of these doctors have a good informal support system, professional coaches can address a variety of topics and needs, and provide a safe setting to admit perceived vulnerabilities and uncertainties.

We really think it can improve physicians’ ability to manage their careers and change the detrimental aspects of their work environments, so that ultimately they can do their job well without feeling overwhelmed.”

Participants – 88 practicing physicians – began the study by filling out several self-assessment questionnaires, querying for burnout, quality of life, resilience, and job satisfaction.

They then completed 6 sessions with a non-physician credentialed professional coach, who worked with the doctors on issues of their choice.

After those six sessions, the physicians filled out the same questionnaires to chart their progress.

Results were promising.

The doctors reported less burnout and a higher quality of life after coaching, as compared to before.

Notably, the researchers also administered these tests on physicians who were not coached. Across the same span of time, these physicians actually reported more emotional exhaustion and lower quality of life, showing how these symptoms can worsen if left unaddressed.

More research remains to be done on the efficacy of professional coaching when combined with other programs, but these results suggest it may be added to a growing list of evidence-based tools to support physicians and, by extension, the patients they serve. While useful, professional coaching should be offered in parallel to organizational efforts to improve the practice environment and address the underlying drivers of burnout among physicians.


Changes in medical practice have augmented stressors for already overburdened physicians, including increased scrutiny, accountability, time constraints, and increasing role definition by non-physicians, all with a concomitant decrease in workplace
control.

The growing mismatch between workload and sense of control, along with unique physician personality factors, contributes to widespread burnout.

One method to address burnout is professional coaching, drawing on strengths, questioning assumptions, and aligning values with purpose, to increase life and career satisfaction.

Burnout is characterized by a low sense of personal accomplishment, emotional exhaustion, cynicism and depersonalization.
Maslach, a pioneering burnout researcher, noted that burnout starts when “energy turns into exhaustion, involvement turns into cynicism, and efficacy turns into ineffectiveness.”
Numerous studies note rates of burnout between 25 % and 60 % in a wide spectrum of specialties.
A 2012 U.S. study found that 47 % of 7,288 physicians experienced burnout, considerably higher than in the general population.

Of note, over 50 % of 578 general internists experienced burnout, second only to emergency physicians.

In addition to deleterious effects on physician well-being, burnout contributes to decreased physician retention, and correlates with self-reported suboptimal care, patient noncompliance, andmedical errors.

Moreover, physician distress contributes to staff turnover, failing morale, and decreased
cohesiveness of the entire healthcare enterprise.
The etiology of physician burnout not only includes growing external demands and decreased workplace control; socialization factors also play a role. Medical training emphasizes perfectionism, denial of personal vulnerability, and delayed
gratification.

Traits such as compulsiveness, guilt, and self-denial may facilitate success in medical education and training; however, in a long-term career, these same traits can
fuel feelings of inadequacy.

Set in a professional culture that stigmatizes weakness and self-care these factors contribute to burnout, when external pressures over whelminternal sense of control.

Professional coaching, long used by executives and making inroads within the medical profession, may lessen burnout.

Coaching involves “partnering with clients in a thought provoking and creative process that inspires them to maximize their personal and professional potential”.29 Coaching presupposes sufficient inner resources and the necessary expertise to tackle life challenges, and provides the guidance to harness these internal mechanisms.

A core coaching construct is amplifying a client’s internal locus of control, defined as the
belief that one’s actions have as much or more impact on life outcomes than external forces or individuals.

Studies in a variety of professions note an inverse correlation between internal locus of control and burnout.

In addition, coaching increases self-efficacy and self-determination, vital counterbalances to burnout, and critical for physicians rapidly losing workplace control.

The overarching premise of professional coaching, in fact, is that people have more
control over their life circumstances and satisfaction than they typically realize.
At the heart of coaching lies an iterative process of examining seemingly fixed thoughts and circumstances.

Clients learn to question automatic thoughts, beliefs, and perceptions, thus discerning between facts, assumptions, and interpretations.
Consciously shifting perspective is another technique for revealing new options for action, thus increasing choice and control.

By exercising authority over their thoughts and beliefs, people can move from reactivity to purposeful response.

Enhanced self-reflection and self-awareness are key to improving physician resilience the flexibility to withstand and bounce-back from external stressors, and are foundational to the coaching enterprise.
Coaching also helps expose and challenge negative emotional patterns, including self-defeating inner dialogue (e.g., “People think I’m a great physician, but they don’t see the real me.”)

In addition, coaches encourage clients to focus awareness of their cognitive, emotional, and physical experience in the present, a central tenet of mindfulness.

Coaches help clients clarify values and align them with professional and personal goals, an objective of known importance in decreasing physician burnout.

Rather than assign uninspiring to-do lists, coaches build motivation by eliciting solutions from clients, thus increasing personal investment, and making next steps obvious, possible, and even invigorating.
Helping clients identify, bolster, and apply strengths in challenging situations is another technique, important in a medical culture known to malign personal weakness.

Coaching applies techniques from the field of positive psychology, the scientific study of the strengths and virtues that enable optimal functioning of individuals and communities.

ithout minimizing painful emotions, positive psychology emphasizes engagement, meaning, and accomplishment.

Engagement, “characterized by energy, involvement, and efficacy—the direct opposites of the three burnout dimensions,” is particularly important.

While deepening engagement with work, coaches also attempt to revive creative pursuits (e.g., music, art, writing) and hobbies, which can serve as meaningful sources of renewal.

Other successful interventions for physician burnout include many strategies embedded in professional coaching.

Mindfulness training decreases burnout in physicians, as do discussion groups and other means of promoting self-reflection and awareness.

Other aspects of coaching that appear promising for ameliorating physician burnout include aligning values with professional duties and increasing one s sense of
purpose and engagement,

Integral for coaching and vitally important for quality patient care and the overall integrity of health systems is helping physicians reach their highest potential.

From a non judgmental and championing stance, coaches help clients envision
and move toward peak life and work performance.
It is important to compare coaching with other behavioral interventions.

Cognitive-behavioral therapy (CBT,) a diagnosis-driven and goal-oriented method of improving coping, modifies thought patterns to improve coping and encourages clients to question whether negative thoughts are actually untested assumptions.

Unlike coaching, CBT is classically delivered in a prescriptive and standardized manner.50 The professional coaching emphasis on wellness, enhanced function, accountability, and achieving goals differs from the pathology-based and diagnosis-based fields of traditional psychology and psychiatry, and thus carries less stigma.

Coaching also considers the client the expert on their life, evoking Integral for coaching and vitally important for quality patient care and the overall integrity of health systems is helping physicians reach their highest potential.

From a non judgmental and championing stance, coaches help clients envision and move toward peak life and work performance.

It is important to compare coaching with other behavioral interventions. Cognitive-behavioral therapy (CBT,) a diagnosis-driven and goal-oriented method of improving coping, modifies thought patterns to improve coping and encourages clients to question whether negative thoughts are actually untested assumptions.

Unlike coaching, CBT is classically delivered in a prescriptive and standardized manner.

The professional coaching emphasis on wellness, enhanced function, accountability, and achieving goals differs from the pathology-based and diagnosis-based fields of traditional psychology and psychiatry, and thus carries less stigma.

Coaching also considers the client the expert on their life, evoking wisdom from clients’ experience, as opposed to the teaching and advising characteristic of mentoring.
Although all involve behavioral change, coaching is not psychological treatment and is oriented toward highfunctioning individuals.

Coaching is not appropriate with active psychiatric illness (such as major depression, psychosis, or obsessive compulsive disorder), and not effective in the setting of active substance abuse. Coaches are not trained mental health professionals and should have a low threshold for recommending psychological and/or psychiatric evaluation.

Since burnout and depression often co-exist, in the absence of a major depressive episode, physicians can choose whichever approach they prefer, as overlap exists.
Coaching takes place in person or by phone.

For physicians suffering from burnout, weekly or biweekly 1-hour sessions would likely be required for 6 to 12months.

Widely employed in the business world, studies reveal financial return of times on investment.

In addition, coaching can strengthen diverse professional skills, including decisiveness, time management, productivity, communication, leadership, and teamwork.


Journal information: JAMA Internal Medicine
Provided by Mayo Clinic

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