Physician Well-Being: Prioritizing Your Own Health Through a Personal Health Improvement Plan

 

You can’t take care of others optimally unless you first take care of yourself. Start today.

Fam Pract Manag. 2020 Jan-Feb;27(1):27-32.

Author disclosure: no relevant financial affiliations disclosed.

Chris is a family physician who provided the full spectrum of primary care for nearly 20 years. She delivered babies for young mothers she had taken care of since they were teens, covered hospital admissions, and took call in a small group practice. She was also a passionate teacher and leader to medical students, and she contributed to a community-based research collaborative focused on domestic violence prevention.

I worked with Chris for many years and watched her give her all to medicine. When she left her position, she felt angry, isolated, unsupported, anxious, distrusting, guilty, and worthless. These feelings didn’t develop after one bad day at work. They came after years of unrelenting chronic stress, which came like waves continuously crashing on the shore. From the outside, it may have seemed like Chris no longer cared. But she did care. She cared so much and aimed so high that it may have contributed to her fatigue and disengagement.

When Chris left in search of greener pastures, she shared that she had “nothing left to give.” She needed a fresh start. But three years into a new practice, she began having similar thoughts and feelings. The cycle was repeating. Her tank was once again near empty. We stayed in touch, and when one of her family members was diagnosed and soon died of cancer, Chris stopped working. She felt numb, absent from human functions and feelings, dehumanized. Depersonalization is what we often call it.

Chris had spent so many years taking care of so many people that she had no energy left to take care of herself. It had finally caught up with her.

KEY POINTS

  • Physicians must take care of themselves to have the physical and emotional energy to take care of others.

  • Saying “no” to perfection, saying “yes” to help from your team, and getting in touch with your emotions are all key to self-care.

  • To get started with self-care, complete the self SWOT and the Personal Health Improvement Plan.

PRIORITIZING OUR OWN HEALTH

Unfortunately, my colleague’s story isn’t uncommon in health care today. Diminished resources and expanded expectations have contributed to a growing epidemic of burnout among physicians and other health professionals, which has detrimental effects on our practices and our patients.14 Medicine, while very rewarding, is extremely demanding, and the culture and environment have been demonstrably toxic to the workforce beginning as early as the first year of medical school.57 Evidence-based strategies are emerging to address these factors and to support both personal and system wellness, but more research is needed.8,9

Drs. Sinsky and Bodenheimer have made the case that health care organizations need to pursue the “Quadruple Aim,” which adds the goal of improving the work life of physicians and staff

ABOUT THE AUTHOR

Dr. Pipas is a family physician and Professor of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, and the Department of Medical Education at the Geisel School of Medicine at Dartmouth. She is the author of A Doctor’s Dozen: 12 Strategies for Personal Health and a Culture of Wellness and has been recognized as a leader in wellness, education, research, and clinical care. Her recent awards include the 2019 Society of Teachers of Family Medicine Humanism Award and the 2019 Family Medicine Education Consortium This We Believe Award. Dr. Pipas serves as the chief wellness officer for CaseNetwork.

Author disclosure: no relevant financial affiliations disclosed.

References

show all references

1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general U.S. working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600–1613....

2. Dewa CS, Loong D, Bonato S, Thanh NX, Jacobs P. How does burnout affect physician productivity? A systematic literature review. BMC Health Serv Res. 2014;14:325.

3. Shanafelt TD, Dyrbye LN, West CP, Sinsky CA. Potential impact of burnout on the U.S. physician workforce. Mayo Clin Proc. 2016;91(11):1667–1668.

4. Ratanawongsa N, Roter D, Beach MC, et al. Physician burnout and patient-physician communication during primary care encounters. J Gen Intern Med. 2008;23(10):1581–1588.

5. Brazeau CM, Shanafelt T, Durning SJ, et al. Distress among matriculating medical students relative to the general population. Acad Med. 2014;89(11):1520–1525.

6. Dyrbye LN, West CP, Satele D, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443–451.

7. Leiter MP, Maslach C. Six areas of worklife: a model of the organizational context of burnout. J Health Hum Serv Adm. 1999;21(4):472–489.

8. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017;92(1):129–146.

9. Panagioti M, Panagopoulou E, Bower P, et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Medic. 2017;177(2):195–205.

10. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–576.

11. Sanchez-Reilly S, Morrison LJ, Carey E, et al. Caring for oneself to care for others: physicians and their self-care. J Support Oncol. 2013;11(2):75–81.

 
 

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