An epidemic is looming, but the condition spawning this epidemic is atypical. Prevalence appears to be high among physicians. Close contacts are not likely to suffer from direct infection, as the condition is not spread by airborne particles or physical contact; however, close contacts do suffer from complications of the condition. The condition I am describing is A-fib – administrative fibrillation.
Administrative fibrillation is a condition of rapid, disorganized administrative activity triggered by overcommitment. It occasionally co-mingles with a related condition, academic fibrillation. A detailed description of the latter condition is beyond the scope of this manuscript.
Age, achievement and ambition are risk factors for administrative fibrillation. Age is relevant because greater administrative responsibilities are often afforded to older and more experienced individuals. Achievement is relevant because of the “curse of competence,” whereby an achiever receives an overabundance of administrative opportunities owing to past successes. Ambition is the most dangerous risk factor, providing a steady stream of stimulation to the fibrillation process until burnout occurs. A powerful multiplier effect exists when multiple risk factors are present.
The affected physician may first exhibit a degree of superficiality. As the disease progresses, he or she becomes less engaged in minor administrative roles. Ultimately, more global dysfunction develops. Over time, these symptoms can impact clinical roles as well, undermining the core of the physician identity and jeopardizing patient care.
Embolization is the most feared consequence of administrative fibrillation. Lack of focus, disorganization and lack of productivity may embolize from the professional arena to the personal arena, affecting family function, civic involvement and social relationships. There is no anticoagulant. One must treat the underlying cause.
Pope John Paul II described the relationship between humans and work when he said, “However true it may be that man is destined for work and called to it, in the first place work is for man and not man for work.”1 He also stated that man does not gain dignity from his work but brings dignity to his work.
For the physician with administrative fibrillation, work has ceased being “for” him. The fundamental problem may be in the man, not in the work, and the initial intervention should be personal. The physician will need to find balance and perspective by clarifying priorities, learning to say no and developing relationships and interests outside of work. As Mark Twain is quoted as saying, “The physician who knows only medicine, knows not even medicine.”
Professional intervention is also important. Inefficiency, waste and bureaucracy not only contribute to physician overwork and burnout but also affect quality of care. Initiatives to redesign our practices are being spearheaded by groups such as the AAFP and the Institute for Healthcare Improvement (IHI). As Don Berwick, MD, MPP, president and CEO of IHI, has stated, “Every system is perfectly designed to achieve the results it achieves.”2 Only fundamental redesign – in our practices and in our lives – will give us different results.
It has been said that “A-fib begets A-fib.” The longer a physician is afflicted, the less likely he or she will find a way out before personal or professional morbidity have been realized. Physicians must not be hesitant to confirm this diagnosis in themselves and their colleagues and to initiate appropriate change.