Dike Drummond MDStop Physician Burnout: What to Do When Working Harder Isn't Working

This is an important book for doctors. Too many doctors-in UK and internationally are burnt out. It's estimated 1 in 3 doctors are burnt out at any point in time. Nearly all doctors have had periods of burnout during their career. It's an occupational risk in many settings- and medicine is one of the most obvious professions to suffer widely and deeply from it. The author is a doctor, and works with doctors, but what he describes in doctors can be seen in several other settings- law enforcement and military settings come to mind immediately, but it can catch people in many other jobs. What Drummond says here for doctors can be adapted to other burnout settings readily.Burnout matters for many reasons. Christina Maslach (of the inventory) describes burnout as "an erosion of the soul caused by a deterioration of one's values, dignity, spirit and will." It matters to the affected individual because it is unpleasant in its own right, and also because it sets the ground for more serious subsequent problems- mental health issues such as depression, suicide, alcohol and drug problems. It sets the ground for social problems such as relationship breakdown. It sets the ground for work place issues to arise.It matters more widely because illness in a professional such as a doctor is not just an individual tragedy to the affected doctor but is also a risk to the wider world- their patients,their colleagues, their organisations, their families. Burnt out doctors are more likely to make mistakes, in basic politeness, and in their medicine, run up complaints, run up negligence suits, become disruptive at work, end up with regulatory problems. They have moved over time from enthusiastic and helpful young doctors to becoming disillusioned, dispirited, exhausted, often cynical mid career doctors. Sometimes they hide this outcome as "battle hardening" and "hard won experience" from "fighting in the trenches, in the front line infantry", against disease and against bureaucracy." As doctors we are often a bit too fond of military metaphors, even though some have campaigned against them.Burn out is one of the main pathways through which good doctors move into poor performance and it is bad for doctors, patients and the healthcare system. It's needless, inhumane to the sufferer (who usually feels badly done to), inhumane to others (who get less well treated) and inefficient and expensive to healthcare organisations (burnt out staff generate complaints, malpractice costs, work place disruption, and high staff turnover.) Too often the problems only emerge as end stage symptoms- complaints and disciplinary issues- when they could, and should, have been headed off upstream by sensible personal expectation setting, facilitated by decent personnel management strategies. For individual doctors reading and acting on the ideas in this book is one prophylactic measure you can make quickly. Do it now.The high prevalence of burnout in doctors is a significant problem for doctors, patients and health care organisations alike generating misery and consuming personal and financial resources. There is no reason why we should allow health care systems to run in this way. It's wrong for everybody. In the UK the GMC states that a doctor "must make care of the patient their first concern" I have long thought that there is an unacknowledged presupposition in here which is, "The doctor needs to maintain themselves in such a condition that they can make care of the patient their first concern, and be supported by their employers so that this can happen." In the UK the NHS has never had any form of staff maintenance programme- they just pay them and moan if they go off sick. High standard professionals are very expensive pieces of human resource- that cost a fortune to grow and develop over time. You wouldn't buy a piece of machinery such as an MRI scanner and not have a maintenance schedule would you? Why do we assume human resources need any less maintenance? ( I discuss this further in chapter 12 "How to stay sane and healthy as a doctor"of my book  The New GP's Handbook: How to Make a Success of Your Early Years as a GP ) In the current UK NHS (and judging from this book and others such as  First Do No Harm: Being a Resilient Doctor in the 21st Century  and  Doctors and Their Health  this strategy is used in USA and many other countries as well) it's assumed doctors will keep on running with next to no maintenance for many years. It's not a true assumption and the current significant shortages of general practitioners and A+E staff in the UK are a consequence of this. Older doctors are retiring early. Mid career doctors are moving sideways. Younger doctors are either not entering certain specialities or moving abroad soon after qualifying. Doctors' children are not following their parents into the profession as much as they used to. Meanwhile ministers and managers and health educators are wondering where in the world they'll get some more staff from. (And there's some significant moral criticism to be made of this strategy of denuding other countries of their own scarce healthcare professional resource rather than generating and training enough healthcare staff from within our own country) Patients are wondering when, by whom and if they'll get seen.When will a healthcare system realise that to look after patients well it needs to look after its professionals well? All jobs come down to a balance of satisfaction, salary and support, and if that balance is disrupted unfavourably then the professionals are a skilled, intellectually agile and mobile workforce, and will move.This book is a welcome arrival in the quest to sort out these problems- both for physicians and for patients. There's a current suggestion from Don Berwick that healthcare can be aligned along three organising goals-Enhancing the patient experienceImproving population healthReducing costsDrummond suggests- and I and I think many others interested in doctors health issues would agree, that there should be a fourth aim of keeping the workforce healthy and motivated. Staff cannot give what they haven't got- and burnt out doctors and other healthcare staff are running on unpaid overdrafts, not healthy balances. If staff in healthcare organisations are burnt out they will not be able or willing to help towards the goals of better patient care. You'll get some work out of them, and patients will get seen and treated, but the joy, the fun, the connections that make healthcare about far more than its technicalities will go missing. The guidelines may get followed, but the care may not be very good. In the end you can end up with staff doing the system's business, not the patient's- and with scenarios such as the one described in this book  The BMJ Mid Staffordshire Inquiry book  from Mid-Staffordshire, UK.Drummond's book is a very helpful manual for people who have got burnt out, or who may be either recovering from, or about to head towards it- that's most doctors- and many other healthcare staff. He describes the prevalence, the symptoms, the impact, the physiology and many helpful strategies for dealing with it. His model of our energetic bank accounts is very useful- and the division of them into physical, emotional and spiritual is helpful. His description of how we need rest and recuperation to replenish these is excellent. We do as doctors need to care for our patients- but we cannot do this for long at the price of ourselves- we need to regenerate ourselves so that we are ready to really care for patients at our next clinic. Some years ago Roger Neighbour, in his classic text,  The Inner Consultation: How to Develop an Effective and Intuitive Consulting Style of Roger Neighbour 2nd (second) Revised Edition on 01 October 2004 described the concept of "housekeeping" between consultations- the idea being that we should sweep clear any distractions and intrusions before the next patient comes into our consulting room. Many doctors could see what he was saying, but systematically most dismissed it as naive and unrealistic. The NHS superstructures didn't even hear it, and simply looked at numbers of patients and appointments. Drummond's book is a plea for some medical housekeeping on an industrial scale to keep our profession (which has huge strengths and great value) actually able to function. He uses the vigourous term "head trash" and there's a lot of it about in all of us.Drummond is very good at summarising the hidden curriculum of medical school- the view that is never actually stated, but somehow an expectation is communicated that doctors should be workaholics, superhero, emotion free, lone ranger and perfectionist. They should also be tireless and able to function as well at the end of a long shift as at the beginning. It's an impossible set of expectations to fulfil, and the sooner we as doctors drop them the better. One bit Drummond misses out here is the insights from cognitive psychology (e.g. as summarised in this book  Willpower: Rediscovering Our Greatest Strength ) about how we make decisions and about how our ability to do this well over extended time periods is actually limited. Humans simply cannot do high standard, high concentration intellectual and decision making work for too long before the processes go astray. We need breaks for physical and mental regeneration. We don't need an extra meeting squeezed in at lunchtime.Drummond's account of the difference between a problem (which is sorted by a solution) and a dilemma- the two horns of which have to be held in balance, acknowledged, lived with, and navigated between is a helpful model. His suggestion that we should each take time to build our ideal practice description and then see how much this idea overlaps with our current jobs is very helpful. He reckons that if he speaks with physicians in or near burn out when they do this many of them find some small changes in their current set up take them close enough to what they want and allow them a good accommodation with their work. Drummond is very strong on how well doctors are motivated by away from motivation- don't do this and you won't get a complaint. He encourages us to notice more than problems, and to set clear positive goals that compel us to move towards them. He sees burnout as a frustration signal telling us something needs to change. He hopes people will pick up the signals for themselves, or from some kind and gentle other (e.g. a nudge from a spouse, or a good colleague) rather than running into the brick wall of divorce, or malpractice or regulatory problems. The more doctors read this book, the more likely such hopes are to be realised. Healthy doctors make good decisions for themselves and with and about their patients. Burnt out doctors cannot always see what they or their patients need.There's a huge amount in this book that will help people suffering from burnout to recognise their problem and do something about it. Drummond's message is to all doctors (as all of us are at risk of burning out- even if we're not there already) and to the wider management of healthcare systems- employ good people and help them to do a good job- don't run them into the ground. I think Drummond has performed an act that will help in healing the lives of many doctors and may if adopted at the higher levels of health care systems make them more healthy places to work within too. This will be good for doctors who need to get their burnout issues sorted out, and will be good for patients- as they will get to see healthier, happier and more alert doctors who will be able to treat them with greater accuracy and greater interest and kindness.I can enthusiastically recommend this book to my fellow doctors either for current needs or future prophylaxis. It may well help people in other walks of life suffering from burnout too.

Very well written review about such an important subject that is often overlooked in medical schools the world over. I would recommend to all doctors to read through and follow the author’s advice.

Good book for those who have had "enough". I’ve passed this on to many people. It’s a little American-focussed but the principles are sound.

Despite its Americanisms this book has a great deal of good sense to impart. It is designed in manageable chunks to digest and makes for an easy read. Well worth buying if you really want to make a change the way you run your life, or allow your life to run you.