Moral Distress and Moral Strength Among Clinicians in Health Care Systems: A Call for Research

Connie M. Ulrich and Christine Grady
NAM Perspectives. 
https://doi.org/10.31478/201909c


Here is an excerpt:

Evidence shows that dissatisfaction and wanting to leave one’s job—and the profession altogether—often follow morally distressing encounters. Ethics education that builds cognitive and communication skills, teaches clinicians ethical concepts, and helps them gain communication skills and confidence may be essential in building moral strength. One study found, for example, that among practicing nurses and social workers, those with the least ethics education were also the least confident, the least likely to use ethics resources (if available), and the least likely to act on their ethical concerns. In this national study, as many as 23 percent of nurses reported having had no ethics education at all. But the question remains—is ethics education enough?

Many factors likely support or hinder a clinician’s capacity and willingness to act with moral strength. More research is needed to investigate how interdisciplinary ethics education and institutional resources can help nurses, physicians, and others voice their ethical concerns, help them agree on morally acceptable actions, and support their capacity and propensity to act with moral strength and confidence. Research on moral distress and ethical concerns in everyday clinical practice can begin to build a knowledge base that will inform clinical training—in both educational and health care institutions—and that will help create organizational structures and processes to prepare and support clinicians to encounter potentially distressing situations with moral strength. Research can help tease out what is important and predictive for taking (or not taking) ethical action in morally distressing circumstances. This knowledge would be useful for designing strategies to support clinician well-being. Indeed, studies should focus on the influences that affect clinicians’ ability and willingness to become involved or take ownership of ethically-laden patient care issues, and their level of confidence in doing so.

DC Types Have Been Flocking to Shrinks Ever Since Trump Won.

And a Lot of the Therapists Are Miserable.

Britt Peterson
www.washingtonian.com
Originally published July 14 2019

Here two excerpts:

In Washington, the malaise appears especially pronounced. I spent the last several months talking to nearly two dozen local therapists who described skyrocketing levels of interest in their services. They told me about cases of ordinary stress blossoming into clinical conditions, patients who can’t get through a session without invoking the President’s name, couples and families falling apart over politics—a broad category of concerns that one practitioner, Beth Sperber Richie, says she and her colleagues have come to categorize as “Trump trauma.”

In one sense, that’s been good news for the people who help keep us sane: Their calendars are full. But Trump trauma has also created particular clinical challenges for therapists like Guttman and her students. It’s one thing to listen to a client discuss a horrible personal incident. It’s another when you’re experiencing the same collective trauma.

“I’ve been a therapist for a long time,” says Delishia Pittman, an assistant professor at George Washington University who has been in private practice for 14 years. “And this has been the most taxing two years of my entire career.”

(cut)

For many, in other words, Trump-related anxieties originate from something more serious than mere differences about policy. The therapists I spoke to are equally upset—living through one unnerving news cycle after another, personally experiencing the same issues as their patients in real time while being expected to offer solace and guidance. As Bindeman told her clients the day after Trump’s election, “I’m processing it just as you are, so I’m not sure I can give you the distance that might be useful.”

This is a unique situation in therapy, where you’re normally discussing events in the client’s private life. How do you counsel a sexual-assault victim agitated by the Access Hollywood tape, for example, when the tape has also disturbed you—and when talking about it all day only upsets you further? How about a client who echoes your own fears about climate change or the treatment of minorities or the government shutdown, which had a financial impact on therapists just as it did everyone else?

Again and again, practitioners described different versions of this problem.

The info is here.

Physicians struggle with their own self-care, survey finds

Jeff Lagasse
Healthcare Finance
Originally published July 26, 2019

Despite believing that self-care is a vitally important part of health and overall well-being, many physicians overlook their own self-care, according to a new survey conducted by The Harris Poll on behalf of Samueli Integrative Health Programs. Lack of time, job demands, family demands, being too tired and burnout are the most common reasons for not practicing their desired amount of self-care.

The authors said that while most doctors acknowledge the physical, mental and social importance of self-care, many are falling short, perhaps contributing to the epidemic of physician burnout currently permating the nation's healthcare system.

What's The Impact

The survey -- involving more than 300 family medicine and internal medicine physicians as well as more than 1,000 U.S. adults ages 18 and older -- found that although 80 percent of physicians say practicing self-care is "very important" to them personally, only 57 percent practice it "often" and about one-third (36%) do so only "sometimes."

Lack of time is the primary reason physicians say they aren't able to practice their desired amount of self-care (72%). Other barriers include mounting job demands (59%) and burnout (25%). Additionally, almost half of physicians (45%) say family demands interfere with their ability to practice self-care, and 20 percent say they feel guilty taking time for themselves.

The info is here.

The Business of Health Care Depends on Exploiting Doctors and Nurses

Danielle Ofri
The New York Times
Originally published June 8, 2019

One resource seems infinite and free: the professionalism of caregivers.

You are at your daughter’s recital and you get a call that your elderly patient’s son needs to talk to you urgently.  A colleague has a family emergency and the hospital needs you to work a double shift.  Your patient’s M.R.I. isn’t covered and the only option is for you to call the insurance company and argue it out.  You’re only allotted 15 minutes for a visit, but your patient’s medical needs require 45.

These quandaries are standard issue for doctors and nurses.  Luckily, the response is usually standard issue as well: An overwhelming majority do the right thing for their patients, even at a high personal cost.

It is true that health care has become corporatized to an almost unrecognizable degree.  But it is also true that most clinicians remain committed to the ethics that brought them into the field in the first place.  This makes the hospital an inspiring place to work.

Increasingly, though, I’ve come to the uncomfortable realization that this ethic that I hold so dear is being cynically manipulated.

By now, corporate medicine has milked just about all the “efficiency” it can out of the system.  With mergers and streamlining, it has pushed the productivity numbers about as far as they can go.

But one resource that seems endless — and free — is the professional ethic of medical staff members.

This ethic holds the entire enterprise together.  If doctors and nurses clocked out when their paid hours were finished, the effect on patients would be calamitous.  Doctors and nurses know this, which is why they don’t shirk.  The system knows it, too, and takes advantage.

The demands on medical professionals have escalated relentlessly in the past few decades, without a commensurate expansion of time and resources.  For starters, patients are sicker these days.  The medical complexity per patient — the number and severity of chronic conditions — has steadily increased, meaning that medical encounters are becoming ever more involved.  They typically include more illnesses to treat, more medications to administer, more complications to handle — all in the same-length office or hospital visit.

The information is here.

Doctors are burning out twice as fast as other workers. The problem's costing the US $4.6 billion each year.

Lydia Ramsey
www.businessinsider.com
Originally posted May 31, 2019

Here is an excerpt:

To avoid burnout, some doctors have turned to alternative business models.

That includes new models like direct primary care, which charges a monthly fee and doesn't take insurance. Through direct primary care, doctors manage the healthcare of fewer patients than they might in a traditional model. That frees them up to spend more time with patients and ideally help them get healthier.

It's a model that has been adopted by independent doctors who would otherwise have left medicine, with insurers and even the government starting to take notes on the new approach.

Others have chosen to set their own hours by working for sites that virtually link up patients with doctors.

Even so, it'll take more to cut through the note-taking and other tedious tasks that preoccupy doctors, from primary-care visits to acute surgery. It has prompted some to look into ways to alleviate how much work they do on their computers for note-taking purposes by using new technology like artificial-intelligence voice assistants.

The info is here.

Promoting competent and flourishing life-long practice for psychologists: A communitarian perspective

Wise, E. H., & Reuman, L. (2019).
Professional Psychology: Research and Practice, 50(2), 129-135.

Abstract

Based on awareness of the challenges inherent in the practice of psychology there is a burgeoning interest in ensuring that psychologists who serve the public remain competent. These challenges include remaining current in our technical skills and maintaining sufficient personal wellness over the course of our careers. However, beyond merely maintaining competence, we encourage psychologists to envision flourishing lifelong practice that incorporates positive relationships, enhancement of meaning, and positive engagement. In this article we provide an overview of the foundational competencies related to professionalism including ethics, reflective practice, self-assessment, and self-care that underlie our ability to effectively apply technical skills in often complex and emotionally challenging relational contexts. Building on these foundational competencies that were initially defined and promulgated for academic training in health service psychology, we provide an initial framework for conceptualizing psychologist well-being and flourishing lifelong practice that incorporates tenets of applied positive psychology, values-based practice, and a communitarian-oriented approach into the following categories: fostering relationships, meaning making and value-based practice, and enhancing engagement. Finally, we propose broad strategies and specific examples intended to leverage current continuing education mandates into a broadly conceived vision of continuing professional development to support enhanced psychologist functioning for lifelong practice.

The info is here.

134 Activities to Add to Your Self-Care Plan

GoodTherapy.org Staff
www.goodtherapy.org
Originally posted June 13, 2015

At its most basic definition, self-care is any intentional action taken to meet an individual’s physical, mental, spiritual, or emotional needs. In short, it’s all the little ways we take care of ourselves to avoid a breakdown in those respective areas of health.

You may find that, at certain points, the world and the people in it place greater demands on your time, energy, and emotions than you might feel able to handle. This is precisely why self-care is so important. It is the routine maintenance you need do to function your best not only for others, but also for yourself.

GoodTherapy.org’s own business and administrative, web development, outreach and advertising, editorial and education, and support teams have compiled a massive list of some of their own personal self-care activities to offer some help for those struggling to come up with their own maintenance plan. Next time you find yourself saying, “I really need to do something for myself,” browse our list and pick something that speaks to you. Be silly, be caring to others, and make your self-care a priority! In most cases, taking care of yourself doesn’t even have to cost anything. And because self-care is as unique as the individual performing it, we’d love to invite you to comment and add any of your own personal self-care activities in the comments section below. Give back to your fellow readers and share some of the little ways you take care of yourself.

The list is here.

Note: Self-care enhances the possibility of competence practice.  Good self-care skills are important to promote ethical practice.

Not “burnout,” not moral injury—human rights violations

Pamela Wible
www.idealcare.org
Originally posted March 18, 2019

Here is an excerpt:

Moral injury now extends beyond combat veterans to include physicians in 2018 when Dean and Talbot announced their opposition and alternative to the label physician “burnout.” They believe (as I do) that physician cynicism, exhaustion, and decreased productivity are symptoms of a broken system. Economic forces, technological demands, and widespread intergenerational physician mental health wounds have culminated in a highly dysfunctional and toxic health care system in which we find ourselves in daily forced betrayal of our deepest values.

Manifestations of moral injury in victims include self-harm, poor self-care, substance abuse, recklessness, self-defeating behaviors, hopelessness, self-loathing, and decreased empathy. I’ve witnessed all far too frequently among physicians.

Yet moral injury is not an official diagnosis. No specific solutions are offered at medical institutions to combat physician moral injury though moral injury treatment among military may include listening circles (where veterans share battlefield stories), forgiveness rituals, and individual therapy. The fact is most victims of moral injury struggle on their own.

With no evidence-based treatments for physician moral injury and zero progress after forty years of burnout prevention, what next? Enter the real diagnosis—human rights violations—with clear evidence-based solutions.

The info is here.

In battle against doctor burnout, reading—for fun—is fundamental

Sara Berg
American Medical Association News
Originally posted January 18, 2019

Here is an excerpt:

How reading replenishes

One survey of 513 physicians examined the impact of non-medical reading habits on burnout. The chances of emotional exhaustion or depersonalization fell as physicians became more consistent readers.

When compared to nonreaders, the relative risk of burnout for consistent readers—those who read at least one book per month—fell by 19 percent across the emotional exhaustion and 44 percent across the depersonalization domain.

In an unpublished study by Dr. Marchalik, more than 200 urology trainees were surveyed about work characteristics, as well as relaxation techniques. These included watching movies, meditation, yoga, reading and other ways of relaxing. Meditation, exercise and yoga were not protective against burnout— but reading was.

Controlling for the biggest predictors of burnout, which were resident level, work hours and gender, reading made an impact: the odds of burnout decreased by 59 percent for residents who read for relaxation. A similar effect was seen in Dr. Marchalik’s national survey of palliative care providers, in which the odds of burnout dropped by 39 percent for readers, even when controlling for age, clinical discipline and the presence of fatigue.

The info is here.

What is ‘moral distress’? A narrative synthesis of the literature

Georgina Morley, Jonathan Ives, Caroline Bradbury-Jones, & Fiona Irvine

Nursing Ethics

First Published October 8, 2017 Review Article  

https://doi.org/10.1177/0969733017724354

Introduction

The concept of moral distress (MD) was introduced to nursing by Jameton who defined MD as arising, ‘when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. MD has subsequently gained increasing attention in nursing research, the majority of which conducted in North America but now emerging in South America, Europe, the Middle East and Asia. Studies have highlighted the deleterious effects of MD, with correlations between higher levels of MD, negative perceptions of ethical climate and increased levels of compassion fatigue among nurses. Consensus is that MD can negatively impact patient care, causing nurses to avoid certain clinical situations and ultimately leave the profession. MD is therefore a significant problem within nursing, requiring investigation, understanding, clarification and responses. The growing body of MD research, however, is arguably failing to bring the required clarification but rather has complicated attempts to study it. The increasing number of cited causes and effects of MD means the term has expanded to the point that according to Hanna and McCarthy and Deady, it is becoming an ‘umbrella term’ that lacks conceptual clarity referring unhelpfully to a wide range of phenomena and causes. Without, however, a coherent and consistent conceptual understanding, empirical studies of MD’s prevalence, effects, and possible responses are likely to be confused and contradictory.

A useful starting point is a systematic exploration of existing literature to critically examine definitions and understandings currently available, interrogating their similarities, differences, conceptual strengths and weaknesses. This article presents a narrative synthesis that explored proposed necessary and sufficient conditions for MD, and in doing so, this article also identifies areas of conceptual tension and agreement.

The research is here.

Why Are Doctors Killing Themselves?

The Practical Professional in Healthcare
October/November 2018

Here is an excerpt:

The nation loses 300 to 400 physicians each year, the equivalent of two large medical school classes, and more than a million patients lose their doctor.  According to a new research study encompassing data from the past ten years, physicians are committing suicide at a rate that’s more than twice as high as the average population—higher even than for veterans.

With a critical shortage of physicians looming and advocates like Pamela Wible calling attention to the problem, the increasingly urgent question remains: Why are doctors killing themselves? And what can be done to help?  In response, researchers are ramping up their efforts to understand the causes of
physician suicide; leading hospitals, medical schools and professional organizations are pioneering new programs and interventions; and regulators are reconsidering how they might revise the licensing/renewal process to support their efforts.

The info is here.

There are several other articles on physician self-care, which applies to other helping professions.

Psychological health profiles of Canadian psychotherapists: A wake up call on psychotherapists’ mental health

Laverdière, O., Kealy, D., Ogrodniczuk, J. S., & Morin, A. J. S.
(2018) Canadian Psychology/Psychologie canadienne, 59(4), 315-322.
http://dx.doi.org/10.1037/cap0000159

Abstract

The mental health of psychotherapists represents a key determinant of their ability to deliver optimal psychological services. However, this important topic is seldom the focus of empirical investigations. The objectives of the current study were twofold. First, the study aimed to assess subjective ratings of mental health in a broad sample of Canadian psychotherapists. Second, this study aimed to identify profiles of psychotherapists according to their scores on a series of mental health indicators. A total of 240 psychotherapists participated in the survey. Results indicated that 20% of psychotherapists were emotionally exhausted and 10% were in a state of significant psychological distress. Latent profile analyses revealed 4 profiles of psychotherapists that differed on their level of mental health: highly symptomatic (12%), at risk (35%), well adapted (40%), and high functioning (12%). Characteristics of the profiles are discussed, as well as potential implications of our findings for practice, trainee selection, and future research on psychotherapists’ mental health.

Here is part of the Discussion:

Considering that 12% of the psychotherapists were highly symptomatic and that an additional 35% could be considered at risk for significant mental health problems, the present findings raise troubling questions. Were these psychotherapists adequately prepared to help clients? From the perspective of attachment theory, the psychotherapist functions as an attachment figure for the client (Mallinckrodt, 2010); clients require their psychotherapists to provide a secure attachment base that allows for the exploration of negative thoughts and feelings, as well as for the alleviation of distress (Slade, 2016). A psychotherapist who is preoccupied with his or her own personal distress may find it very difficult to play this role efficiently and may at least implicitly bring some maladaptive features to the clinical encounter, thus depriving the client of the possibility of experiencing a secure attachment in the context of the therapeutic relationship. Moreover, regardless of the potential attachment implications, clients prefer experiencing a secure relationship with an emotionally responsive psychotherapist (Swift & Callahan, 2010). More precisely, Swift and Callahan (2010) found that clients were, to some extent, willing to forego empirically supported interventions in favour of a satisfactory relationship with the therapist, empathy from the therapist, and greater level of therapist experience. The present results cast a reasonable doubt on the ability of extenuated psychotherapists, and more so psychologically ill therapists, to present themselves in a positive light to the client in order to build strong therapeutic relationships with them.

Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction

Maria Panagioti, Keith Geraghty, Judith Johnson
JAMA Intern Med. 2018;178(10):1317-1330.
doi:10.1001/jamainternmed.2018.3713

Abstract

Objective  To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction.

Data Sources  MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched.

Study Selection  Quantitative observational studies.

Data Extraction and Synthesis  Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I2) and publication bias were performed.

Main Outcomes and Measures  The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs.

Results  Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007).

Conclusions and Relevance  This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.

Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis.

Maria Panagioti, PhD; Keith Geraghty, PhD; Judith Johnson, PhD; et al
JAMA Intern Med. Published online September 4, 2018.
doi:10.1001/jamainternmed.2018.3713

Abstract

Importance  Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction. However, this evidence has not been systematically quantified.

Objective  To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction.

Data Sources  MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched.

Data Extraction and Synthesis  Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I2) and publication bias were performed.

Main Outcomes and Measures  The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs.

Results  Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007).

Conclusions and Relevance  This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.

The research is here.

Doctors’ mental health at tipping point

Chris Hemmings
BBC.co.uk
Originally posted September 3, 2018

Here is an excerpt:

'Last taboo'

Dr Gerada says the lack of confidentiality is a barrier and wants NHS England to extend the London approach to any doctor who needs support.

She believes acknowledging that doctors also have mental health problems is "the last taboo in the NHS".

Louise Freeman, a consultant in emergency medicine, says she left her job after she felt she could not access appropriate support for her depression.

"On the surface you might think 'Oh, doctors will get great mental health care because they'll know who to go to'.

"But actually we're kind of a hard-to-reach group. We can be quite worried about confidentiality," she said, adding that she believes doctors are afraid of coming forwards in case they lose their jobs.

"I was absolutely desperate to stay at work. I never wavered from that."

One of the biggest issues, according to Dr Gerada, is the effect on doctors of complaints from the public, which she says can "shatter their sense of self".

The info is here.

When Doctors Struggle With Suicide, Their Profession Often Fails Them

Blake Farmer
NPR.org
Originally posted July 31, 2018

Here is an excerpt:

A particular danger for doctors trying to fend off suicidal urges is that they know exactly how to end their own lives and often have easy access to the means.

Wenger remembers his friend and colleague as the confident professional with whom he had worked in emergency rooms all over Knoxville — including the one where she died. That day three years ago still makes no sense to him.

"She was very strong-willed, strong-minded, an independent, young, female physician," says emergency doctor Betsy Hull, a close friend. "I don't think any of us had any idea that she was struggling as much personally as she was for those several months."

That day she became part of a grim set of statistics.

A harsh reality

An estimated 300 to 400 doctors kill themselves each year, a rate of 28 to 40 per 100,000 or more than double that of general population. That is according to a review of 10 years of literature on the subject presented at the American Psychiatry Association annual meeting in May.

The information is here.

Mind-body practices and the self: yoga and meditation do not quiet the ego, but instead boost self-enhancement

Gebauer, Jochen, Nehrlich, A.D., Stahlberg, D., et al.
Psychological Science, 1-22. (In Press)

Abstract

Mind-body practices enjoy immense public and scientific interest. Yoga and meditation are highly popular. Purportedly, they foster well-being by “quieting the ego” or, more specifically, curtailing self-enhancement. However, this ego-quieting effect contradicts an apparent psychological universal, the self-centrality principle. According to this principle, practicing any skill renders it self-central, and self-centrality breeds self-enhancement. We examined those opposing predictions in the first tests of mind-body practices’ self-enhancement effects. Experiment 1 followed 93 yoga students over 15 weeks, assessing self-centrality and self-enhancement after yoga practice (yoga condition, n = 246) and without practice (control condition, n = 231). Experiment 2 followed 162 meditators over 4 weeks (meditation condition: n = 246; control condition: n = 245). Self-enhancement was higher in the yoga (Experiment 1) and meditation (Experiment 2) conditions, and those effects were mediated by greater self-centrality. Additionally, greater self-enhancement mediated mind-body practices’ well-being benefits. Evidently, neither yoga nor meditation quiet the ego; instead, they boost self-enhancement.

The paper can be downloaded here.

The Burnout Crisis in American Medicine

Rena Xu
The Atlantic
Originally published May 11, 2018

Here is an excerpt:

In medicine, burned-out doctors are more likely to make medical errors, work less efficiently, and refer their patients to other providers, increasing the overall complexity (and with it, the cost) of care. They’re also at high risk of attrition: A survey of nearly 7,000 U.S. physicians, published last year in the Mayo Clinic Proceedings, reported that one in 50 planned to leave medicine altogether in the next two years, while one in five planned to reduce clinical hours over the next year. Physicians who self-identified as burned out were more likely to follow through on their plans to quit.

What makes the burnout crisis especially serious is that it is hitting us right as the gap between the supply and demand for health care is widening: A quarter of U.S. physicians are expected to retire over the next decade, while the number of older Americans, who tend to need more health care, is expected to double by 2040. While it might be tempting to point to the historically competitive rates of medical-school admissions as proof that the talent pipeline for physicians won’t run dry, there is no guarantee. Last year, for the first time in at least a decade, the volume of medical school applications dropped—by nearly 14,000, according to data from the Association of American Medical Colleges. By the association’s projections, we may be short 100,000 physicians or more by 2030.

The article is here.

Preventing Med School Suicides

Roger Sergel
MegPage Today
Originally posted May 2, 2018

Here is an excerpt:

The medical education community needs to acknowledge the stress imposed on our medical learners as they progress from students to faculty. One of the biggest obstacles is changing the culture of medicine to not only understand the key burnout drivers and pain points but to invest resources into developing strategies which reduce stress. These strategies must include the medical learner taking ownership for the role they play in their lack of well-being. In addition, medical schools and healthcare organizations must reflect on their policies/processes which do not promote wellness. In both situations, there is pointing to the other group as the one who needs to change. Both are right.

We do need to change how we deliver a quality medical education AND we need our medical learners to reflect on their personal attitudes and openness to developing their resilience muscles to manage their stress. Equally important, we need to reduce the stigma of seeking help and break down the barriers which would allow our medical learners and physicians to seek help, when needed. We need to create support services which are convenient, accessible, and utilized.

What programs does your school have to support medical students' mental health?

The information is here.

Double warning on impact of overworking on academic mental health

Sophie Inge
The Times of Higher Education
Originally published on April 4, 2018

Fresh calls have been made to tackle a crisis of overwork and poor mental health in academia in the wake of two worrying new studies.

US academics who conducted a global survey found that postgraduate students were more than six times more likely to experience depression or anxiety compared with the general population, with female researchers being worst affected.

Meanwhile, a survey of more than 5,500 staff in Norwegian universities found that academics reported higher levels of workaholism than their administrative colleagues and revealed that the group appears to be among the occupations most prone to workaholism in society as a whole. Young and female academics were more likely than their senior colleagues to indicate that this had an impact on their family life.

The information is here.