Having written tangentially about burnout several weeks ago, I was not surprised when I was one of many who received a general invitation to attend a burnout prevention seminar.
According to the invite, I had the opportunity to spend a few hours with experts who were poised to educate a group of healthcare providers about burnout and teach them effective tools to prevent mental stress. Apparently, the first invitation generated few acceptances, so a repeat email went out a week later.
I wondered who these experts might be, so I went online to look them up. Apparently, there are now dozens of companies that have developed programs to address physician and nursing burnout. They have written books; they give seminars; they do focus groups; and they are available for private counseling.
All, of course, for a fee.
If your organization is interested in your "wellness," it can arrange for these counselors to come to your medical center or practice. Of course, every situation is different, so counselors often ask interested parties to complete surveys that inquire about feelings of stress and the type of activities that cause frustration.
Nothing makes more sense than to fill out forms that are intended to tell people that you hate filling out forms.
What do these programs seek to do? Many have a common theme. If counselors can enhance awareness of the potential for burnout, then healthcare providers can take steps to heal.
The programs have wonderful names, which include "Finding Meaning in Medicine." They advocate establishing an internal "Wellness Committee," which is supposed to create a "Wellness Toolbox." They make sure that every healthcare provider has a "wellness" coordinator. Many programs advocate establishing "wellness" as a quality indicator, which can be assessed by an annual "Wellness Survey." (I am not joking!)
So if you are frustrated and angry about the extraordinary difficulties of practicing medicine in a worthwhile manner in the modern era, you now have the opportunity to hear experts talk about your feelings. And you get the opportunity to hear your colleagues say in public that they are just as annoyed as you are.
A primary thrust of these counseling sessions is to inform stressed-out healthcare providers that they are not alone. Someone out there understands how we feel. The assumption is: if you realize that you are not the only person who is burned out, then by some mysterious process, you won't let it affect your relationships with colleagues or patients.
A core philosophy of many burnout prevention programs is to teach people how to achieve mindfulness. Mindfulness encourages people to focus their attention on experiences occurring in the present moment. Theoretically, any focus on the present should keep you from thinking too much about the past and the future. If you hate your daily routine, the solution is not to think about how miserable you were earlier in the day or how likely you are to be miserable later. For now, you can simply be aware of your breathing and sense the blood coursing through your vessels. The goal is to eliminate the negativity of memories and the anxieties of forethought. Just disconnect your executive functions from your limbic system -- voila! You have it made.
Please do not get me wrong. I am actually a big fan of mindfulness. But it is a practice that is achieved through months (years?) of gaining an understanding that your transient thoughts and feelings are not necessarily actionable. A 2-hour seminar won't let anyone achieve the peace that mindfulness can offer.
To be sure, not every organization charges a fee for counseling to prevent physician or nursing burnout. Many national societies have free programs that can be accessed online. All someone needs to do is sit in front of a computer screen for hours, moving through modules that attempt to remind them what life should be about and help them forget what it is really like.
Are these programs successful? Those who have made a business of professional counseling claim that their programs make an enormous positive difference. Surveys done shortly after participation uniformly indicate a reduction in perceived stress and some sense of improved adaptation to the difficulties of professional life.
But one wonders: Would it matter if physicians or nurses engaged in a seminar or listened to music or went to a sports event? Does the metric assess something that is truly meaningful? Is the benefit durable? Can a 2-hour seminar really make the frustrations of a professional life filled with the constant need for intense documentation, inadequate standards, and suboptimal patient engagement more bearable? Do the feelings of powerlessness really abate?
You already know the answers. Mindfulness will not alleviate the bureaucratic silliness and stupidity. It is not supposed to. Burnout seminars are not intended to change the system.
The regimentation of medical care has had disastrous consequences for both healthcare providers and patients. The current system does not consistently deliver compassionate quality care, and it drives physicians to achieve metrics that have no meaning and provide no fulfillment. The burnout of healthcare providers is not related to the presence of stress; it is related to a lack of mission, wonderment, and joy.
The appropriate human response to the current status quo in medicine is anger and outrage. Yet, burnout prevention seminars are intended to provide a sedative. It is possible that attending a seminar might help for a short time, but it solves nothing. When the sedative wears off, the absence of fulfillment is still starkly apparent. The pervasive sense of ill-ease is still there. And consequently, the rate of departure of experienced and talented healthcare professionals from the practice of medicine has not diminished.
So why have all of these burnout prevention programs suddenly appeared? The primary purpose of having a burnout prevention program is to allow institutions to claim that they care about the burnout problem.
Just think about it. By creating an infrastructure, institutional leaders can assert that they are being sensitive to everyone's needs. And if before-and-after surveys show -- using artificial metrics -- that stress subsides, they can claim that they are addressing the problem. Essentially, the burnout seminars become just another part of the documentation empire. If the metric (however meaningless) gets better, you have obviously done your job.
Burnout programs will continue to grow. They support an important pretense: that our leaders are dealing constructively with the challenges of those who are responsible for the delivery of medical care. But burnout programs do not address any of the real problems of medicine today or the incredible difficulties that are faced by physicians and nurses. Yet, without a doubt, they provide profit to those who would promote the promise of peace for a price.
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