National Patient Safety Awareness Week 2018

I saw Dr. George Dawson’s post about Dr. Michael Weinstein’s commentary entitled “Out of the Straitjacket” in the NEJM published on March 1, 2018. I agree that Dr. Weinstein’s experience is compelling and he specifically mentions burnout, a key factor critically important in his depression. Physician burnout fits with National Patient Safety Awareness Week, March 11-17, 2018. Burnout can lead to problems with maintaining patient safety, according to many sources one can easily find on a cursory internet literature search.

Physician burnout rates probably exceed 50% according to Shanafelt and colleagues (reference below). There are both physician-related and health care system-related factors involved in making doctors vulnerable to burnout. The systems factors probably don’t get enough press, although I found one well-written article about it by Markian Hawryluk, published February 22, 2018 on line in the BendBulletin, an Oregon newspaper. Hawryluk mentions a study which speaks to the relationship between burnout and patient safety:

“In a study of some 7,100 U.S. surgeons, burnout was an independent predictor of medical errors and medical malpractice suits. While the researchers said it was unclear whether burnout led to mistakes or the mistakes led to burnout, they concluded it was likely a two-way street. Burnout led to errors, which in turn fueled greater burnout.”

Physician burnout is one factor contributing to the shortage of psychiatrists, according to the NPR article “Severe Shortage Of Psychiatrists Exacerbated By Lack Of Federal Funding” by Samantha Raphelson, published March 9, 2018 on line.

The shortage is keenly felt across the Midwest, including Iowa, despite the recent listing in U.S. News and World Report as the best state in the nation for health. That said, the state medical and psychiatric societies are working diligently to generate solutions to the shortage and also are committed to addressing burnout. I’m eagerly anticipating the Match Day results coming this Friday, March 16, 2018. The University of Iowa Hospitals and Clinics typically does very well in the Match every year, including the Psychiatry residency. And I’m also wishing the new Psychiatry Residency programs well at Mercy Medical Center and Broadlawns in Des Moines.

The shortage of psychiatrists is likely to get worse before it gets better, according to Raphelson. That’s because of the graying out effect, which refers to the upcoming retirement of the 59% of us who are in the baby boomer age range.

There are organizational factors which can be addressed to manage burnout. As Shanafelt and colleagues point out:

“The evidence indicates that actions at the organization and individual level can counter a national problem. Substantive progress, however, is unlikely to occur until there is a coordinated effort to address this issue at the national and state, organization, leader, and individual levels.”

However, I think they don’t go far enough on the issue of Maintenance of Certification (MOC):

“Organizational policies that require physician maintenance of their certification must be accompanied by appropriate allocation of professional time for physicians to complete these tasks.”

I have zero time for the empty busy work of MOC, as anyone can clearly see from my post about a day in the life of a C-L Psychiatrist. And I refuse to allocate “pajama time” to it, which means even more time at home working on medical documentation (see the Hawryluk article):

“And every hour spent at home on work-related tasks — a phenomenon doctors call pajama time — increases the risk by 2 percent” [of burnout-J.A.].

There is plenty to do for Patient Safety Awareness Week–fifty two weeks a year.

Reference:

Shanafelt, T. D., et al. (2017). “Addressing Physician Burnout: The Way Forward.” JAMA 317(9): 901-902.

2 thoughts on “National Patient Safety Awareness Week 2018

  1. I think you’re right about the NEJM writer’s situation. Burnout was probably a contributor although he was clearly depressed and had a vulnerability for that, including a family history.

    I also agree with you about stressor-related mood problems. I see demoralization in people every day in the general hospital. I don’t think antidepressants are helpful for those who are mainly “sick and tired of being sick and tired.”

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  2. Good points Jim,

    The other issue is where “burnout” fits in psychiatric diagnostics.

    In the NEJM commentary it seemed to be there in addition to the depression and a contributing factor to worsen depression. So do we leave it at that level in the formulation or consider it a separate entity like an adjustment disorder or grief? In the former case I have had many people tell me about severe job related stress and “my problems would be over if I won the lottery”. When it came down to it – they expected me to be able to treat them for depression in the context of that ongoing stressor even when I explained to them that there was minimal evidence that treating depression would improve their situation. On the other hand I talked with a hospital intensivist a few months ago. She decided to work in a primary care clinic after nearly 2 decades of ICU rotations. She felt incredibly better – like a longstanding burden had lifted. In the NEJM commentary, the depression sounds more clear cut, but there seem to be no good guidelines on treating burnout especially if the person expects to return to the same toxic environment.

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