Don’t Stress by Pat Conrad MD

One way to avoid stress in medicine might be to avoid reading Family Practice News, so you could view me as either benefactor or malefactor in bringing you the latest.

An article in the “Practice Economics” section tells us “Shifting stress perceptions can reduce burnout, lawsuits.”

• Several studies have physician emotional burnout to an increase in medical errors. In what surely could be a candidate for Ridiculous Study of the Week, the article cites the Harvard Risk Management Foundation. This bunch had a study previously published that sampled 353 physicians at a teaching hospital using – deeeep breath here – “patient performance ratings.” The study found that those docs who ranked lower in patient satisfaction were more likely to be sued. Please take a moment to insert your own sarcasm and/or profane derision.

So burnout leads to errors; the author presumes that errors somehow directly correlate with patient dissatisfaction, which will get you sued. So let’s reduce burnout!

• Dr. Colin West of The Mayo, Minn. says that “if you are depersonalized toward others and you’re not treating them as other human beings…that could then lead to increased litigation risk” due to poor communication. (I think for many of us, our litigation risk would rise substantially if we communicated to the patient what we are really thinking). Dr. West’s remedy: “mindfulness training, yoga, connecting with colleagues are all options for preventing burnout.”
• Dr. Daniel Friedland, internist and founder of a national consulting firm providing “physician resilience programs” recommends a 4-step approach: 1) recognizing reactivity 2) reappraising stress and self-doubt 3) cultivating creativity 4) focusing on what matters most. Friedland states that using these strategies builds resiliency by reducing chances of making mistakes and the chances of being sued.

Friedland’s recommendations are similar to many offered on this site over the years, and I don’t mean to specifically tear them down. Nor am I really opposed to whatever the hell “mindfulness training” means, and I suppose I could stomach hanging out with colleagues occasionally to drink a few cold ones and watch a ladies’ yoga class…just kidding, lighten up.

Really what bugged me about this article beyond its churnings of the bleeding obvious is that none of it – and nothing that physicians can initiate on their own – really deals with the causes of the stress increase.

We are told to work harder at satisfying patients, and to maintain a physician-patient relationship as one of equals, in which the other party bears no responsibility and no blame. That’s masochism. What does it say about a profession that has developed its own sub-industry to deal with stress, rather than mobilizing its members to reverse those stressful root causes? Dr. West says, “we need to come up with a toolkit of solutions.” Right.

We can build an entire hardware store of solutions, but if they don’t include less mindless work, less fear of patients, and more fun, then the whole thing is academic. More cash would work for awhile, if only to allow one to spend less time at work.