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Approach aims to deepen doctors' connections with patients, colleagues

By JULIE MINDA

Research demonstrates that physician burnout is taking a toll not only on the physicians themselves but also in some cases on the patients they treat. CHI Health neurologist Dr. Prasanna Tadi believes that physician burnout has reached "public crisis" level, and he is looking for remedies that work.

Dr. Prasanna Tadi, left, talks with research co-investigators about protocols for his studies on reducing physician burnout. Shown from center to right are Creighton University medical students Emma Parks, Serenity McAndrews and Elizabeth Hartley. Andrew Jackson

Tadi's approach engages medical students, residents and physicians in a community of their peers to celebrate their accomplishments, talk about the issues they are facing, explore ways to improve their well-being and adapt healthy routines that mitigate the impact of their demanding, high-stress career path. He also is exploring ways to deepen the spirit-replenishing connections between physicians and their patients. Tadi is spearheading a series of pilot studies and related research to determine how well these interventions work. He'll use the findings to refine and/or expand this approach.

Tadi says, "Physicians are losing the sense of having meaning in their work. My big hope is that we find some solutions for this burnout — some evidence-based solutions." In addition to his role at Omaha, Neb.-based CHI Health, Tadi is director of a neurology clerkship, director of wellness and an assistant professor of neurology at Creighton University, a Jesuit school in Omaha.

Broken connections
Studies have shown that burnout can lead to physicians providing lower-quality care and it can be associated with reduced patient satisfaction, increased medical errors and more malpractice payouts as well as increased staff turnover, which can contribute to physician shortages. Tadi says that attending physicians, residents and medical students suffer from higher rates of depression, anxiety and suicide, as compared with people outside the medical profession.

He has experienced periods of burnout, to the point that he once considered exiting the profession. "We became doctors to make a change" for the better in the lives of suffering people. But, he says, many physicians find once they begin to practice that they do not have much control over their schedule, and this can mean that they cannot spend as much time as they wish with each patient. Given the hectic pace of medical practice, Tadi says, "We can miss the personal touch and the caring" that provide professional fulfillment.

Time is so short, he says, practitioners may find it difficult to determine the best treatment options for an individual patient. Another real concern for physicians is patients who can't afford to follow doctors' orders and take their prescription meds as directed.

Elizabeth Hartley and Eric Villanueva are fourth-year medical students at the Creighton University School of Medicine, and co-investigators in some of Tadi's physician well-being research. Hartley says medical students are susceptible to burnout because of the workload, career uncertainties, feelings of inadequacy and feelings of isolation that seem to be part and parcel of medical school.

Villanueva says he has seen numerous peers suffering from exhaustion. He adds that physicians and medical students often are expected to demonstrate superhuman resilience, never letting their personal struggles interfere with their pursuit of perfection, and so they may resist seeking help when they feel burned out.

Creating community
Tadi believes that encouraging physicians to create a community of support and a safe space to address burnout can be an essential part of the remedy. And so he has developed a model that links physicians and physicians-to-be in peer groups that meet on a regular basis. Tadi uses the acronym CHEER to represent the activities that are part of these gatherings. Participants:

• Celebrate their accomplishments
• Hear one another's successes and challenges in a safe environment
• Invite the Expertise of wellness experts
• Engage in discussion about how to apply those experts' advice
• Recharge by putting wellness routines into practice in their daily lives

For more than a year, Tadi has been assembling research teams made up of physicians, residents and medical students to implement the CHEER model and to conduct research on its effectiveness. (See sidebar.)

Expansion plans
Tadi says he is optimistic that these pilot programs and studies of the CHEER model will encourage physicians to create their own support communities and that this will prompt them to talk about the stressors in their lives, improve the culture, form friendships and build trust with one another. He anticipates that increased trust among physician colleagues will help to reduce the stigma around medical providers seeking help for themselves.

Hartley says, "On a systemic level, the problems within the medical system that lead to physician burnout are copious, convoluted, complicated, and will not be solved with our relatively simple research."

However, she says she hopes that the research team can show that building community, emphasizing the positives of the profession, enhancing relationships and nurturing healthful lifestyles can improve the well-being of individual clinicians.

"I hope that this research is able to create a program or a set of guidelines that can be applied to medical schools and residency programs across the country," she says.