Physician wellness and remediation

Abstract

Medicine is an exceptionally demanding as well as rewarding profession. Physicians must maintain the ability to work hard, at optimal levels of excellence, under high levels of demand and accelerating change in the healthcare environment. This requires stamina and adaptability. Workrelated distress is common in trainees and physicians and is associated with significant suffering, incompetence, lapses in professionalism, and attrition from the profession. At the worst end of the spectrum for the individual, this distress may result in depersonalization, emotional exhaustion, and a sense of low personal accomplishment. These symptoms characterize a syndrome now called burnout. Physicians are also at high risk for other stress-related issues such as depression, anxiety, substance abuse, and suicidality. Certain individual (e.g., resilience, relational competence, active health maintenance) and workplace (e.g.: safety orientation, mutual support, and flexibility) characteristics protect against burnout. In this chapter, Dr. Williams draws from her extensive experience first as an Associate Internal Medicine Residency Program Director and then as a psychiatrist who developed and ran a physician wellness program for a large healthcare system. She describes the common causes and consequences of stress, distress, and burnout in medical trainees and practicing physicians. She discusses strategies for identification, prevention, and treatment of physician distress and suggests a four-pronged approach toward physician wellness, which includes both programmatic and individual strategies.