Burnout among healthcare professionals is at an all-time
high. Its drivers include longer work hours, the push to see more patients,
more scrutiny by administrators, and loss of control over our practice. We seem
to spend more time with the electronic medical record and less time
face-to-face with our patients.
I have faced burnout personally. My son passed away at the
age of 29, which was beyond painful. At the same time, I felt burdened by the
growing number and complexity of metrics by which I was judged at work. Days in
the operating room and intensive care unit seemed more and more exhausting, and
my patience was becoming shorter and shorter. I was fortunate to have had a long-standing
meditation practice as well as sabbatical time that I used to decompress and
re-evaluate my career. Many of us are not so lucky. More than half of
physicians have serious signs of burnout, and more than one physician commits
suicide every day.
So many of us feel burned out these days because in our
rapidly changing profession we are asked to do more for less and with
inadequate resources. We suffer from exhaustion, self-criticism, and worry
about what will happen next to our practice, our families, and ourselves. If we
want to save our practices, patients, marriages- even our lives, we must
acquire personal resilience.
Fortunately, we can increase our resilience and happiness and reverse burnout by embracing a few simple principles—Gratitude, Acceptance, Intention, and Nonjudgment (GAIN)—that we can put into motion in our everyday lives at the hospital, at home, or wherever we are.
If you are like most doctors, you are sick of hearing about burnout. I know I am. There is a big debate on whether burnout is real or whether physicians are suffering from something more sinister like moral injury or human rights violations. That doesn’t matter. In the end, no matter what name we give the problem, the real issue is that physicians are in fact suffering. We are suffering a lot. Some of us—around one physician per day—are forced to alleviate their suffering by taking their own life. Each year, a million patients lose their physicians to suicide. Many more physicians suffer in silence and self-medicate with drugs or alcohol in order to function.
We are losing more physicians each year to early retirement or alternate careers. There are an increasing number of coaches and businesses whose single purpose is to help doctors find their side gigs and transition out of medicine. This loss comes at a time of an already depleted workforce that will contribute to massive physician shortages in the future. Perhaps even more troubling is that those physicians who remain in medicine are often desperate to get out. It is the rare physician these days that recommends a career in medicine to their own children. We now have a brain drain of the brightest students who would rather work on Wall Street than in a hospital.
As a physician trained in positive psychology, I have been committed to helping other physicians and students improve their well-being. The focus on well-being is a welcome change in medicine. But is it enough?
I am a naturopathic doctor, and because I operate outside of insurance-based medicine, I have, what most healthcare providers would consider, lots of time with my patients. My typical first patient appointment is 90 minutes long and my follow-up visits are 30 minutes long.
What, you may ask, do I do with all this time? I get to know my patients by listening to their stories, their concerns and their hopes. We delve into their health concerns, we review their medical records, and we explore lifestyle-based strategies to optimize their healing and wellbeing.
In short, I listen and apply what I know in partnership with each patient with the goal of empowering them towards greater wellness. Over and over, I hear from my patients how unusual this is. They speak about the 5-minute visits with their doctors that feel rushed and disconnected. They express frustration and dismay about being a diagnosis, not a person, when seeing their healthcare providers.
A recent survey conducted by the New York Times found that two-thirds of Americans support some form of change to the current healthcare system and favor moving towards greater insurance coverage for all. My experience for almost 25 years leads me to conclude that underlying this vision of healthcare is a deep-seated desire for patients to be cared for and listened to.
Physical inactivity is a mounting challenge for America. In reviewing the 2013-2015 American time use survey, we found that most Americans report spending their daily leisure time watching screens, and devote only a small fraction of leisure time—24 minutes for men and 14 minutes for women—to physical activity. A recent longitudinal examination of the National Health and Nutrition Examination Survey showed that sitting time increased by an hour a day between 2007 and 2016, with the largest increases among adolescents ages 12-19 and adults, 20 years and older. As mortality rates for heart disease have begun to climb, increases in sedentary behavior bodes poorly for future control of disease and health care costs.
The explosion in streaming apps and content is likely contributing to the increased sitting time. According to the Motion Picture Association of America, TV and movie views have more then doubled between 2014 and 2018. The availability of multiple series and the ability to binge watch can keep people glued to their couches for hours at a time. The immersive quality of the programming makes it increasingly difficult for viewers to pull themselves away from their screens. Yet, the technology could provide options to help viewers watch and still get regular physical activity.
Currently, after each episode, an option is available to allow the viewer to immediately call up the next episode. Why not consider adding a pop-up that can remind viewers that sitting more than 20-30 minutes at a time may not be good for health, and that it’s important to move around to avoid chronic diseases? A narrator could ask viewers to treat themselves to an activity break. Then the viewers could have the option to choose a short video that can guide them through a 10- minute exercise break. Or even a 5-minute break. Something is better than nothing.
There could be many options, from a just a simple stand up and stretch, like the 7th inning break at a baseball game, to vigorous workouts, like the 7-minute workout published by the American College of Sports Medicine or doing a Bhangra dance with a Bollywood film star.
How is Walmart leading the convergence of clinical care and retail? With global scale that allows for everyday low prices in every community, Walmart is innovating both the clinical and lifestyle sides of healthcare. From pharmacy, food, sporting goods, and more, Walmart is creating an ecosystem that is homebase for a healthy lifestyle.
As the world’s biggest private health plan—with 1.4 million associates worldwide —Walmart is also expanding its associate wellbeing program by partnering with Fresh Tri, an innovative app that uses neuroscience to change behavior by offering practical suggestions, combating iterative thinking to meet specific goals.
Filmed at AHIP’s Consumer Experience & Digital Health Forum in Nashville, TN, December 2018.
Let’s climb into the WABAC Machine (and, yes, that’s the way it’s spelled) and set the dial for 2008.
Then-candidate Barack Obama, campaigning on the promise of universal health coverage, enlisted Harvard professor David Cutler as his key adviser on that topic. Business lobbying associations were not thrilled about their members having to cover all their full-time employees and incorrectly assumed, then as now, that the major drivers of healthcare cost were employees smoking, overeating, and not exercising. Prof. Cutler suggested, quite correctly, that one way to assuage that concern would be to allow employers to spend less money covering employees with those three health habits.
Fast-forward to 2009, when it appeared that — with enough concessions to enough vested interests — the Affordable Care Act (ACA) could become a reality. Business lobbying groups were, then as now, powerful entities. Using Prof. Cutler’s suggestion, they were pacified by allowing businesses to tie up to 30% of total premium dollars to employee health (in practice, largely employee weight). Generally, the business lobbying groups engineered this withhold in the shadows. It wasn’t until 2015 that one of those business groups, the Business Roundtable, publicly admitted that the 30% withholdwas the main reason they bought into the ACA.
Today on Health in 2 Point 00, Jess and I report from a hedgehog cafe in Tokyo. In this episode, Jess asks me about Bright Health’s $200 million raise and the significance of Amazon’s new EMR product. We also talk about Health 2.0 Asia-Japan, which is happening right now (December 4-5) in Tokyo, showing us the health care market outside of the U.S. Look forward to hearing from some great speakers at the conference, including John Bass from Hashed Health on blockchain, Fred Trotter on security, David Ewing Duncan on the new wellness and personalized medicine, and Adam Pellegrini from Fitbit. And, of course, Jess will be interviewing just about everyone—including a hedgehog—about innovation for WTF Health —Matthew Holt
It’s late late at #hin2pt00 central. But somehow Jessica DaMassa wakes me up enough to get my views on Redbrick & Virgin Pulse, the VA finally inking the Cerner deal and Iora Health getting another $100m to build out their primary care model. Be warned, Jessica thinks I’m not full of cheer about any of it!–Matthew Holt
What do employers want more than anything? Healthy, engaged, productive, energized, and thriving employees who provide great customer service and high quality products. What they have is all too often the antithesis of that.
This article is about why and how to move away from “wellness” to “wellbeing.” Wellness is one dimensional—the absence of illness. But for employees to thrive, they need so much more. The essence? They need to be happy with what they are doing and where they are doing it. Without that, good physical health, engagement, and productivity are almost impossible. It’s as simple as that, and with happiness comes success on multiple levels for the employee and the employer. And yet the all too many of today’s American employees are dreadfully unhappy with their jobs and bosses. It’s time for that to change.
The companies that successfully address the deteriorating health (both physical and mental/emotional) of their employees have a huge competitive advantage, and not just from reduced healthcare coverage, but in cultivating more enthusiastic, productive, and engaged employees which drive competitive and financial success through better products and better service.
Dee Edington confirmed this in his book Zero Trends when he wrote: “Our mission is to create shareholder value. We create shareholder value because we have innovative, creative, and quality products and services. We have innovative, creative, and quality products and services because we have healthy and productive people.”
This is, as we say in Massachusetts, “wicked important.” Yet most American CEOs do not yet see it as even rising to their level of attention. That is nothing short of astonishing given how much they pay for healthcare coverage and the truly poor value they receive in return. Starbucks pays more for employee coverage than for coffee. GM pays more for coverage than for steel. Businesses don’t realize it, but they are truly in the healthcare coverage business whether they like it or not. And that doesn’t even begin to total up the costs of disengagement, absenteeism, and turnover.Continue reading…