We came across this forum posting on Medscape, which we post as a supplement to the JAMA articles noted earlier this month. It is an interesting twist on a case study format that may sound familiar. What follows (not included here) is currently over 160 response posts from other physicians, highlighting the relevance of the topic of physician burnout.
Title on Medscape: “Community CME: Physician Burnout: Can You Recognize This in Yourself and Your Colleagues?”
“Dr. T is 43 years old, married, and a family physician in a multispecialty group practice; she graduated from residency 12 years ago. She came to the office for her annual well-woman examination. Her husband is a lawyer with a busy and stressful work schedule, and they have a healthy 13-year-old daughter. She has been followed by her physician for 6 years, mainly for preventive care and occasional acute conditions, such as bronchitis and urinary tract infection.
Her medical history is benign with no pertinent diseases, and her family history is positive only for cardiovascular disease with hypertension in her grandmother and her father.
When updating her psychosocial history, she admits that she is “in need of a vacation” because of a heavy call burden despite giving up her obstetric practice several years ago. Her last vacation was “years ago; I can’t remember when.” However, she is unable to take a vacation because “[her] husband is also a workaholic, and [she] cannot leave call to [her] partners since they are just as stressed out as [she is].” She has no specific plans to take time off work and doubts that she would even enjoy a vacation.
Dr. T reports feeling increasingly frustrated by her patients who she believes are complaining more, adding to the burden of paperwork, the daily grind of 15-minute appointments, and insurance billing challenges that she already faces. She lost her temper at her staff recently, throwing a chart at a receptionist (and narrowly missing her) and storming out of a meeting. Working with people on a daily basis has become a strain. She wonders whether family medicine is the right career path for her and states that she would not recommend choosing the medical profession to her daughter. She feels tired and cannot enjoy family life at the end of the day. She admits that she is irritable, and wonders aloud whether this affects her clinical decision-making and whether her clinical skills have declined. A depression screen is conducted; it is negative for sleep, eating, or concentration disturbance; recent weight change; low mood; tearfulness; change in eating habits; and suicidal ideation. Her alcohol intake is reported as 0.50-1 glass of wine per day. The conclusion is that she is overworked, and the following steps are recommended:
· Exercise;
· Relaxation; and
· More leisure time with her husband.
(Of note: the remainder of Dr. T’s exam was normal, as were her annual screening tests, including Papanicolaou [Pap] smear and mammogram.)
Three months later, the physician runs into Dr. T at a professional meeting. She confides that she is seeking a divorce and her daughter is extremely upset. She is concerned about the impact of her impending divorce on her career and her daughter.”
To see the full series of response posts, please visit Medscape. Membership may be required to access.
