Executive Summary

Forty percent of 218 transplant surgeons surveyed reported high levels of emotional exhaustion, according to a recent study. To prevent burnout, ethicists can do the following:

• Act as mediators to address disruptive behavior.

• Reach out to physicians after unexpected bad outcomes.

• Provide support when clinicians disclose errors.

 

Forty percent of 218 transplant surgeons surveyed reported high levels of emotional exhaustion, according to a recent study conducted at the Henry Ford Transplant Institute in Detroit.1 Greater emotional exhaustion was linked to lower decisional authority, higher psychological work demands, and lower coworker support.

No other area of healthcare is as closely scrutinized, monitored, and regulated as transplant surgery, notes Mary Ellen Olbrisch, PhD, ABPP, professor of psychiatry and surgery and a clinical psychologist at Virginia Commonwealth University in Richmond. “Statistics for the program must be updated on a timely basis and compared to peers, and inspectors drop in at will,” she adds. “Every team member must prove he or she is up to speed on a regular basis.”

Lead author Michelle T. Jesse, PhD, wasn’t surprised by the data, except for one finding: Almost half of respondents — all highly-trained individuals who perform life-saving surgical interventions — reported a low sense of personal accomplishment.

“Why they reported this is not entirely clear and requires further study. But we hypothesized there are a few things at play,” says Jesse, a senior staff psychologist at Henry Ford Health System.

The surgeons did not feel they were having a positive impact or were accomplishing what they intended. Possible reasons for this include the considerable morbidity and mortality of the patient population, and the ever-evolving regulatory oversight of organ transplantation. “Without clear endpoints, it can be difficult to work toward clear goals,” explains Jesse.

Interventions at institutional level

Clinical ethicists could be part of a group that approaches hospital leaders to obtain support for the development of a burnout prevention program if one is not already in place. “Very few institutions have a peer support program. Ethicists are in a position where they could bring these issues to light,” says Jo Shapiro, MD, director of the Center for Professionalism and Peer Support at Boston-based Brigham and Women’s Hospital.

In Shapiro’s experience, most hospital leaders are easily convinced. This is in part because they are well aware of the hidden costs of burnout, both in terms of financial loss and physician satisfaction. “The amazing thing is that this is such an easy argument to make,” says Shapiro. “But it does require somebody to act as a champion and say, ‘This matters.’”

Jesse says the following practices can help to prevent burnout at the organizational level:

• supportive administrative policies for appropriate work-life balance;

• encouraging providers to take time off when needed or wanted;

• encouraging positive interpersonal interactions;

• providing educational opportunities for identifying and treating burnout.

“Creating institutions where the moral and ethical views of caregivers at all levels are equally valued, and where all can call on the ethics committee or consultants, also contributes to a work atmosphere that is healthy for all,” says Olbrisch.

Burnout sometimes manifests itself as inappropriate behavior. Providers in need of help might be identified as disruptive. “There is far less tolerance for abusive behavior from prima donna providers than there used to be, perhaps to the point where there is too little tolerance for appropriate expressions of anger or a little humor,” says Olbrisch.

Ethicists are ideally suited to serve as mediators to keep tense interpersonal situations from escalating. “This may mean that a physician who is experiencing burnout gets appropriate help and support, rather than getting in trouble with the licensing board or losing a job,” says Olbrisch.

Likewise, ethicists can step in to support individuals who are affected by a colleague’s disruptive behavior. “If there is a pattern of disrespectful behavior, the chance of people in that team experiencing burnout is high,” says Shapiro. Here are two other situations where ethicists can step in to prevent burnout:

When unanticipated bad outcomes occur.

Physicians are often told, “It’s not about you. It’s about the patient and family.” “That’s true. But the well-being of the people providing the care will absolutely influence the care that the patient gets,” says Shapiro.

Physicians are unlikely to ask for support in this scenario; ethicists can approach them instead. “You can say, ‘That was a tough thing that happened. Let’s make sure you get some peer support,’ instead of waiting for them to reach out,” suggests Shapiro.

When a patient is harmed by a medical mistake.

Physicians are increasingly encouraged to disclose adverse events to patients and family, but often lack guidance in doing so. “Physicians often feel guilty, ashamed, and incompetent, and need to know who is going to say what to the patient,” says Shapiro. “They need support in doing the right thing in being transparent.”

Reference

  1. Jesse MT, Aboulijoud M, Eshelman A. Determinants of burnout among transplant surgeons: A national survey in the United States. American Journal of Transplantation 2015; 15:772-778.

SOURCES

  • Michelle T. Jesse, PhD, Senior Staff Psychologist, Henry Ford Health System, Detroit, MI. Phone: (313) 916-5243. Fax: (313) 916-1771. Email: mjesse1@hfhs.org.
  • Mary Ellen Olbrisch, PhD, ABPP, Professor of Psychiatry and Surgery, Department of Psychiatry, Virginia Commonwealth University, Richmond. Phone: (804) 827-0053. Fax: (804) 828-0220. Email: molbrisch@mcvh-vcu.edu.
  • Jo Shapiro, MD, Director, Center for Professionalism and Peer Support, Brigham and Women’s Hospital, Boston. Phone: (617) 525-9797. Fax: (617) 582-6024. Email: jshapiro@partners.org