Is burnout a negative outcome on its own? Or, is it a surrogate outcome? Do we care about burnout because of how it affects patient outcomes and patient satisfaction? Or, is it something to worry about on its own because of the distress it causes practitioners?
Perhaps the answer lies in a combination of all of these questions.
Although I learned a great deal in medical school, burnout, resilience and their interaction with empathy wasn’t something I think I learned enough about.
In the theoretical understanding of burnout, there’s a clear link with how we understand empathy. However, there isn’t a lot of literature discussing the connection between them.
We know that burnout is associated with attrition—people burnout and they leave medical practice. It’s also associated with medical errors, or at least perceived medical errors—people who score highly on burnout ratings also report themselves as having made more medical errors. Moreover, burnout is highly associated with the patient’s sense of their interaction with the doctor. Or, in other words, their satisfaction with the process.
As a medical student, I remember thinking, ‘That looks scary. I hope I’m able to do it and still be active and healthy.’
Perhaps it isn’t perfect, but the three-factor model of burnout has been a helpful tool in clinical practice. It considers emotional exhaustion, depersonalization/cynicism (you start treating other people functionally (e.g. as objects as opposed to complicated human beings)) and a lost sense of personal effort (you start feeling like your work isn’t making the difference you wanted it to).
Empathy isn’t necessarily something that drains you emotionally. Nevertheless, it requires emotional resources. It demands that a certain amount of energy be present in order to do it well.
When people in the medical profession are rushed, or thinking of someone in terms of a disease process rather than a person who is experiencing distress, those concerns serve as barriers to empathy.
It’s the pressures of the work environment and often the lack of time that clinicians actually have. In medical school, it’s also the sheer volume of information. It gets easier once you master the medical science of the treatment and management of the patient.
However, at a time when you’re literally just trying to remember, ‘What does hypernatremia mean?’ ‘What causes that?’ it’s not easy to attend fully to the person in the room with you.
Then, once you start treating patients, how do you know if you’re being empathetic enough, or too empathetic?
© 2020 Clea Machold. All Rights Reserved.