Berks County Medical Society Medical Record Spring_2018 - 5

Editorial CommEnts

Promoting Physician Resiliency
by Raymond C. Truex, Jr., M.D., FACS, FAANS,
Medical Director, Pennsylvania Physicians' Health Program

e all know by now that this is
a very "hot" topic. Articles and
seminars on physician burnout
are everywhere. With good reason. Dr. Tait
Shanafelt, in a survey of U.S. physicians,
found that in 2014, 54% exhibited at least
one symptom of burnout. When I was
a younger doctor, medical practice was physically and emotionally
demanding because of exhaustive work hours, difficult to attain
academic demands, threat of medico-legal action, and tyrannical
department chairmen. Over time, some of these factors have
modulated, but have given way to newer
causes of emotional fatigue, characterized
by the intrusion of corporate medicine, the
introduction of the electronic medical record,
time limitations on individual office visits,
proliferating nonsensical rules, intrusions into
the doctor-patient relationship, and loss of
the individual physician's control of his life.
Burnout can be manifested in many ways,
including the depersonalization of patients,
poor medical record keeping, depression,
substance abuse, suicide, and increased risk of
medical malpractice lawsuits, among others.
Recognition of this phenomenon has led
some hospital systems to offer instruction in
stress-reduction practices such as mindfulness
meditation and yoga.
In my opinion, prevention of burnout also may require a
physician to develop a personal resiliency program, which may
utilize concepts similar to the recovery process followed by
individuals with a substance use disorder. This is an active selfimprovement process that encourages an ongoing recognition of
one's own attributes and weaknesses, and an honest attempt to
correct one's faults; development of spirituality, honesty, humility,
gratitude, and a positive attitude; learning to apologize when in
the wrong; willingness to seek help and follow good direction;
and to be of assistance to others. Recovering individuals try not
to control every situation and to avoid finding fault with everyone
and everything around them, but rather concentrate on making
themselves a better individual. In contentious situations, they can
always turn to the nondenominational Serenity Prayer, which reflects
the wisdom of the ages: "God, grant me the serenity to accept the
things I cannot change, the courage to change the things I can, and
the wisdom to know the difference."

Most people have heard of recovery, some of them know what
it entails, but only a few actually try to live such a program. When
followed, a recovery program provides a framework for living
designed to reduce the stress in an individual's life, but in reality,
that framework could be beneficial to anyone, including those
without a substance use disorder. Recovery is an effective antidote
to burnout, and also to the stressors of everyday life, and as such,
reduces the call of mood altering chemicals to anesthetize the pain of
life's various challenges.
I believe that a solution to burnout requires external systemic
remedies, which must come from within
the hospital systems - which increasingly
dominate the physician's life - to make
internal corrections which restore a measure
of physician autonomy. But a component
of the solution might also reside within the
individual physician, an internal remedy which
increases the resiliency of that person. That's
where organized medicine may have a role.
The Foundation of the Pennsylvania
Medical Society recognizes that burnout
threatens every physician. Heather Wilson,
Executive Director of the Foundation,
informs me that the Foundation has been
conceptualizing a process to promote
physician resiliency, to circumvent the
development of burnout in physicians. This program will include
one or more of the following components:
1. A resiliency toolkit with resources for individuals to build
their resiliency skill
2. A video series with CME, when applicable, designed to
address multiple components of building resilience - i.e.
effective communication, dealing with conflict, self-care in
stressful times
3. Exploring the development of workshops to train peer
coaches for resiliency - these trained people can be the go-to
resource for their place of employment
4. Scheduling resiliency workshops for physicians (retreat style
format) focused on enhancing personal resiliency
The Foundation's toolkit for the individual physician's
prevention of burnout by developing resiliency might well utilize
some of the same concepts as a program of recovery from addiction,

SPRING 2018

Berks County Medical Society Medical Record Spring_2018

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