Published on Feb 16, 2021

Video Transcript

[MUSIC PLAYING] JOHN WHYTE: Welcome, everyone. I'm Dr. John Whyte, chief medical officer at WebMD. And you're watching "Coronavirus in Context."

Today, I want to talk about burnout, especially about burnout in physicians, how it impacts them personally and professionally. So to provide some insight, I've asked Dr. Peter Yellowlees. He's the chief wellness officer at UC Davis Health. Dr. Yellowlees, thanks for joining me.

PETER YELLOWLEES: Very nice to be here, John. And looking forward for conversation.

JOHN WHYTE: You know, Medscape have put out a report. We do it every year. And this year, it's entitled, "Death by 1,000 Cuts, The 2021 Physician Burnout and Suicide Report." And one of the important findings was that burnout hasn't changed that much since last year. But it's increased slightly, particularly in women physicians. Does that surprise you?

PETER YELLOWLEES: No, I don't think it does. I mean, I think, look, it's very hard to know how much emphasis to put on almost any report around well-being or burnout at the moment during the pandemic because the reality of life is that all physicians have been affected by the pandemic, just has everybody else. And we're going through, essentially, a disaster response cycle, which we understand well and which is stressful.

JOHN WHYTE: 20% of physicians stated that they experienced burnout for the first time this year as a result of COVID. But it's interesting that burnout among specialties has changed. And this year, it's actually critical care, rheumatology, and infectious disease that had the highest percentage of physicians with burnout. Just in case you're wondering, dermatology and plastic surgery were among the lowest. But how does this factor in into burnout? Those are the specialties that we see primarily addressing the pandemic.

PETER YELLOWLEES: Right. I think that's exactly right. And that's the reason. I mean, these are the specialties that are particularly under fire and under pressure, where their work has changed, quite dramatically in many instances, and where they're also increasingly concerned about the potential spread of infection to their families, to other people, obviously getting COVID themselves. And so it's totally predictable.

And I think it's going to be interesting in the long term as to how these specialties manage and whether people in fact want to go into them in the same numbers as they have in the past. They've all been pretty popular specialties in the past. But whilst we know there's an increase in medical school applicants at the moment, I wonder if they'll be going into these particular specialties.

JOHN WHYTE: Some people might be thinking, so physicians are burned out. Everyone's burned out. But what we also saw in this report is how burnout impacts them professionally. They talked about its impact on when they become exacerbated by patients, that they're not listening to patients. They're making some errors in their judgment when they're tired and burned out. How concerned should we be about the impact of burnout on the delivery of care?

PETER YELLOWLEES: I think it's a very important issue. And in fact, the issue that most of my colleagues speak about is the difficulty speaking to some patients who've actually had COVID, some patients who have even been ventilated, and who refuse to admit that they've had COVID because they don't believe it exists, and where that itself has been extremely stressful for the physicians. There's complete denial of reality that is going around. And there's essentially a mass delusion, as far as I'm concerned. And physicians are on the sharp end of that, being confronted with patients who are very sick but refuse to accept the fact.

JOHN WHYTE: Burnout often leads to depression. But is depression causing physicians to make more medical errors?

PETER YELLOWLEES: So we know that both burnout and depression lead to increased medical errors. I think you should probably think of burnout as being a sort of minor variant of depression, maybe a vulnerability factor for depression. I mean, burnout normally is a self-limiting disorder. But it can certainly move on and be a vulnerability factor so that people eventually develop depression or other psychiatric disorders or substance use disorders.

So I think we should think of it as being a vulnerability factor primarily, rather than a specific disorder in its own self. And we know that burnout is primarily caused by external organizational factors or stresses rather than internal factors related to the physicians.

JOHN WHYTE: Well, you're the chief wellness officer. If these are external factors that are causing burnout, how do we fix it? Let's start off with first, how does the individual physician help address issues of burnout? And then more broadly, how does the health care system?

PETER YELLOWLEES: So I think the individual physician has to look at both their local organizational issues and their own personal issues. Now, we know that local leadership and good leadership in small teams, in large teams, in organizations makes a huge difference. So simply acknowledging the great work that people are doing, thanking them, being aware of the sorts of stresses that they're under, and acknowledging those things is really important.

Educating people about the normal process of, essentially, disaster recovery psychologically and of, essentially, the areas around disaster mental health, what is normal, what is abnormal. I mean, we're going through a process where most of us, quite honestly, are adversely affected by this pandemic disaster. And it's not unreasonable to acknowledge that and to then attempt to move on from that stage.

Now, if you move to, at an individual level, we know very clearly from multiple literature evidence factors that physicians as a group are highly resilient. At entry to medical school, physicians are more resilient than equivalent graduate students elsewhere, less depressed and less burned out.

The problem that physicians have is we're squeezed in a really difficult system, generally. And we develop burnout because of those systemic issues. Now, what that means is that we have to actually focus on the good resilience capacity that we have and relearn that and support that. It's not that we're not resilient. But there's but there's no reason why you can't improve your resilience and support yourself better.

JOHN WHYTE: Well, give us some tips how to do that. Is it about meditation? Is it about trying to maximize sleep? We know it's about eating healthy. That's not always something that people can do without some preparation. What are your tips?

PETER YELLOWLEES: So John, it's about all of those self-maintenance things. But particularly, I think, sleep, really important to monitor your sleep. Make sure you're getting enough. Exercise, we know that exercise is good for your mental health. There's no question about that. There's a lot of evidence to support that. So regular walking, cycling, running. You can do all of those things, even while you're socially distanced.

Obviously, nurture your relationships. Spend time on your relationships. I've got a number of colleagues who actually are very pleased that their children are being homeschooled at the moment because they're spending much more time with their children than they would normally. Even if a married couple are physicians, they're able to sort of work their shifts around that. So look at all of these, I think, self-care approaches.

JOHN WHYTE: I was going to ask you about self-care because people have been talking about that. But you pointed out physicians are good at resilience. Some people would argue physicians aren't good at self-care. There's a reason why we say the smart physician doesn't ascribe to the attitude of heal thyself. So we're not so good when it comes to managing our own health, isn't that right?

PETER YELLOWLEES: I think that is unfortunately true. And I think that's one of the things that physicians need to learn. I mean, we know that more than 30% of physicians don't have a primary care physician of their own. So one of the things we encourage people to do is go and see your primary care physician. At least get yourself checked over. Do the maintenance that you advise your patients to have with your own physician. So I think you're absolutely right. I think we have to use less denial about our own health and focus more on that, quite honestly, in this situation.

JOHN WHYTE: What do you find is the biggest mistake clinicians make when it comes to burnout? Is it a pull yourself up by your own bootstraps approach? Is it denial? Is it, I'll deal with that later, I'm too busy? From your experience, what really has been the key challenge in getting people to recognize this as physicians?

PETER YELLOWLEES: I think the biggest mistake that physicians have is that they continue what we were all taught in medical school, which is that if you want to succeed in something, you just work harder. And so you do more. You work a few extra hours, that you can plow through and overcome almost anything by just working more and longer hours and harder. And that's obviously not true. But it's what we're taught.

And it's what we're trained to believe. And it's what a lot of the residency programs are based on. And I think we've got to get away from that mantra. But that is, unfortunately, a very common belief that physicians hold. And in reality, what we need to be doing is working smarter, not harder.

JOHN WHYTE: I want you to take out your crystal ball. I see you have an apple.


That's good for self-care.

PETER YELLOWLEES: There you are. I'm looking after myself.

JOHN WHYTE: Take out your crystal ball. Tell me what next year's report on burnout and suicide is going to show us.

PETER YELLOWLEES: I think that it's probably going to be similar rates to now but probably not much less. So I'm not expecting dramatic improvements. I hope, obviously, that we'll be through most of the pandemic by then and that our work will have returned more to what is a new normal.

I think there are potentially some really big silver linings associated with COVID. I think learning to use telemedicine equivalent technologies for patients is actually going to be really good for us. And there is increasing amounts of evidence to show that, despite the Zoom fatigue, using video with patients is actually good for our mental health as physicians. And certainly, we know that patients love it. So I think that's important.

I think a lot of health systems have discovered that, actually, transparent honesty with all of their staff is a really important matter. And certainly, that's coming through fairly clearly. So I think we're going to have more communication across and within our workplaces, which I think will be helpful as a consequence of COVID.

And I think there's been an increased emphasis on the importance of health care workers as essential workers and as people who have a difficult job, potentially a dangerous and life-threatening job on occasions, and who need that validated. So I think there are some positive things will come out of COVID that will help physicians. But I wouldn't expect an immediate improvement, unfortunately, in burnout rates because those are very slow to change.

JOHN WHYTE: I want to thank you for sharing your insights today as well as for all that you're doing in order to help address issues of burnout.

PETER YELLOWLEES: Well, thank you very much indeed. And it's a real pleasure to be here. And I greatly appreciate Medscape's focus on burnout because it is really important for the profession.

JOHN WHYTE: And thank you for watching.