Who will protect us from ourselves? Hmmm, us of course.

University of Toronto Internal Medicine Resident Dr Michael Fralick and CMAJ Senior Associate Editor Dr. Ken Flegel teamed up to write a powerful editorial this week.

"Physician burnout:  Who will protect us from ourselves" suggested physicians focus on mindfulness, take time away from work, apply principles of behaviour-modification, use their common-sense (e.g., exercise, healthy eating), and apply lessons from the business world (e.g., ending company email at the end of the day or eliminating email altogether) to minimize their risk of burnout.

Burnout seems to be a much more complex issue, however.  After all, physicians are not victims of their own vulnerabilities.  Rather, they are highly successful and competent architects of their own success.  Indeed, The Canadian Physician Health Survey found that doctors work hard to promote their own good physical health:

- only 5% reported poor physical health that interfered with practice

- only 8% were obese

- only 3% smoked cigarettes

- only 1% consumed 5 drinks or more on a regular basis

- doctors averaged 4.7 hours of exercise per week and 

- they ate fruits and vegetables 4.8 times a day.

Fralick and Flegel's nod to mindfulness is a wise one.  The literature is full of solid studies showing very positive links between mindfulness and physical/mental health gains for physicians.  Even the New York Times has blogged about mindfulness and emphasized its value for all.  

Their suggestion of implementing lessons from the world of industry is more thought provoking. But reducing or ending email (or other such digital intrusions or work extensions) may not be enough.  And duty hour regulation is an issue that has mainly focused on the training years of the physician life cycle.  The natural consequences for practicing physicians is largely unknown, and there is emerging evidence that regulated hours has a negative effect on trainees. 

Perhaps, as noted in the editorial, looking the commitments made by and expectations put on physicians for their "off-duty" time is more critical.  After all, that is when research is done, forms completed, teaching offered & meetings attended - and all largely done in a volunteer capacity.  Doubtful Volkswagen, the Bank of Montreal, Goldman Sachs Group Inc, and other corporations would have these sorts of relationships with their contractors or senior employees.  Why is this expected in medicine?

Protecting physicians from burnout will require a deeper, much deeper, approach.  Screening for and enhancing skills of resiliency, de-stigmatizing stress and mental illnesses, having rapid access to prevention and promotion programs, building highly functional teams of clinical excellence, practicing principles of appropriate human resource management, and ensuring health-workplaces are themselves modelling best practices of both work and health are critical components of change.

These principles of self-advocacy can be implemented by physicians themselves.  Indeed, if one looks at new constructs of training (e.g., CanMEDs 2015) they will be.  The future seems rather bright.

What do you do to advocate for your own health and wellness?