“Approaching wellbeing is a shared responsibility,” says Colin P. West, MD, PhD.
In this installment of “Begin Your Journey,” Colin P. West, MD, PhD, talks with host Scott A. MacDiarmid, MD, FRCPSC, about self-assessing for burnout. West is a professor of biostatistics, medical education, and medicine at Mayo Clinic in Rochester, Minnesota. MacDiarmid is a urologist with Alliance Urology Specialists in Greensboro, North Carolina.
MacDiarmid: You've spoken before about there being multiple causes, that means there are multiple solutions [and that] you should individualize it, you should be intentional. I think these are important philosophies for our listeners.
West: This is really critical, because approaching wellbeing is a shared responsibility. We need to evolve from this historical mindset of, "Well, just get tougher, suck it up. Why aren't you more able to deal with these stressors?" because physicians and other health care professionals are doing a remarkable job keeping their heads above water as it is. At the same time, we do have a responsibility to bring our best selves to our work within our spheres of influence. We've already talked about maintaining and strengthening our resilience. That's not a bad objective. While we're waiting for organizational/structural solutions to develop, which is going to take more time, it's really important that physicians not just be hapless victims going along with the current. We need to step back and self assess. And we're not very good at doing this. When we've looked at evaluations of objective measurement tools for wellbeing, for example, and this is actually a study of surgeons that my colleague, Lotte N. Dyrbye [, MD, MHPE], did a number of years ago, 89% of practicing surgeons rated their wellbeing as at least as good as that of their peers. So 89% thought they were above average, 70% of surgeons who are actually in the bottom third for wellbeing metrics thought they were above average. So our self awareness, even though we have a reputation, sort of self imposed, of complaining about things a lot, is that we think, "Yeah, things aren't great, but I'm handling it better than my neighbors." The reality isn't always that way. So we have to self assess; we have to think, "OK, there are these categories of drivers that can tip me toward distress. Or, if they're optimized, they can push me towards wellbeing; they can get me out of this languishing phase, and I can actually be thriving in my work, I can be joyful, I can really connect with those meaningful interactions with my patients." To get to that point, though, you have to be able to, as you said, look in the mirror, and one thing I advocate for is write down across these lists of drivers, where am I? Is my workload something that I think I can sustain? If, as you mentioned, I'm going in at 8 pm on a postoperative day to check on my patients, how is that serving my family, my personal life, and my patient life? For many people, that's going to be okay, because it's so rewarding and so meaningful, and their families understand how that fits into their whole human being state. But for other people, it becomes, you know what, there's already a team taking care of this patient; what I'm doing is superfluous. And what I'm really doing is separating myself from other parts of my life that I need to attend to more. That requires individualizing your solution approach and being intentional about mapping where you are across all of these different drivers. If we don't do that, the evidence suggests that we, contrary to how people think about how physicians think in particular, actually look through rose-colored glasses at how our careers are going. And we aren't aware that we could be doing better in areas that are subject to improvement and do have levers that we can pull to get to those improvements.
This transcription was edited for clarity.