Clinician Wellbeing

"We all want high quality, safe, compassionate patient care, but we have generally neglected the emotional and physical well-being of those who provide such care. "

Evidence clearly indicates that physicians are suffering. This is harming our profession, our colleagues, other health care team members, and sometimes our patients. There are efforts nationally and internationally to explore ways of promoting wellness and decreasing the high levels of burnout among physicians. While promoting wellness is a complex challenge, and the solutions will need to be multifactorial, the literature suggests that the most effective interventions are organizational. Instead of putting the burden solely on us as individuals to be able to cope with challenging environments, we should be working toward improving the culture and processes in the workplace.

WHY WELLNESS MATTERS

Physician wellness is of paramount importance to our patients, to each of us as individuals and to our profession. There is a convincing body of literature indicating that physician wellness is not close to the level it should be. Concerningly, we are seeing a high prevalence of physician burnout, depression, and suicide.1 There are 2 basic reasons for providing the resources to improve wellness. First, it is the morally right thing to do. Physicians—our colleagues—are suffering. Second, it supports the outcomes we care about. It is difficult to provide high-quality compassionate patient care when we ourselves are emotionally, physically, or cognitively challenged. We know, for example, that burnout is associated with increased medical errors and less compassionate care.

Overview

Why Wellness Matters

SOLUTIONS TO A COMPLEX PROBLEM
There is enough evidence of a crisis requiring immediate attention. This is a complex problem, and we recognize that no one solution or approach will provide a cure. There is general agreement that there are 3 broad areas where change might have a positive impact:

Work culture
Efficiency of practice
Personal resilience.5

Although all areas are important, recent evidence suggests that organizational approaches have the highest impact on promoting well-being.6 Some technical solutions will be needed, but the challenges will also require adaptive solutions that address issues of trust and support.7

PROGRAMS TO SUPPORT CLINICIAN WELLBEING

Need a description here? There are multiple programs to help create a culture of trust in the organization, in service of improving clinician wellness and patient quality. The following are some of these key programs:

Peer Support
Professionalism
Disclosure & Apology
Feedback Training

Many individuals and organizations are working together to foster clinician wellness. A collaborative approach to such a complex challenge is critical as we move forward.

Solutions to Complex Problem

Programs to Support

Clinician Wellbeing Resources

Clinician Wellbein Resources

PUBLICATIONS & RESEARCH

Physicians’ needs in coping with emotional stressors: The case for peer support. Hu Y, Fix M, Hevelone N, Lipsitz S, Greenberg C, Weissman J, and Shapiro J. JAMA Surg 2012; 147(3):212-217.

Emotion and coping in the aftermath of medical error: A cross country exploration. Harrison R, Lawton R, Perlo J, Gardner P, Armitage G, Shapiro J. Online Jrl Patient Safety 2013.

Wisdom in medicine: What helps physicians after a medical error. Plews-Ogan M, May N, Owens J, Ardelt M, Shapiro J, Bell SK. Acad Med. 2015 Sep 4. [Epub ahead of print].

The impact of adverse events on clinicians: what's in a name? Wu AW, Shapiro J (co-corresponding author), Harrison R, Scott SD, Connors C, Kenney L, Vanhaecht K. J Patient Saf 2016 (in press).

Peer support for clinicians: a programmatic approach. Shapiro J, Galowitz P. Acad Med. 2016 Sep;91(9):1200-4.

Well-being in medical education: A call for action. Ripp JA, Privitera M, West C, Leiter R, Logio L, Shapiro J, Bazari H. Acad Med. 2017 Jul;92(7):914-917.

We Have Enough Information to Act. Shapiro J. Otolaryngol Head Neck Surg. 2018;158(6):985-986.

IN THE MEDIA

Narrating Medicine: Offering a Shoulder When a Doctor Might Need It National Public Radio/WBUR CommonHealth blog, October 2016.

As patients turn violent, doctors and nurses try to protect themselves STAT (a national publication from Boston Globe Media Partners), November 2015.

Many Brigham workers sought help from peer counseling Boston Globe, March 2015.

Forgiving ourselves for being human: Normalizing the isolating experience of adverse events Arnold P. Gold Foundation's Humanism in Medicine blog, October 2014.

The Crisis of Burnout Among U.S. Physicians Academic Medicine AM Rounds blog, February 2014.

PODCASTS, WEBINARS & VIDEOS

Caregiver Wellness Through Peer Support and Community In A Time of COVID-19
Beth Israel Lahey Health Primary Care Team this Thursday at noon. Dr. Jo Shapiro participates in an organizational-wide virtual forum with the Beth Israel Lahey Health Primary Care Team hosted by Dr. Matt Germak.

AAO-HNS Coronavirus Disease Podcast Series Episode 6: ENTs Personal COVID-19 Experiences [April 3]
William R. Blythe, MD, AAO-HNS Board of Directors, and Partner at East Alabama ENT is joined by Jo A. Shapiro, MD, Associate Professor of Otolaryngology-Head and Neck Surgery at Harvard Medical School, and founder of the Center for Professionalism and Peer Support at Brigham and Women’s Hospital (and who is currently recovering from COVID-19), and Julie L. Wei, MD, Division Chief of ENT and Audiology at Nemours Children’s Health System and Director of Resident and Faculty Wellbeing, discuss the importance of physician wellness during the COVID-19 pandemic.

AAO-HNS Coronavirus Disease Podcast Series Episode 10: Physician Wellness (Peer Support) [April 27]
Jo A. Shapiro, MD, Associate Professor of Otolaryngology-Head and Neck Surgery at Harvard Medical School, and founder of the Center for Professionalism and Peer Support at Brigham and Women’s Hospital, is joined by William R. Blythe, MD, AAO-HNS Board of Directors, and Partner at East Alabama ENT; Sonya Malekzadeh, MD, AAO-HNS Board of Directors, Professor of Otolaryngology, and Director of the Residency Program at Georgetown University School of Medicine, and Assistant Chief of Surgery at the Washington, DC VA Medical Center; and Julie L. Wei, MD, Division Chief of ENT and Audiology at Nemours Children’s Health System and Director of Resident and Faculty Wellbeing, in a peer support session during the COVID-19 pandemic. The podcast is also offered in a Video Version.