The expectations trap in medicine Marchalik, Daniel
The Lancet (British edition),
09/2023, Letnik:
402, Številka:
10408
Journal Article
Recenzirano
“The practice of medicine”, he observed, “is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.” In addition to sparking a series ...of conversations about the nature of marriage and ageing, these works explore the modern relationship to work and career prestige. For Toby, the idealised version of medicine exists in tension with the realities of modern health care—an anti-Oslerian transition from art to trade, from calling to business.
ObjectiveTo examine how perceived leadership behaviours affect burnout, professional fulfilment and intent to leave the organisation among physicians.DesignAnonymous cross-sectional survey study from ...November 2016 to October 2018.Setting12 036 attending and resident physicians at 11 healthcare organisations participating in the Physician Wellness Academic Consortium (PWAC) were surveyed to assess burnout and professional fulfilment and their drivers.ParticipantsA sample of 5416 attending physicians with complete data on gender, specialty, leadership, burnout and professional fulfilment.Main outcomes and measuresThe leadership behaviour of each physician’s supervisor was assessed using the Mayo Clinic Participatory Management Leadership Index and categorised in tertiles. Multivariable logistic regression analyses examined the effect of leadership behaviour rating of each physician’s supervisor on burnout, professional fulfilment and intent to leave controlling for gender and specialty.ResultsThe response rate was 45% across 11 institutions. Half of the respondents were female. Professional fulfilment increased with increasing tertiles of leadership behaviour rating (19%, 34%, 47%, p<0.001). The odds of professional fulfilment were 5.8 times higher (OR=5.8, 95% CI: 5.1 to 6.59) for physicians in the top tertile compared with those in the lowest tertile. Physicians in the top tertile were also 48% less likely to be burned out (OR=0.52, 95% CI: 0.45 to 0.61) and reported 66% lower intent to leave (OR=0.34, 95% CI: 0.26 to 0.44). Individuals who rated their supervisor’s leadership in upper tertiles relative to lower tertiles exhibited lower levels of burnout (18% vs 35% vs 47%, p<0.001), and intent to leave (16% vs 24% vs 50% p<0.001).ConclusionPerceived leadership behaviours have a strong relationship with burnout, professional fulfilment and intent to leave among physicians. Organisations should consider leadership development as a potential vehicle to improve physician wellness and prevent costly physician departures.
Reviews of physician distress, such as Canadian physician S E D Shortt's 1979 article “Psychiatric illness in physicians” viewed professional stress as a trigger that exacerbated physicians' ...underlying “vulnerability that antecedes their entry into medical school” since, Shortt argued, doctors were “inordinately susceptible” to drug misuse, unusually prone to depression, and had a “high frequency of unstable marriage, sexual maladjustment and divorce”. Profoundly transformed by his earlier life, his burnout is portrayed as an emotional equivalent to a person with leprosy who is permanently affected by the disease. Since the late 1970s, as knowledge of burnout has advanced, the poignant accuracy of Greene's metaphor became increasingly clear. From automation to improved physician–patient connectivity and widespread implementation of EHR, these advances addressed some of medicine's more cumbersome limitations, making it possible to access patients' past records with ease, order panels of laboratory tests at the click of a button, and record patient histories on computers. ...if history has taught us anything, it is that burnout is as dynamic as medicine itself and reactive solutions will always lag behind. ...a successful approach to addressing burnout must be pre-emptive—a mindful modernisation that considers the wellbeing implications of technological, economic, and administrative changes before they are implemented.
The rapid explosion of medical knowledge of the 19th and 20th centuries required a transformation in medical education, which, to that point, had been marked by low educational standards. To combat ...the lack of regulation, the 1910 Flexner Report recommended sweeping reforms. By 1930, students hoping to enroll in a medical school would need to complete courses in chemistry, physics, and biology, leaving little room for the liberal arts.Medicine is once again changing. The impact of artificial intelligence is being felt across all medical fields, and the nature of physicians' jobs in the new landscape of intelligent machines will inevitably also have to change. What will the role of new physicians be? And how should medical education be amended to meet those needs?In 2017, the Georgetown University School of Medicine graduated the first group of students from its Literature and Medicine Track-the first U.S. medical school track dedicated to the study of literature. This Invited Commentary explores the work done in, and the scholarship resulting from, this novel educational program and suggests ways in which literature could be used to prepare future doctors for the evolving demands of the medical field.
Sleep-related impairment in physicians is an occupational hazard associated with long and sometimes unpredictable work hours and may contribute to burnout and self-reported clinically significant ...medical error.
To assess the associations between sleep-related impairment and occupational wellness indicators in physicians practicing at academic-affiliated medical centers and the association of sleep-related impairment with self-reported clinically significant medical errors, before and after adjusting for burnout.
This cross-sectional study used physician wellness survey data collected from 11 academic-affiliated medical centers between November 2016 and October 2018. Analysis was completed in January 2020. A total of 19 384 attending physicians and 7257 house staff physicians at participating institutions were invited to complete a wellness survey. The sample of responders was used for this study.
Sleep-related impairment.
Association between sleep-related impairment and occupational wellness indicators (ie, work exhaustion, interpersonal disengagement, overall burnout, and professional fulfillment) was hypothesized before data collection. Assessment of the associations of sleep-related impairment and burnout with self-reported clinically significant medical errors (ie, error within the last year resulting in patient harm) was planned after data collection.
Of all physicians invited to participate in the survey, 7700 of 19 384 attending physicians (40%) and 3695 of 7257 house staff physicians (51%) completed sleep-related impairment items, including 5279 women (46%), 5187 men (46%), and 929 (8%) who self-identified as other gender or elected not to answer. Because of institutional variation in survey domain inclusion, self-reported medical error responses from 7538 physicians were available for analyses. Spearman correlations of sleep-related impairment with interpersonal disengagement (r = 0.51; P < .001), work exhaustion (r = 0.58; P < .001), and overall burnout (r = 0.59; P < .001) were large. Sleep-related impairment correlation with professional fulfillment (r = -0.40; P < .001) was moderate. In a multivariate model adjusted for gender, training status, medical specialty, and burnout level, compared with low sleep-related impairment levels, moderate, high, and very high levels were associated with increased odds of self-reported clinically significant medical error, by 53% (odds ratio, 1.53; 95% CI, 1.12-2.09), 96% (odds ratio, 1.96; 95% CI, 1.46-2.63), and 97% (odds ratio, 1.97; 95% CI, 1.45-2.69), respectively.
In this study, sleep-related impairment was associated with increased burnout, decreased professional fulfillment, and increased self-reported clinically significant medical error. Interventions to mitigate sleep-related impairment in physicians are warranted.
The things we carry Meffert, Liana; Marchalik, Daniel
The Lancet,
07/2024, Letnik:
404, Številka:
10447
Journal Article, Book Review
Recenzirano
Watashiato captures our curiosity about the impact we have had on the lives of those we know; etterath is the emptiness one experiences after a long process is finally complete, for instance after ...the completion of residency or graduation from medical school. Ada Limón's book of poetry, The Carrying, can be read as a meditation on the everyday experiences that inspire feelings of sonder. Limón's collection asks us to slow down and pay attention to the fleeting moments that we have conditioned ourselves to ignore. Yet Limón also recognises that for the physician, hers is one of dozens of daily encounters. In medicine, carrying, too, has its own contexts, although entirely different from the grief and loss Limón articulates in her poetry. The Carrying challenges us to recognise that although we can never truly know another's experience it is worthwhile to remain attentive to the complexity of those inner worlds—worlds that hold infinite possibilities. ...as Emily Dickinson observed in a letter to her friend Mary Higginson, “I fear we have all sorrow, though of different forms”. Sometimes clinicians pause and listen; sometimes we are too busy or emotionally drained.
On not cutting corners Marchalik, Daniel; Rehm, Diane
The Lancet,
04/2024, Letnik:
403, Številka:
10437
Journal Article, Book Review
Recenzirano
Adopted by an obstetrician named Hema and an internist-turned-surgeon named Ghosh, the twins spend their childhood on the premises of the Missing Hospital, run by missionaries in Addis Ababa. A ...prohibited sexual encounter between Shiva and Genet, whom Marion loves, plays a part in Genet's mother's suicide and later in Genet's radicalisation and participation in a plane hijacking. Marion enters surgical training in the USA and unexpectedly reunites with his estranged father. Done poorly it could keep him in hospital with one complication after another till he dies.”
The others in the room Petrov, Dmitriy; Marchalik, Daniel
The Lancet (British edition),
09/2023, Letnik:
402, Številka:
10404
Journal Article
Recenzirano
The smell of lemons brings him back to caring for his granddaughters, squeezing lemons into their brown hair in the summer. The smell of pepper reminds him of sunlight in a dusty house, old books, ...and Charlie's boredom. Charlie's room represents one of the complexities of working in medicine: for health-care workers, the patient is seldom the only person who requires support. ...to care often means to account not only for the laboratory values and imaging results, but also for the toll an illness has on a patient's loved ones.
Laughter is the best medicine Petrov, Dmitriy; Marchalik, Daniel
The Lancet (British edition),
06/2023, Letnik:
401, Številka:
10391
Journal Article
Recenzirano
The early-2000s television show Scrubs, written and produced by American screenwriter Bill Lawrence, is a whimsical exploration of the lives of hospital trainees. Rather, Scrubs shows self-doubt and ...failure, the ennui of repetitive work, the unavoidability of mistakes and death, and the tensions of hospital relationships. Research suggests that laughter might raise the pain threshold and improve glucose tolerance, have positive effects on the immune system, and lower blood pressure. ...in a job as stressful and demanding as health care, it can often be the medicine that physicians themselves desperately need.
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