9 responses to “Physician well-being during COVID-19 — burnout & moral injury”

  1. This article leaves out the most effective form of treatment for burnout: Involvement and engagement in the health care system via meaningful and informed involvement in Quality Improvement.

    Ref: Mayo Clinic Strategies To Reduce Burnout: 12 Actions to Create the Ideal Workplace (Mayo Clinic Scientific Press) 1st Edition
    by Stephen Swensen MD MMM (Author), Tait Shanafelt MD (Author)

  2. This is an important topic but unfortunately I think that this article offers an outdated and incomplete perspective. Some might conclude that it misses the mark entirely. Words like “autonomy” and “system” do not appear in the content, yet are critical components, based on systematic reviews of the available evidence on confronting physician burnout.

    Readers might consider instead:

    By way of analogy, I can explain:
    When flowers don’t grow, do we blame the flowers and tell them to look after themselves better? No. We must improve the soil, the light conditions, the fertilizer, the watering, pull out competing weeds… Yes, sometimes there is a problem with the seed, but without an environment (or system) to nurture the seeds, there is no hope in them growing well. Blaming the seed and telling it to do some self-help reading is not likely to be effective. No amount of germination yoga will help the seedling grow if there is no light shining on it.

    I won’t be changing my practice based on this article; I think it is diminishing to physicians to state that the first step is
    “starting with you.” This may make them feel responsible when that is not a constructive response. Perhaps, instead acknowledge that feeling burned out is NOT the fault of the physician.

  3. I’m a bit disappointed that ongoing racism in our healthcare system (and in supports for physicians!) was left out of this article. As an Indigenous physician, this has been a primary source of distress and burnout for many years. I’ve recently found an Indigenous therapist (not through the physician health program) and found it to be a game changer. How are supports changing to better represent and address challenges experienced by historically and presently oppressed groups?
    I absolutely agree with Frank about getting involved, but even this leaves me completely disheartened at times.

  4. I agree, as a GP I feel that covid has depersonalized my interactions with patients. I have taken a more wait and see approach to complaints to try to avoid excess burden on the health care system, deferring B/W and investigations that I have felt are not urgent. The problem then becomes worry that I am missing something or that the person won’t call back to follow up on worsening symptoms.

  5. I am not an expert in this field, but have been doing a fair bit of reading and spend a lot of time discussing it with colleagues and friends.

    In my opinion, “burnout” or “moral injury” are the most important issues facing our healthcare system. We should be focussing on it. If we don’t have enough people to look after patients, we have no healthcare system at all. It is, after all, people that care for people and not “hospitals” or “office buildings” that care for people. Working in healthcare should be the best job one could possibly have, yet it is the field hit hardest by “The Great Resignation”.

    In order to address the issue of burnout, I would like to know what is driving it. There is obviously something, or likely many things, that has/have changed in the last 20 years. We didn’t need yoga and mindfulness back then and we didn’t see the critical staffing shortages we see today.

    I’m not a believer, nor have I come across quality evidence, to support a single or “best” solution. Focussing on going it alone with psychotherapy, or yoga, or mindfulness is unlikely to work on its own. I think we need to focus on determining the drivers of burnout and on improvement at every level of our system (individuals, departments, health authorities, and the ministry). Although individuals definitely can and should take some responsibility, relying on solutions entirely at the level of the individual is doomed to fail. Doctors need autonomy, community, work environments that align with the altruistic values of the profession, work-life balance, etc.

  6. As a GP I am so grateful and feel so privileged to be in a position to support and improve the health of my patients. It has been surprising on how much more patience and gratitude I have been receiving on a daily basis in my interaction with patients. It has been as if their mental health needs has opened a new understanding of how to support them. Every challenge is only a tool to use to optimize your skills and become the physician you need to be. I thank my patients often for their kindness and their response is reciprocal ! .. go figure .

  7. Hi Rebecca,

    Thank you for your feedback. I agree that the racism experienced by providers is a driver of burnout and challenge in our healthcare system. A noteworthy piece by Villa, Ahmad & Mammoliti (2020) underscores the discrimination that physicians face within medical culture and the systemic behaviours that lead to this occupational phenomenon. Another resource that builds on this conversation is a podcast episode of the Canadian Medical Association’s The Sound Mind: Racism in medicine. Introducing anti-racism curriculum, diversity and inclusion training, fostering safe spaces for physicians to connect and discuss racism among their peers, and quality improvement projects are just a few of the strategies that are suggested as a step in the right direction.
    I appreciate your note and will ensure that I include it in future work and advocacy about physician burnout.

    Ontario Medical Association article:
    Villela, R. M., Ahmad, Y., & Mammoliti, M. (2020). Systemic discrimination. Ontario Medical Review. Retrieved October 7, 2021, from https://www.oma.org/newsroom/ontario-medical-review/87-5/systemic-discrimination/.

    CMA podcast:

  8. I am disappointed that this article ended with putting the onus back on the physician again. In our professional work, we encounter a lot of this type of microaggression, when in fact the system is setting us up to fail. We constantly are asked to do more with less when capacity and resource issues have worsened over the years. No wonder we are burned out.

  9. Editor’s note: An ongoing challenge at TCMP is that the short nature of articles precludes full exploration of complex topics like this. It’s beyond scope for a single article to address all things, especially systemic issues, but things like advocacy for change and getting involved with the healthcare system (as noted by some commenters) can help with systemic issues that some commenters are discussing. On the flipside, despair over the systemic nature can make someone feel helpless and unable to move forward, and in that light the article does offer some help to get unstuck, even if it has to start with the person suffering.

    We’re exploring other articles at TCMP to look at other factors, but we hope the posts can also help expand the conversation.

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