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April 15, 2020

Service to Others May Be the Answer to Physician Burnout

Author Affiliations
  • 1Walter Reed Department of Surgery, Uniformed Services University, Bethesda, Maryland
JAMA Surg. Published online April 15, 2020. doi:10.1001/jamasurg.2020.0046

There is a crescendo of attention focused on compassion training in health care. Importantly, this is not just about meeting the needs of patients, but also about learning how compassion can bring personal joy. Some of these concepts can be conceptualized as seva: a service that is performed without any expectation of result or award for performing it. Such services can be performed to benefit other human beings or society. “Seva is an ancient Sanskrit term, which originally referred to the service performed by members of the community.”1 A more recent interpretation of the word is “dedication to others.”

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    4 Comments for this article
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    reaction to burnout
    Thomas Walsh |
    interesting proposal. physician burnout is sadly a very serious issue. however, your proposal treats the symptoms rather than the cause of the problem. what we need is true respect, accompanied by a dramatic decrease in interference, from non-clinical coworkers. physicians are among the most highly trained people in our society and most highly respected members of our society. the most recent COVID crisis has sadly proven that we rank among the most valuable resource in any society. we need to be treated with respect and collegiality each day at work. I promise that we will ten see much less problem from physician burnout.
    thanks for your thoughts in the article
    CONFLICT OF INTEREST: None Reported
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    It’s BS, not burn out.
    Michael Plunkett, AB MD MBA | Practice/teaching
    Totally disagree. And I’ve been playing this game for 48 years.

    Medical students and all physicians, by their very nature, are altruistic. But, in today’s world with all its regulations, documentation, compliance, etc. etc. etc. it’s easy to burn out. In fact it’s the natural response. Who wouldn’t burn out?

    In “the day“ you used to look in the ear, make a diagnosis of otitis media, prescribe amoxicillin, and then see if the patient got better.

    Today you have to click 1000 boxes in your EMR, make sure you list whether it’s
    left ear or right ear, (As if the amoxicillin cares which ear it is) click another bunch of boxes and electronically send the prescription to it turns out to be the wrong pharmacy because they switched yesterday. And then you get to do it all over again. And then your EMR wants you to click the right box to see whether they using chewing tobacco or not.

    I really liked being a doctor. I’m not really enjoying being a provider. And, going forward, no one in their right mind is going to be doing this. Our bright young people will find other occupations where they are valued and appreciated.

    CONFLICT OF INTEREST: None Reported
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    Seva Service & COVID19
    Lynne Baines, Ph.D. | Oxford University
    This commentary could not be more timely as doctors and allied healthcare providers work with COVID19 patients. Under increased stress, they are living in fear of their own lives, while oftentimes separated from support networks of family and friends. We can only hope for their own well-being and that of their patients, that their instinctive altruism and psychological first aid skills, are as highly developed as their medical intervention. For this is a deadly and largely unknown virus. There are daily reports of front line healthcare providers overcoming their own fears trying to save the lives of their patients, only to contract the virus and die themselves. This could be viewed as a seva service, but without the joy. However, for those who survive, once the pandemic has subsided and they have debriefed, they can take comfort in knowing that their performance has unquestionably benefited other human beings and society as a whole.
    CONFLICT OF INTEREST: None Reported
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    PHYSICIAN BURNOUT IN LOW AND MIDDLE INCOME COUNTRIES IS ALSO A PROBLEM
    Lynne Baines, Ph.D | Uniformed Services University
    Jindal has rightly pointed out increased emphasis and inclusion of global surgery in medical school and residency curriculums to facilitate “dedication to others” (seva), which will give meaning, purpose of profession, and balance in life . It has been shown that bidirectional learning experiences fostered by global surgery electives will generate compassion and also improve care delivered in both high-income and low-income countries.
    However, care should be exercised in selection of the host country as physician burnout in low and middle countries (LMIC) has also reached a crisis point. Chemali et al. investigated the burden of burnout among
    healthcare providers in the Middle East, through a systematic review which found 138 articles that met inclusion criteria. The Maslach Burnout Inventory was the most common tool to measure burnout, which ranged from between 40 and 60%. Dhusia et al. questioned 300 resident doctors working in public sector hospitals across Mumbai, India, by the "Copenhagen Burnout Inventory". They found that the residents worked 88 h/week and 56.66% (n = 170) showed scores of burnout. Zang et al. carried out a cross-sectional survey across 30 provinces comprising 3016 Chinese doctors, of which 2617 completed valid questionnaires and found that the overall prevalence of burnout symptoms was 85.79%. They concluded that burnout symptoms among Chinese doctors were associated with age, professional title, and long working hours.
    I suggest that enthusiasm for Global Health and Surgery electives from high income countries should be tempered by consideration of burnout in healthcare workers in LMICs. Furthermore, benefits to LMIC healthcare workers and institutions should be clearly defined.
    REFERENCES
    Jindal RM. Service to Others May Be the Answer to Physician Burnout [published online ahead of print, 2020 Apr 15]. JAMA Surg. 2020;10.1001/jamasurg.2020.0046. doi:10.1001/jamasurg.2020.0046

    Chemali Z, Ezzeddine FL, Gelaye B, et al. Burnout among healthcare providers in the complex environment of the Middle East: a systematic review. BMC Public Health. 2019;19(1):1337. Published 2019 Oct 22. doi:10.1186/s12889-019-7713-1

    Dhusia AH, Dhaimade PA, Jain AA, Shemna SS, Dubey PN. Prevalence of Occupational Burnout among Resident Doctors Working in Public Sector Hospitals in Mumbai. Indian J Community Med. 2019;44(4):352‐356. doi:10.4103/ijcm.IJCM_78_19

    Zhang S, Wang J, Xie F, et al. A cross-sectional study of job burnout, psychological attachment, and the career calling of Chinese doctors. BMC Health Serv Res. 2020;20(1):193. Published 2020 Mar 12. doi:10.1186/s12913-020-4996-y
    CONFLICT OF INTEREST: None Reported
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