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Fatigue in Surgery: Managing an Unrealistic Work Burden

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The SAGES Manual of Quality, Outcomes and Patient Safety

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Abstract

The issue of physician wellness has received increasing attention in recent years for multiple reasons, including issues ranging from physician attrition and suicide to patient outcomes. Multiple factors have been identified as contributing to high levels of burnout, including individual as well as systemic and institutional factors. A number of tools for detecting and monitoring burnout and physician wellness have been developed and have been increasingly deployed in healthcare and professional organizational settings. Strategies for individuals and institutions to employ to mitigate and prevent burnout have been recognized and studied. This chapter will review the current status of our understanding of surgeon burnout and wellness and its measurement, including contributory factors. Mitigation strategies will also be reviewed, with a particular emphasis on looking beyond coping and defensive strategies into the area of promoting and celebrating joy, fulfillment, and meaning in our work.

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References

  1. Freudenberger HJ. Staff burn-out. J Soc Issues. 1974;30(1):159–65.

    Article  Google Scholar 

  2. Shanafelt TD, et al. Burnout among physicians compared with individuals with a professional or doctoral degree in a field outside of medicine. Mayo Clin Proc. 2019;94(3):549–51.. Elsevier.

    Article  PubMed  Google Scholar 

  3. Shanafelt TD, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995–1000.

    Article  PubMed  Google Scholar 

  4. Oreskovich MR, et al. Prevalence of alcohol use disorders among American surgeons. Arch Surg. 2012;147(2):168–74.

    Article  PubMed  Google Scholar 

  5. Bianchi R, Schonfeld IS, Laurent E. Burnout–depression overlap: a review. Clin Psychol Rev. 2015;36:28–41.

    Article  PubMed  Google Scholar 

  6. Shanafelt TD, et al. Special report: suicidal ideation among American surgeons. Arch Surg. 2011;146(1):54–62.

    Article  PubMed  Google Scholar 

  7. Anagnostopoulos F, et al. Physician burnout and patient satisfaction with consultation in primary health care settings: evidence of relationships from a one-with-many design. J Clin Psychol Med Settings. 2012;19(4):401–10.

    Article  PubMed  Google Scholar 

  8. Turner TB, et al. The impact of physician burnout on clinical and academic productivity of gynecologic oncologists: a decision analysis. Gynecol Oncol. 2017;146(3):642–6.

    Article  PubMed  Google Scholar 

  9. Are C, et al. A multinational perspective on “lifestyle” and other perceptions of contemporary medical students about general surgery. Ann Surg. 2012;256(2):378–86.

    Article  PubMed  Google Scholar 

  10. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31573-9/fulltext.

  11. Campbell DA Jr, et al. Burnout among American surgeons. Surgery. 2001;130(4):696–705.

    Article  PubMed  Google Scholar 

  12. Dyrbye LN, et al. Relationship between work-home conflicts and burnout among American surgeons: a comparison by sex. Arch Surg. 2011;146(2):211–7.

    Article  PubMed  Google Scholar 

  13. Lindeman B, et al. Association of burnout with emotional intelligence and personality in surgical residents: can we predict who is most at risk? J Surg Educ. 2017;74(6):e22–30.

    Article  PubMed  Google Scholar 

  14. • No Authors Listed. Rule emphasizes quality and cost savings. Hosp Case Manag. 2011;19:148–9. Summary of The Centers for Medicare and Medicaid Services (CMS) 2012 final rule on the Inpatient Prospective Payment System (IPPS). Rule establishes that hospitals will receive a net 1% increase in reimbursement, also proposes to add a measure of Medicare spending per beneficiary to the Hospital Inpatient Quality Reporting program and the Value Based Purchasing program in effort to reduce costs by rewarding efficient care rather than volume. Finally in an effort to reduce preventable healthcare associated infections HAIs, the rule introduces new quality measures to be implemented in 2014 and 2015.

    Google Scholar 

  15. Kohn L, Corrigan J, Donaldson M, editors. To err is human: building a safer health system. Washington, DC: National Academy Press; 1999.

    Google Scholar 

  16. Bates DW, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280(15):1311–6.

    Article  CAS  PubMed  Google Scholar 

  17. Zulman DM, Shah NH, Verghese A. Evolutionary pressures on the electronic health record: caring for complexity. JAMA. 2016;316(9):923–4.

    Article  PubMed  Google Scholar 

  18. Berguer R, Forkey DL, Smith WD. The effect of laparoscopic instrument working angle on surgeons’ upper extremity workload. Surg Endosc. 2001;15(9):1027–9.

    Article  CAS  PubMed  Google Scholar 

  19. van der Schatte Olivier RH, et al. Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery. Surg Endosc. 2009;23(6):1365.

    Article  PubMed  Google Scholar 

  20. Cook DA, et al. Physician attitudes about maintenance of certification: a cross-specialty national survey. Mayo Clin Proc. 2016;91(10):1336–45. Elsevier.

    Article  PubMed  Google Scholar 

  21. Dacey RG, Nasca TJ. Seniorization of tasks in the academic medical center: a worrisome trend. J Am Coll Surg. 2019;228(3):299–302.

    Article  PubMed  Google Scholar 

  22. Mattar SG, et al. General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors. Ann Surg. 2013;258(3):440–9.

    Article  PubMed  Google Scholar 

  23. Wiggleton C, et al. Medical students’ experiences of moral distress: development of a web-based survey. Acad Med. 2010;85(1):111–7.

    Article  PubMed  Google Scholar 

  24. Munch S, de Kryger L. Moral wounds: complicated complications. JAMA. 2001;285(9):1131–2.

    Article  CAS  PubMed  Google Scholar 

  25. Dean W, Dean A, Talbot S. Reframing clinician distress: moral injury not burnout. Fed Pract. 2019;36(9):400.

    PubMed  PubMed Central  Google Scholar 

  26. Jena AB, et al. Malpractice risk according to physician specialty. N Engl J Med. 2011;365(7):629–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Maroon JC. Catastrophic cardiovascular complications from medical malpractice stress syndrome. J Neurosurg. 2019;130(6):2081–5.

    Article  Google Scholar 

  28. Martini S, et al. Burnout comparison among residents in different medical specialties. Acad Psychiatry. 2004;28(3):240–2.

    Article  PubMed  Google Scholar 

  29. PAYE, IBR. Medical student education: debt, costs, and loan repayment fact card. 2013.

    Google Scholar 

  30. Youngclaus J, Fresne JA. Physician education debt and the cost to attend medical school: 2012 update. Association of American Medical Colleges; 2013.

    Google Scholar 

  31. Gray K, et al. Influence of student loan debt on general surgery resident career and lifestyle decision-making. J Am Coll Surg. 2020;230(2):173–81.

    Article  PubMed  Google Scholar 

  32. Maslach C, et al. Maslach burnout inventory, vol. 21. Palo Alto: Consulting Psychologists Press; 1986.

    Google Scholar 

  33. Maslach C, Jackson SE. The measurement of experienced burnout. J Organ Behav. 1981;2(2):99–113.

    Article  Google Scholar 

  34. Eckleberry-Hunt J, Kirkpatrick H, Barbera T. The problems with burnout research. Acad Med. 2018;93(3):367–70.

    Article  PubMed  Google Scholar 

  35. West CP, et al. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med. 2009;24(12):1318.

    Article  PubMed  PubMed Central  Google Scholar 

  36. West CP, et al. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388(10057):2272–81.

    Article  PubMed  Google Scholar 

  37. Martins AE, et al. Impact of a brief intervention on the burnout levels of pediatric residents. J Pediatr. 2011;87(6):493–8.

    Article  Google Scholar 

  38. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf.

  39. Weight CJ, et al. Physical activity, quality of life, and burnout among physician trainees: the effect of a team-based, incentivized exercise program. Mayo Clin Proc. 2013;88(12):1435–42. Elsevier.

    Article  PubMed  Google Scholar 

  40. Anton NE, et al. Effectiveness of a mental skills curriculum to reduce novices’ stress. J Surg Res. 2016;206(1):199–205.

    Article  PubMed  Google Scholar 

  41. Kabat-Zinn J. Wherever you go, there you are: mindfulness meditation in everyday life. Hachette Books; New York, 2009.

    Google Scholar 

  42. Krasner MS, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284–93.

    Article  CAS  PubMed  Google Scholar 

  43. Clayton JM, et al. Evaluation of a novel individualised communication-skills training intervention to improve doctors’ confidence and skills in end-of-life communication. Palliat Med. 2013;27(3):236–43.

    Article  PubMed  Google Scholar 

  44. Bragard I, et al. Insight on variables leading to burnout in cancer physicians. J Cancer Educ. 2010;25(1):109–15.

    Article  PubMed  Google Scholar 

  45. Gunasingam N, et al. Reducing stress and burnout in junior doctors: the impact of debriefing sessions. Postgrad Med J. 2015;91(1074):182–7.

    Article  PubMed  Google Scholar 

  46. Shanafelt T, Goh J, Sinsky C. The business case for investing in physician well-being. JAMA Intern Med. 2017;177(12):1826–32.

    Article  PubMed  Google Scholar 

  47. Leigh JP, et al. Physician career satisfaction across specialties. Arch Intern Med. 2002;162(14):1577–84.

    Article  PubMed  Google Scholar 

  48. Clifton J, et al. The effect of clinical academic service contracts on surgeon satisfaction. Can J Surg. 2007;50(3):175.

    PubMed  PubMed Central  Google Scholar 

  49. Schneider S, Kingsolver K, Rosdahl J. Physician coaching to enhance well-being: a qualitative analysis of a pilot intervention. Explore (NY). 2014;10(6):372–9.

    Article  Google Scholar 

  50. Ripp J, Shanafelt T. The health care chief wellness officer: what the role is and is not. Acad Med. 2020;95(9):1354–8.

    Article  PubMed  Google Scholar 

  51. Raptis DA, et al. Job satisfaction among young board-certified surgeons at academic centers in Europe and North America. Ann Surg. 2012;256(5):796–805.

    Article  PubMed  Google Scholar 

  52. Larsen KN, Kristensen SR, Søgaard R. Autonomy to health care professionals as a vehicle for value-based health care? Results of a quasi-experiment in hospital governance. Soc Sci Med. 2018;196:37–46.

    Article  PubMed  Google Scholar 

  53. Keeton K, et al. Predictors of physician career satisfaction, work–life balance, and burnout. Obstet Gynecol. 2007;109(4):949–55.

    Article  PubMed  Google Scholar 

  54. Ryan RM, Deci EL. Self-determination theory: basic psychological needs in motivation, development, and wellness. Guilford Publications; New York, 2017.

    Google Scholar 

  55. Khullar D, et al. How 10 leading health systems pay their doctors. Healthc (Amst). 2015;3(2):60–2. Elsevier.

    Article  Google Scholar 

  56. Berwick DM. The toxicity of pay for performance. Qual Manag Health Care. 1995;4:27–33.

    Article  CAS  PubMed  Google Scholar 

  57. Shanafelt TD, et al. Career fit and burnout among academic faculty. Arch Intern Med. 2009;169(10):990–5.

    Article  PubMed  Google Scholar 

  58. Shanafelt TD, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600–13. Elsevier.

    Article  PubMed  Google Scholar 

  59. https://www.siumed.edu/chop/chop.html.

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Authors and Affiliations

  1. Southern Illinois University School of Medicine, Department of Surgery, Springfield, IL, USA

    V. Prasad Poola, Adam Reid & John D. Mellinger

Authors
  1. V. Prasad Poola
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  2. Adam Reid
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  3. John D. Mellinger
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Corresponding author

Correspondence to John D. Mellinger .

Editor information

Editors and Affiliations

  1. Department of Surgery, University of Massachusetts Chan Medical School - Baystate, Medical Center, Springfield, MA, USA

    John R. Romanelli

  2. Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA

    Jonathan M. Dort

  3. Department of Surgery, Lenox Hill Hospital, New York, NY, USA

    Rebecca B. Kowalski

  4. Department of Surgery, NYU Langone Medical Center, Brooklyn, NY, USA

    Prashant Sinha

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Poola, V.P., Reid, A., Mellinger, J.D. (2022). Fatigue in Surgery: Managing an Unrealistic Work Burden. In: Romanelli, J.R., Dort, J.M., Kowalski, R.B., Sinha, P. (eds) The SAGES Manual of Quality, Outcomes and Patient Safety. Springer, Cham. https://doi.org/10.1007/978-3-030-94610-4_42

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  • DOI: https://doi.org/10.1007/978-3-030-94610-4_42

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-94609-8

  • Online ISBN: 978-3-030-94610-4

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