2018 ANZCA ASM: Combined Welfare of Anaesthetists SIG and RACS plenary session May 11
In keeping with the conference as a whole, this plenary session was delivered together with the Royal Australasian College of Surgeons (RACS). The theme of the session was “Keeping the passion alive: surviving 21st century practice”, with four talks that complemented each other well with some academic background, personal experiences and novel ideas of how to prevent burnout.
The first speaker was Professor Simon Willcock, discussing “Background of the issue of burnout – an overview of the extent of the problem”. Professor Willcock gave an excellent summary of burnout; its definition, prevalence amongst surgeons (40 per cent) and anaesthetists (six to 40 per cent) and risk factors. Of note, was his observation that despite over 20 years of work and discussion about burnout in doctors, very little has changed. The reality is that most of the interventions that have been used have been reactive and have involved little change to the system that we work in. He said that the time has come for us to take a new approach. He suggested the following:
- Make doctors aware of the problem and the literature.
- Encourage doctors to take responsibility for their own health.
- Accept and value serendipity; come to terms with the fact that we do not have control over what life will throw at us.
- Educate our junior doctors to accept and cope with change and evolution.
- Make training programs more flexible and diverse to encourage career sustainability and flexibility.
- Teach resilience and mindfulness.
- Normalise doctors because we are not different.
The next speaker was Dr Taylor Riall – “Maintaining the fire: wellbeing, resilience and intentional culture”. Dr Riall is a general surgeon and surgical oncologist at the University of Arizona College of Medicine. She is also an executive leadership coach. Dr Riall began by discussing the traditional teaching and culture in medicine that resulted in her episode of burnout in 2014. She spoke about the fact that the fundamental flaw in the culture of strength and invincibility (the “superhuman syndrome”) is the fact that we are not superhuman and we do have the basic human needs for self-care and a life outside medicine. Using statistics to highlight the extent of the problem of burnout in our profession she said that if we do not address this problem we are going to lose many colleagues to burnout and we will no longer attract the brightest and best students into medicine.
Dr Riall then went on to describe her episode of burnout and how she overcame it with the help of a sport psychologist. She came to understand the need to invest in her own wellbeing and to take care of herself and the need for her to advocate for herself. She learnt that as a profession we need to respect the whole self and not just the physician. She suggested how we can go about looking after ourselves and our lives by focussing on four elements; home, work, community and self. We also need to have the courage to define our own success instead of following the old definition in terms of research, teaching and patient care. By knowing what we want we are better equipped to know what we are and are not prepared to take on.
Finally, Dr Riall spoke about the need for us to address the wellbeing of our colleagues as well as ourselves. We need to ensure that we have a work culture that supports the behaviours discussed and provides multiple different career paths. We should start by taking care of ourselves, broaden our definition of success and accommodate our colleagues. She also spoke about the need to educate our juniors, describing a residency wellbeing program that she has been involved in where they have demonstrated that greater self-awareness and emotional intelligence is associated with less emotional exhaustion, cynicism, perceived stress, less depression and increased professional proficiency. The talk ended with the challenge for us to ask ourselves “when were you last on fire” and the reminder that sometimes we get so caught up in the destination that we forget about the journey.
The third speaker was Mr Eric Levi – “Broken Doctors, broken systems”. Mr Levi is an ENT head and neck surgeon in Auckland, and he started his talk by referring to the “elephant in the room” that is mental ill health in medicine. He pointed out that although we have started to talk about the self-care elephant, we have not begun to address the institutional health elephant. He emphasised the fact that burnout is bad for patients and bad for business.
Mr Levi suffered from burnout and took to writing a blog about his experience. His blog went viral with over 250,000 views. He highlighted that we train in the discipline of medicine because we want to do a job that we love, we are good at, we get paid for and the world needs. Loss of these four things leads to burnout and we are constantly being pushed to an edge where these four ideals are no longer met and this is the responsibility of our governments, health leaders and colleges as well as us. We doctors need to develop a “we change or we die” approach if anything is to change. Dr Levi then referred to a 2017 article in the Mayo Clinic Proceedings by Shana Felt et al who have put forward nine organisational strategies to promote engagement and decrease burnout – eight of these being changes at an institutional level.
Mr Levi ended his talk by suggesting how to decrease burnout in our institutions.
- Keep work meaningful
- Find someone to champion good self-care e.g. a welfare advocate
- Encourage cultural change to encourage civility and respect in the work environment
The final speaker was Dr Ira van de Steenstraten – “Anima Sana in Corpore Sano, resilience on the run for the medical career”. Dr van de Steenstraten started by defining resilience as a dynamic, evolving process of positive attitudes and effective strategies. She told us about an AMA Queensland program aimed at equipping young doctors with the resilience and coping skills needed to survive and thrive in medicine. It was piloted in October in 2015 and was so well received that it is been introduced into Queensland Health for all interns, with funding approved for 2017-2019. It is a customisable two or three-part workshop, each workshop taking 1.5 hours. Topics covered included mindfulness, mindful communication skills, strategies to manage burnout and compassion fatigue, skills for managing difficult clinical scenarios, and practical tips on getting help.
I found this welfare session, “Keeping the passion alive: surviving 21st century practice” very worthwhile, not only because what the speakers were saying made sense and was well thought out, but also because we were sharing the floor with surgeons and talking the same language. I hope this means well for our futures working together.
Dr Anna Hallett
Welfare of Anaesthetists SIG executive committee member