Medical Professionalism Best Practices: Addressing Burnout and Resilience in Our Profession

Book Title: Medical Professionalism Best Practices: Addressing Burnout and Resilience in Our Profession

Author: Richard L. Byyny, Richard Byyny, Sean Christensen, and Jonathan Fish, eds

Publication Information: Aurora, CO, Alpha Omega Alpha Honor Medical Society, 2020, 152 pp., paperback

Free access at https://alphaomegaalpha.org/medprof2015.html, paper copies available on request from info@alphaomegaalpha.org.

It’s rare that we are invited to be troublemakers, but here is just such a provocation:

Physicians experience conflict .…They have been professionalized for acquiescence, docility, and orthodoxy. They are taught to be more like sheep than cats.… We need cats who will resist conformity in service of extra-professional forces. The mission… is about saving health care for patients and society, and enabling our profession … to care for patients and not experience burnout (p 4).

This book represents a passionate call for physicians to examine critically the forces that are shaping the practice of medicine, and to have the courage to advocate for patients.

One of a series of monographs published by the honor medical society Alpha Omega Alpha (AΩA), this volume is a collection of 14 essays addressing timely topics. These range from societal pressures eroding professionalism in medicine, to impacts of electronic health records, to how individual physicians can adopt practices that will buffer against stress, and most of all, an exploration of market and business forces that challenge medicine’s professional identity. The monograph includes a thoughtful preface and closing reflections on the challenges at hand.

Richard Byyny, in his preface (coauthored with George Thibault) and in the first chapter, outlines the scope of the problem and identifies professional challenges for physicians that have to do with the “businessification” and corporatization of medicine (p 2). The next essay, by Darrell Kirsch, delves into the role of individual mentoring, with a focus on helpful initiatives in medical training. That topic is picked up in a chapter by Douglas Paauw and Sheryl Pfeil that includes excellent case studies, and also in Anne Eacker’s “Well-being Definition and Measures in Medical Education.” Dr Eacker discusses issues such as student debt and provides a case study of how the University of Washington School of Medicine approached these challenges.

Carrie Horwitch’s essay on professionalism and burnout as they relate to the electronic health record investigates issues of moral injury and potential pitfalls for physicians. She identifies some fixes that are relatively easy to implement, and others that might be quite challenging to the status quo. For example, she recommends that “a minimum of 30 minutes with patients should be the standard of care,” based on her own analysis, bolstered by a 2015 article by Linzer, et al.1

The issues raised in this monograph are not easy, and I appreciate the willingness of the authors to wrestle with really big, complex moral and societal issues. One chapter, written by two scholars from Mayo Clinic (Frederic Hafferty and Jon Tilburt), ventures into a rather deep sociological analysis of pressures on medical professionalism, and it invites the reader to invest considerable thought and attention.

Some chapters are quite accessible and very straightforward in their recommendations. For example, Christina Surawicz’ “Personal Strategies to Beat Burnout: The 20 Percent You Can Control” feels very positive and uplifting, because it is full of things that physicians can do right away, and over which they have considerable control.

Other chapters are more sobering. It can be disheartening to have to face squarely the enormity of the entrenched forces causing physicians to experience moral injury. One essay that identifies concrete steps to address these systemic challenges is Steven Wartman’s “Changing the Behavior of Organizations.” It is aimed at those in positions of leadership, and it provides strategic guidance on fostering compassionate change in health care systems.

There are some real gems in this monograph, but nevertheless, I would not recommend reading the whole monograph straight through. The conference presentations on which these essays were based often reviewed the same introductory content, for instance by defining burnout. That makes sense in the conference where these topics were presented, but once the essays are collected, it makes for considerable overlapping content. I would therefore encourage the reader to sample topics of greatest interest, or select authors whose work you most want to explore, and delve into those chapters.

The call to rethink our approaches to medical education and health care delivery is a daunting one. The authors point out that we are in difficult times, and remind us that medicine has successfully overcome challenges throughout its history. We are currently in very choppy waters, globally, nationally, and professionally. This AΩA monograph is free, timely, and contains a great deal of valuable, high-level thinking about what we need to do to navigate this difficult period in history, while holding tight to our moral compass.