Stop Physician Burnout (Book Review)

Stop Physician Burnout (Book Review)

A few weeks ago, I was working at one of the surgery centers and on top of a desk inside one of the physician offices was a book called Stop Physician Burnout.

It immediately caught my eye since I’m one of the wellness champions in my hospital organization.

While I haven’t experienced burnout myself, I know how vitally important it is to stop physician burnout. Burnout is the polar opposite of physician wellness.

I decided to peruse the book. It looked fairly informative and interesting. Since it was in a space shared by physicians (sort of like a library), I decided to take it home and read it.

Here is my summary and review of the book Stop Physician Burnout by Dr. Dike Drummond, MD.

 

Stop Physician Burnout Summary

Stop Physician Burnout was published in 2014 and is 196 pages long. It is a fairly quick read. I’m a relatively slow reader, yet I was able to read it in about a week.

It is written by Dr. Dike Drummond, MD who is a Mayo trained family doctor, professional coach, author, speaker, as well as the founder and CEO of his website TheHappyMD.com.

The target audience of the book is professionals (mainly physicians) who want to prevent or recover from burnout while building a more ideal practice and a more balanced life.

Sometimes when I read a book, I like to take notes on some of the more salient points. That way, I can just refer back to my notes instead of re-reading the book. Below is a chapter-by-chapter summary of the book based on the notes that I had written.

Chapter 1: Burnout Basics

The author begins by discussing the cost of burnout. Most of us are familiar with this. It includes lower quality of care, lower patient satisfaction, disruptive physician behavior, high rates of physician substance abuse, divorce, and suicide.

The Maslach Burnout Inventory (MBI) has become the gold standard in measuring occupational burnout. The MBI measures the following three main symptoms:

• Exhaustion
• Depersonalization – cynicism, compassion fatigue
• Lack of efficacy – lack of purpose in work

The Three Energy Accounts

Instead of the three symptoms above, the Dr. Drummond likes to think of burnout in terms of energy accounts that could potentially go negative (just like how a bank account can have a negative balance debt).

There are three energy accounts:

• Physical – fill this account by taking care of yourself, exercise, proper rest, good food. Depletion leads to exhaustion
• Emotional – fill this account by having adequate time for the important relationships in your life. Depletion leads to compassion fatigue and depersonalization.
• Spiritual – fill this account every time you feel like you are doing meaningful work that aligns with your life purpose. Depletion leads to a lost sense of purpose and meaning.

Don’t let your energy accounts go below empty

Too much stress + Not enough recharge = Negative energy accounts -> Burnout.

The accounts can be interconnected too. Depletion of one energy account can spill over to further depletion of another energy account.

It is much harder to recharge when your energy balance is negative in the same way it is harder to build wealth when you are trying to climb out of debt. If left unchecked, it can lead to a downward spiral leaving the physician with the feeling of “I’m not sure I can go on like this for much longer!”

The four root causes of burnout:

1. The practice of medicine – it is stressful career
2. Your specific job – stressful schedule, challenges with EMR, difficult relationship with admin/staff, etc.
3. Having a life – life itself can be stressful too. Relationship with spouse, raising children, financial stress, family responsibilities, etc.
4. Conditioning of our medical education – we are conditioned since medical school to exhibit certain qualities that may have served us well in the past but could potentially lead to burnout, including:
   • Workaholic
   • Superhero
   • Emotion-free
   • Lone ranger
   • Perfectionist

Recognize the above programming and understand that it is okay to ask for help, delegate to others, and take care of yourself first.

Chapter 2: Take Out The Head Trash

It’s important to take out the “head trash” (self-sabotaging thoughts) first in order to prevent or recover from burnout. These thoughts are as follows:

1. Deal with your inner critic. Don’t let your thoughts prevent you from making the changes you seek and desire.
2. Realize burnout is a dilemma, not a problem. A problem is something that has a solution. But burnout isn’t something that you can just solve. Instead it is a dilemma between two competing horns that you can manage. Define the dilemma, design a strategy to create balance, and build a system.
3. Do the Big 180 by focusing on what you want instead of what you don’t want.
4. Spin plates, one at a time. Like a plate spinner, don’t move on to a second plate until you have the first going full speed. Start small and tackle one task at a time. Taking on multiple action steps at a once may lead to overload and overwhelm without desired results.
5. Celebrate all wins. Even small wins. Celebrate all the progress you’ve made from where you started and spend less time obsessing over the gap between where you are and the end goal. Focus on progress first and notice what is going on right.

Chapter 3: Your Ideal Practice

• When you realize what you want, create an Ideal Practice Description. This should be written down just like your Investor Policy Statement. Your IPD should answer specific questions. What kind of patients do you want to see? What practice setting (office, hospital, or both) do you want to work in? How many hours a week do you want to work? How much do you need to be paid in order to support your family? What kind of practice (solo, physician owned, academic, employee of a large organization)? What part of the country do you want to practice? The answers to these questions creates a specific framework to focus your efforts going forward.
• Then, build a Venn diagram with your current practice on one end and your Ideal Practice Description. Maximize the overlap.

• Ask the following question to create your master plan: “What would you change about this job to increase the overlap with your Ideal Practice?” Make a list of your answers and take action steps.

Chapter 4: The Tools

Commit to regular strategy sessions. Using your ideal practice description, review your current practice and create a strategy/plan. Take action steps to make your current practice more like your ideal practice using the following tools.

Burnout Prevention Matrix

• • Two methods to preventing burnout: decrease stress and increase recharge
  • Two responsible parties: individual physician and your organization
    • Quadrant I: Personal stress relief
      • EMR efficiency and proficiency (the EMR is a common of stress and burnout)
      • Mindfulness, deep breathing – improves focus and relaxation
      • Team huddle – improves leadership and team efficiency
      • Batch Processing – increases productivity, reduces distraction
    • Quadrant II: Personal recharge
      • Schedule hack – schedule important things in your personal life (date night, workout class, vacation, children’s activities, etc.). Writing it down on a schedule show a commitment of prioritizing your personal time and your time with loved ones.
      • Boundary ritual – Any ritual that you do when you leave work and come home. It could be taking a shower, changing clothes, going for a walk, etc. It allows a mindset shift from being a physician to being at home.
    • Quadrant III: Organizational stress relief
      • Educate physicians and organization about burnout
      • Survey providers about burnout and workplace stressors
      • Create, fund, and support a burnout prevention working group to address physicians’ concerns
    • Quadrant IV: Organizational recharge
      • Organizational efforts to improve work-life balance such as sabbatical privileges, onsite programs, resources for seeking help, onsite exercise facilities, organizational social activities and community service events.

Chapter 5: No One Is On An Island

In this chapter, Dr. Drummond addresses leadership and communication skills for a physician leader.

Be a Team Captain. Instead of being a lone ranger, be a captain and utilize your team. Have a vision, ask powerful questions, and lead the discussion with questions rather than just giving orders.

Have a good relationship with your boss. Understand your boss’ personality and communication style as well as his/her goals and priorities. Do your best to align these factors to have more support and increase the likelihood of creating the changes you seek to make.

Build trust with your boss. Have regular meetings and don’t be a whiner. If there is a problem, always bring a win-win solution that gives you more of what you want that also meets one of your boss’s objectives. Remember the “continuation rule”—If you end on a positive note, your next meeting will likely continue on that same trajectory even if your discussion is about a problem.

Regularly express gratitude with your team and say “thank you” with impact. Do this by acknowledging effort and progress. When you see a member of your team doing a good job, take the opportunity to thank them for their hard work.

Chapter 6: Do I have to Change Jobs?

If you used all the tools available and still can’t maximize the overlap between your current job and your ideal practice to the point where you are comfortable with, then it might be time to look for a different job.

However, don’t just quit your job immediately. Use it as a bridge until you find a new job that better fits your ideal practice.

Using your written Ideal Practice Description, you already know what you want. Do a high quality job search and ask questions required to screen them and select the best job that fits the bill.

Chapter 7: Your Exit Strategy

When you retire, it’s important to know that you aren’t just retiring from medicine, but also retiring to a new life.

For most physicians, an exit from medicine is triggered by a financial threshold.  When you no longer need to work to make the money to support your lifestyle, you are financially free. At this point, you work because you want to and not because you have to.

Some physicians say “What would I do with myself? I would get bored.” That’s just head trash. You will find a way to make a contribution to your family and community that matches your sense of purpose in medicine and in life. You will find new passion projects (or reinvigorate old ones) that you hold your enthusiasm once your medical practice is not dominating your time and energy.

It’s a good idea to create an Ideal Retirement Description and write it down too.

Chapter 8: Case Studies

Case studies and real life examples that illustrate how seven physicians in different circumstances managed to create a more ideal life and ideal practice for themselves.

 

Review of Stop Physician Burnout

Overall, I think Stop Physician Burnout is a great book.

Dr. Drummond shares a little bit of his personal story of burnout and his discusses his experience in coaching others which gives him credibility on the subject.

The book is also organized very well and does not include a lot of unnecessary detail that could bog down a reader.

Furthermore, he provides great summaries at the end of each chapter as well as actionable steps so that the reader can apply the knowledge and tools that are learned.

I also like how he encourages frequent re-evaluations, strategy sessions, and reflective journaling as part of the process of preventing burnout and building a more ideal practice and better work-life balance.

Critique of Stop Physician Burnout

I could only think of a few things that I would critique about this book.

I’m not sure if it’s a fair criticism, but the book feels a little bit skewed toward more of a male audience. There is one word in the book that I can think of that can be potentially perceived as misogynistic. Perhaps it could be commonly used in some workplaces, but it is certainly not a word I would repeat out loud in front of my daughter.

This is kind of nit-picking, and probably more of a different taste in style, but some of the words and phrases that he uses are sort of hokey and corny. For example, he would say that in order to celebrate all wins you should “treat yourself like a dog” by doing an equivalent of proudly giving yourself a pat on the back. He also uses the term “squeegee breath” to refer to a deep breath that cleans the window of your awareness and releases any thoughts or feelings that don’t need to be here right now. While some of his phrases are corny, I have to admit that they are memorably corny. So, in a way, I guess the corniness is effective.

And finally, he mentions that physicians should figure out their finances or hire a financial planner toward the end of their career during the exit strategy. However, I believe financial wellness should be addressed way earlier in the beginning of a physicians career, not just the end. Financial hardship can be a major driver for burnout in any stage one’s career.

 

Final Impression

Stop Physician Burnout by Dr. Dike Drummond is a great book filled helpful information, tools, strategies, and action steps for any professional looking to prevent career burnout and build a better life.

I would recommend the book to physicians or other professionals who are interested in burnout. In fact, I might use some of his tools and strategies as a physician wellness champion!

 

If you also read the book, what do you think of it? Is there any other books on physician burnout that you would recommend?