My last post on Optimism in Leadership generated a fair bit of conversation between myself and others in medicine, nursing and beyond. I had identified pessimism as running rampant in doctors, and offered up suggestions for optimistic leadership. One of my friends and trusted colleagues looked at the topic from a different angle and suggested that physicians are less pessimists than they are “beleaguered”. She stated that the beleaguered physician “wears his status as a badge on this sleeve”. She posited that a doctor in such a state “takes real facts and puts them out there as the centre of his or her own story, rather than starting for the tremendous intellectual, emotional and financial privilege we have as physicians, then taking a hard look at what needs to be better and working toward it in that context.” She stated the believes “beleaguerment is the enemy of system reform, especially because many physicians who do not identify as pessimists are the first to exhibit signs of being beleaguered”, and this would prevent them from getting involved.
This conversation really got me thinking. What exactly is beleaguerment? And if it everywhere, what are the causes and most importantly how do we counter it as a profession to ensure that we are active participants in change as it occurs around us, rather than passive observers (which makes us irrelevant) or constant resistors (which makes us unapproachable).
It is true that doctors feel attacked from every direction these days. They are under increasing financial pressure. They are dealing with many older and more complex patients. They feel the burden of hundreds of requests for information on their patients every week. They have more work than they know what to do with. They tend to operate as armies of one in their personalities of perfectionism and high performance.
I wonder if beleaguerment is not a symptom of physician burnout. The 2016 Medscape Physician Lifestyle Report which surveyed 15,800 physicians from 25 specialties, shows that burnout rates by specialty range from 40 – 55%. Major contributors to this feeling include too many bureaucratic tasks, long work hours, the effect of computerization and technology, income levels, loss of leadership, certification requirements, accountability, demanding (and more informed) patients and time constraints. This is an American survey admittedly, but the most recent large Canadian study was in 2009 by Micheal Leitner at Acadia University as published in Canadian Family Physician. This speaks to burnout rates nearing 50% in Canadian doctors, and I presume that things have likely gotten worse, not better. But is beleaguerment the same as burnout? Burnout is a symptoms of chronic stress, of being pushed past the ability to effectively cope. It happens when the traits listed above are not balanced by equally uplifting forces. It shows up as emotional exhaustion, compassion fatigue, detachment from important things in life, decreased feelings of personal accomplishment, and an ongoing sense of pessimism or unhappiness. They are not the same. But I think that both are inextricably linked.
And yet despite all of this no profession is better suited for battling beleaguerment than ours. We advise our patients constantly on how to improve their heath and situation. Why do we not do the same for ourselves? We have a deep knowledge of humanity, the heath care system and our businesses, so why don’t we turn our skills inward to provide joy at work.
How can we as physicians and care providers, who teach our patients techniques that produce the ability to bounce back and find joy , find the same in ourselves? There is much we can do to bounce back into our work and create a greater sense of optimism. The ideas that follow represent a sampling of what is possible and are a place to start rather than an exhaustive or prescriptive list. All of these can help us if our profession is feeling downtrodden or attacked:
- understand the unique opportunity it is to be a health care provider, playing a pivotal role in people’s lives
- get involved … locally, regionally, or broader in things that matter to you and which provide meaning
- find ideas that are positive and people who are working toward change and connect with them
- build a support system… associate with others
- reconnect with the moment – learn the background behind problems and ask the question “why” constantly
- become an active participant in the world which is changing around you, rather than a passive observer
- share stories
- be aware of and happy with where you are, even if you are not entirely content
- laugh more
- own your state of mind and opinion and use it to challenge the current state of affairs
There is no doubt we work and live in incredibly fast paced and challenging times. Sometimes it feels like everything is happening to us rather than with us. Even when this is the case, beleaguerment is not a useful condition for physicians to adopt if we want to have a role in making things better for our patients, ourselves and the health care system. There is no better time than now to adopt an attitude and approach to finding or re-connecting with joy at work both personally and professionally. We must attach to change in a way that embraces it and shows huge leadership in influencing it. Beleaguerment allows us to be convinced that we cannot make a difference in our environment professionally and politically. If we resist it, despite the tremendous effort involved, we have won the fight and the battle!