ICD 10- Z73.0: Burnout

by Raagini Jawa MD, MPH

 

“How are you feeling today?” I asked, as I greeted my seventh clinic patient of the day. What came next was unexpected. My patient posed the same question back to me. “How are you feeling today?” I wasn’t prepared to answer.

 

What I couldn’t tell her was that over the past several months, I had every symptom of early burnout and felt like a weaker provider because of it;

I couldn’t tell her that I was feeling anxious about all of the piled-up disability and prescription paperwork on my desk;

That I was feeling exhausted from staying up late finishing notes rather than being with my family and friends;

That I was feeling hungry as I only had time to hurriedly ingest some saltines before this visit;

That I was feeling worried that if I answered her question truthfully, our 15-minute visit would be further lengthened and I would fall further behind.

 

We are taught early in our training that doctors are supposed to be strong for their patients. We are taught that the virtues of hard work and selflessness are key attributes to becoming a successful physician. After just two years of residency, I recognized that those same virtues and our “hang in there” medical culture encourages a façade of strength.

 
The prevalence of burnout among healthcare professionals is annually rising, now exceeding 40-60%. This has contributed to compassion fatigue, compromised professionalism, reduced patient satisfaction, and increased medical errors, physician substance abuse, suicide, and intent to leave practice.

 
We must ask ourselves what has changed in the medical culture in the last 50 years to lead to such a significant increase in burnout that it now warrants its own ICD-10 code.  Is it our ever-changing healthcare delivery system, the digital busywork of EMRs, progressively shrinking office visits, or a combination of these factors? Or, as some might claim, is the new generation of physicians just inherently weaker?

 

The answer to these questions does not lie solely in increased prevalence studies about burnout. We must begin asking questions about which interventions we will attempt to solve this issue. There is an abundance of data that points to the need for prioritization of physician wellness, and in response, mindfulness training has been integrated into many medical schools, residencies, and medical career development programs.

 

While techniques of mindfulness and resilience training are tried and true preventative strategies of burnout, they still put the onus on providers to build up their “burnout immune system” in an already over-stretched schedule.  Recently, the Lancet published a Gold Foundation-supported systematic review and meta-analysis of over 2000 research articles which indicated that both individual-focused AND structural or organizational strategies can lead to meaningful reduction in physician burnout.

 

Thus, in order to truly impact our physician burnout epidemic, the next steps are to challenge the multifactorial systemic problems leading to burnout and to address root causes: namely, the dehumanization and industrialization of medicine. In order to achieve this goal, we should shift our focus back to quality of care over productivity, find creative ways to limit the amount of bureaucratic and administrate tasks physicians have to do. We should make electronic medical records more user-friendly, and increase physician representation in leadership to promote health care reform based on the current realities of clinical practice.

 

My hope for the future is that increased physician-self-advocacy will convince our healthcare industry to make a profound commitment to help keep healthcare human. Until then, we physicians should continue to ask each other “How are you feeling?” so that our patients don’t have to.

 

Raagini Jawa received her MD/MPH from Boston University School of Medicine and is now an Internal Medicine Resident in the HIV pathway at Boston Medical Center. She is a Leonard Tow Humanism in Medicine awardee and Arnold P Gold Foundation Humanism Honor Society member.