Rediscovering the Happiness in Medicine: Think BIG
Part 1: Burnout in dermatology: It’s real!
Symposia on physician burnout are proliferating. The format always seems similar. The problems facing us in medicine are listed and then ideas are brainstormed to determine why the burnout rate is increasing. One can’t help but feel disheartened and overwhelmed about the array of issues facing us in medicine. The ensuing discussion focuses on “approaches to decrease burnout.” This is depressing, too. Go on vacation. Don’t take work home. Exercise more. These always seem like great ideas, but if the key to feeling better is to avoid work, why did we all choose this career in the first place? Ironically, by the end of the symposium, any glimmer of hope for the battle against burnout has been extinguished. Burnout seems inevitable.
Up to 80% of physicians may be experiencing burnout.1 Even dermatologists are suffering “burnout.” Comparing rates of physician burnout in 2011 and 2014, dermatologists are undergoing the most rapid increase in burnout among all medical professions.2 Hours spent on documentation are increasing. Demands on physician productivity are accumulating. Negativity, helplessness, and frustration are snowballing. Recognizing the problems facing us, we are zeroing in on everything wrong in medicine. Perhaps it is time to refocus on everything that is right in medicine. Physicians must not forget why they initially decided to pursue medicine. A medical career can bring joy and fulfillment. To fight the battle of burnout, an unconventional approach is warranted: let’s build happiness.
Flipping focus on burnout is not designed as a method of denying that problems exist. Rather, it opens our minds to different solutions. Happiness researcher Barbara Fredrickson writes, “Unlike negative emotions, which narrow people’s ideas about possible actions, positive emotions do the opposite: They broaden people’s ideas about possible actions, opening our awareness to a wider range of thoughts and actions.”3 Not only will positivity make us feel better, it may be necessary in order to brainstorm solutions to some of the difficulties we face.
To build our happiness and positivity, it is important to improve our actions, not our situations. Research has shown that 50% of our happiness level can be attributed to genetics, 10% to circumstances, and an impressive 40% to voluntary action.4 Too often, the focus is on improving our circumstances as a way to improve happiness. A new job title, a higher salary, or a bigger house may make us temporarily happy, but after a new baseline is established, it is easy to revert back to one’s initial happiness set point. This is known as hedonic adaptation. Hedonic adaptation is useful when something awful happens to help individuals bounce back. But, it also makes the quest for happiness more difficult. In contrast, focusing on actions has a more lasting effect on our happiness.
Part II: Flipping the focus on burnout
There are several approaches that can be used to battle burnout by making life happy. Three action-oriented pillars of happiness are called to mind by the mnemonic BIG (B - bonds; I - impact; G - gratitude).
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Bonds reflect the importance of both intimate (eg, friends, family, and colleagues) and far-reaching (eg, specialty community, entire medical community, country) connections. Like food, water and shelter, bonds reflect a basic human need and are necessary to human survival. Strong bonds have been linked with better health and longevity, whereas weak social connections and loneliness increase the risk for poor health. It is essential that bonds are cultivated with fellow physicians, nurses, staff, and patients. Take a moment to check in with a colleague, start the day with a team huddle or find a common thread of interest with your patient. The web of support built around us may catch us if we fall. Today, social media or email often serves as the catalyst for building relationships. Although it has its drawbacks, it also has benefits, as electronic media can help to initiate and continue relationships. Many physicians build upon relationships by collaborating with physicians at different institutions via email and phone. Additionally, several Facebook groups serve as a forum to discuss difficult cases, and other groups, such as the physician moms group, serve as a place to garner emotional support. However, it is important to remember that, although electronic media can be used to help initiate or facilitate relationships, it should not replace face-to-face relationships, as these serve as one of the backbones of our happiness.
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Impact refers to influencing and helping others. As physicians, this part comes easily since opportunities abound in our lives. Helping others increases one’s own happiness as much or more than the happiness of those being helped. It is valuable to take a moment to recall the patients you have healed and other lives you have touched. Consider the mentorship, support, and knowledge provided to colleagues or trainees. Each physician should consider the tremendous impact he or she has had on the communities as a respected healer and leader.
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Finally, gratitude is essential toward any quest of happiness. In the words of Robert Emmons, a prominent gratitude researcher, gratitude has a broad definition reflecting, “A sense of wonder, thankfulness and appreciation for life.”5 Individuals who are grateful have lower depression, higher self-esteem, better sleep, less negative physical symptoms, and many other positive outcomes. Gratitude can also stall the hedonic treadmill and prevent physicians from taking so many things for granted. Gratitude should be shared with others by verbally expressing appreciation or writing letters to those who have helped you. However, even private gratitude, such as taking a few minutes at the close of the day to consider the things for which we are grateful, can contribute to a long-lasting boost to happiness.
Physicians are given an enormous privilege to impact and help others. Yet, to help others, physicians must help themselves by rekindling the passion to serve and heal. So, let’s build happiness and think BIG, focusing on bonds, impact, and gratitude. It may be the thing that saves us from burnout.
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Additional Info
- Rotenstein LS, Torre M, Ramos M, et al. Prevalence of burnout among physicians: a systematic review. JAMA. 2018;320(11):1131-1150.
- Shanafelt, T, Boone, S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385.
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Fredrickson B. Positivity. New York: Crown; 2009.
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Lyubomirsky S. The How of Happiness. New York: Penguin Books; 2008.
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Emmons R. Thanks!: How the New Science of Gratitude Can Make You Happier. Boston: Houghton Mifflin Harcourt; 2007.
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