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Physicians: Neither Victim nor Villain (04:45)

If we consider physician burnout to be a shared problem, what can we do to address it? asks Steve Swensen.

“As physicians, we’re not victims, but the external environment isn’t necessarily the villain either, and we have to take some responsibility,” says Christine Sinsky. Physicians are too used to just taking on “one more thing,” she says. “It’s time to say no. It’s time to draw a line and say at this time I am done with work, and I am going home to my family. I am not shortchanging my children of my time.”

We need to find solutions for what Sinsky refers to as “pajama time,” or documentation work at home. Because physicians, she adds, have a responsibility to say that what they’re being asked or expected to do is not sustainable.

“We can’t continue to do that. We have to find solutions, for ourselves, and for the next generation.”

In addition to finding those solutions, Sinsky emphasizes reflection on both personal and professional life. “What is the meaning and the mission of the work that I do? What’s the meaning and the mission of the life I lead outside of medicine? And to not lose sight of those things,” she says.

Tait Shanafelt agrees, and offers three key tactics. The first is to perform an exercise he has physicians do — including himself — which is to create a list of personal priorities and professional priorities. The hard part is integrating them. “What I usually tell folks is, ‘I don’t know what you wrote down in your professional priority or personal priority list, but I can guarantee you that your two lists are not compatible.’”

“I use the example that if I think that I am never going to miss a soccer game and I’m going to be a world expert in the treatment of folks with chronic lymphocytic leukemia, that those are incompatible values. I am going to miss some soccer games to make a difference and care for the patients with this disease,” says Shanafelt. “But how many games is it okay to miss and still have the relationship with my wife and kids that I want?”

The second tactic is to optimize meaning at work, and to be cognizant of your motivations and interests, and then be intentional of how to achieve growth in those areas, recognizing that, over time, those interests may change.

Lastly, Shanafelt says to focus on what really matters in your personal life — loved ones, self-care, hobbies, etc. — and to protect them by building firewalls around those activities. “You have to have those spaces in the personal life where, no matter what, work will not intrude on it.”

From the NEJM Catalyst event Leadership: Translating Challenge to Success at Mayo Clinic, June 2, 2016.

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