Palliative care, burnout, and the pursuit of happiness

Abstract

I was attending a lecture at the Third Joint Clinical Conference of the NHPCO/AAHPM/HPNA (National Hospice and Palliative Care Organization, American Academy of Hospice and Palliative Medicine, and Hospice and Palliative Nurses Association) in New Orleans last week when I had an epiphany. The talk was by John Finn, MD, the medical director of Hospice of Michigan (a large, multicenter hospice organization based in Detroit). He was speaking on “selfpreservation skills for the hospice professional” to a packed room. While Dr. Finn spoke, I suddenly realized how relevant his talk was to me and to many practitioners in our field. My “bolt of lightning,” as I will explain, struck as I pondered his words about the dangers of pessimism and cynicism and the benefits of optimism and trust. Professional burnout is not confined to palliative care, or even to medicine. “Burnout” is a response to unremitting stress and is described as a “syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment”1 resulting in depression, anxiety, and degraded interpersonal relationships. Overt symptoms are legion and include irritability, appetite disorders, memory disturbances, lack of impulse control (e.g., shouting, acting out), and even self-destructive behaviors. Given the stresses in dealing with death-and-dying issues, paperwork, regulatory upkeep, distressed families, late or inappropriate referrals, and marginal reimbursement, it is no surprise that nurses, social workers, aides, chaplains, physicians, and all other hospice and palliative caregivers are at risk. Before proceeding, it should be noted that palliative care physicians report lower levels of burnout and other stress-related disorders than do other specialists, at least in the United Kingdom, where these studies were performed.2 English palliative-care consultants report less stress from overload than their colleagues and relate gratification from the positive relationships they enjoy with patients. To further illustrate the point, compare the 28-percent “burnout and psychiatric disorder” rate in the UK study of oncologists and palliative care specialists2 to the 76 percent burnout rate among internal medicine residents in Rochester, Minnesota1 for a stunning juxtaposition. What was extremely interesting in the UK palliative care study was that burnout was significantly more common in those who felt they were insufficiently trained in the communication skills required for the job.3 In Dr. Finn’s talk, he referenced an article by Jim Loehr and Tony Schwarz titled “The Making of a Corporate Athlete,” which appeared in the January 2001 Harvard Business Review.4 Sounding board