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On Sept. 8, Dr. Tait Shanafelt, chief wellness officer at Stanford Medicine, spoke at the 2018 Hawaii Health Workforce Summit. His words are worth consideration, especially by the medical profession.

“If I were to suggest to you that we have a system level problem in our health care delivery system that eroded quality of care, reduced access to care, undermined patient satisfaction, and that it was such a pervasive problem that it affected half of the patients seeking medical care in the United States today, we would mount a very robust effort to address that system issue. …we have that problem…we have not responded… that problem is burnout and stress in our nurses, physicians, advanced practice providers and other health care professionals,” said Shanafelt.

The Mayo Clinic and Stanford Medical center have both assessed that physician burnout is one of the top strategic risks to the future survival of their health care organizations and have begun investing in creating a culture of wellness throughout their organizations.

Dr. Shanafelt was followed by Dr. Dyke Drummond, who offered actionable steps for healthcare workers to increase their resiliency and ward off burnout. However, “If you believe like I do that physicians are the canary in the coal mine of medicine, then it is clear the epidemic of physician burnout is an indictment of the mine, not the resilience of the canary.”

Last month at the annual meeting of the American Academy of Pediatrics Hawaii Chapter, local pediatrician Dr. Stephen Yano spoke to the pediatric community and their families about “Healing the Healer.” He recommended this advice:

B — Breathe deep and remember your blessings
L — Live, laugh and love
E — Exercise to live
S — Sleep seven to eight hours a night
S — Smile and be social

Why all this talk about stress, burnout, resiliency and culture of wellness in the health care field?

We pediatricians are called to give. We have had the good fortune of finding and refining our talent. We received support from our communities and now have the wonderful opportunity to be intimately involved in the lives of infants, children, young adults and their families in their quest for a better health. By following this calling, we pediatricians find great joy and fulfillment in doing meaningful work.

However, along with joy we have stress from the complex act of caring for the health of our patients. We need to manage this stress. We continuously learn and relearn to understand ourselves, to prioritize, to reach out to loved ones and colleagues, to manage our limited resources, and sometimes we learn how to say no; because we pediatricians want to see our patients until the end of time. Pediatricians and other physicians need to guard against having our love, passion, loyalty and spirit taken away, or we cannot give to their patients; we cannot become higher performing physicians.

Signs Of Illness

Layered on top and throughout the stress of caring for patients is the increasing stress of changing health plan requirements, rules and tasks that give rise to unintended consequences that in turn pollute the coal mine by stifling the ability of health care providers to thrive, threaten the joy of work and diminish the esprit de corps. We have evidence that Hawaii physician canaries are struggling. They are showing signs of illness: an early indicator of health system dysfunction.

This is why Dr. Shanafelt’s message and Drs. Drummond’s and Yano’s advice are so pertinent to Hawaii physicians, health care professionals, health system administrators and more importantly to the people of our state.

We should envision a future where those who run the coal mine and are changing the health care practice environment have learned to “ask, listen and empower”; where community leaders have invested in and trust physicians and other health care clinicians; where attention has been paid and investments made to keep the coal mine clean.

Other healthcare institutions like Mayo Clinic and Stanford Medical have taken the lead into the future and have set an example of how to partner with front line clinicians seeking to create joy filled teams of health care professionals and build organizational cultures of wellness.

In the meantime, physicians in Hawaii work on your resilience, partner with others and commit to breathe deep, laugh and love, exercise, sleep and smile.

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