By Dr. Kenneth H. Cohn

Invariably, as the time draws near for me to post my monthly blog, someone helps me find the inspiration and make the time. This month, credit goes to Thomas Dahlborg, whose most recent entry recounted the difficult tradeoffs of a primary care physician who feels more like a production worker than healer.

I trained at a time when medicine was a calling and enjoy working as a locum tenens surgeon in New England. I empathize with the physicians Mr. Dahlborg describes, who fit Morrison's definition of hamster healthcare, running faster just to stay in the same place.

In an article about workplace burnout, I recounted the story of a cardiothoracic surgeon who wrote:

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"Patients and their families did not matter anymore; in fact, they were often obstacles, even enemies...I wondered, 'What have I become?' I had been breaking the speed limit of life, and the law was catching up with me. I had no breathing room, no margin, no reserve. I was physically and emotionally exhausted.

"Now, four years later, I am a much happier member of a three-person group of hospital-employed thoracic surgeons...The journey from where I was to where I am now required a huge pushback against a system that rewards producers and turns a blind eye to the consequences until they get out of hand and patients and families suffer....Only rarely do healthcare professionals connect the dots between their personal philosophy and their daily activities."

Burnout occurs when work and/or personal demands exceed one's ability to cope. It involves a continuum of responses ranging from acute exhaustion after being up all night on call to mood swings, impaired performance, or suboptimal coping strategies, such as disruptive behavior and/or substance abuse. (I devoted a chapter to this topic in my book, Better Communication For Better Care: Mastering Physician-Administrator Collaboration.

The Maslach Burnout Inventory defines three components: emotional exhaustion, decreased empathy, and lack of personal accomplishment. In the largest survey regarding burnout among physicians conducted thus far, 40 percent of surgeons met criteria for burnout and 30 percent screened positive for depression, according to a report in the June 2009 issue of Surgery News, the official newspaper of the American College of Surgeons.

We may not be able to control the global forces that are shaping healthcare economics, but we can benefit from taking stock periodically of where we are and how we're feeling, i.e., "connecting the dots." The following are ways that healthcare professionals can invest in improving their situation (Boyatzis R, McKee A, Goleman D. Reawakening your passion for work. Harvard Business Review, April 2002: 86-94):

* Define your core values regarding your career, family, health, finances, and spirituality
* Finish the sentence: "In my life, I have done __ and now I _."
* Envision the future: Look ahead five to fifteen years. What will a typical day, week,
or month might look like?
* Review the above answers with a formal or informal coach who gives you permission to think creatively.

In a previous post on Hospital Imapact, I described the difference that just a 15-minute "physician mentoring" discussion made regarding the following questions. Connecting the dots gave physicians clarity on their niche:

* What are you really good at (expertise)?
* What do people pay you for (market)?
* When was the last time you felt really alive (passion)?

In summary, we are experiencing a tidal wave of feelings of exhaustion, decreasing empathy, and inadequate accomplishment among healthcare professionals:

* Are you seeing this phenomenon where you work?
* What are its manifestations in terms of patient care, morale, and job retention?
* What solutions have you tried where you work, and what have been successful?

Ken Cohn is a practicing general surgeon, MBA and CEO of HealthcareCollaboration.com. He divides his time between providing general surgical coverage and speaking, writing, teaching, and consulting on physician-hospital relations.