Organized Surgery Begins to Battle Burnout

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General Surgeon Lifestyles -- Linking to Burnout: Medscape Survey by Carol Peckham March 28, 2013

General Surgeon Lifestyles — Linking to Burnout: Medscape Survey
by Carol Peckham
March 28, 2013

US surgeons are burned out and the numbers are staggering. Whether experiencing emotional exhaustion, depersonalization, or a low sense of personal achievement, 4 in 10 US surgeons exhibit signs and symptoms of burnout. Among neurosurgeons that number jumps to nearly 60%. Burned out surgeons are more likely to report substance abuse, clinical depression, and suicidal ideation. They are more prone to medical errors.

Interestingly, academic practice, trauma sub-specialty, increased nights of call, longer hours worked, younger age, female gender, and small children at home were all risk factors for burnout. For those of you who are new to this blog, I am a female academic trauma surgeon who routinely works long hours and takes in-house call while my small children are at home.

To be clear, these data prove associations and associations do not equal causation; but still, it is sobering to think that so many who entered a profession to fundamentally improve the lives of others are themselves leading such troubled lives due to their chosen occupation.

The occupational hazards of surgical careers are multiple. We suffer moral distress when our patients experience complications or die whether or not an error occurred. We develop compassion fatigue by bearing witness to our patients’ collective and continuous suffering no matter how successful any individual’s outcome may be. Due to our long and often erratic hours, we suffer from chronic fatigue and sleep deprivation. The physical plight caused by fatigue is complicated by many hours on our feet and maintaining awkward postures in the operating room. By routinely putting our patients before ourselves, we often exhibit illness presenteeism. Not infreqeuently, we face the double bind of choosing between being there for our patients or being there for our family. Meanwhile, whether it’s catching up with billing and coding one day, keeping up with meaningful use another day, or spending days studying subjects totally irrelevant to one’s daily practice for maintenance of certification, delivering care in the modern error mandates many a frustrating task that ultimately does nothing to benefit our patients. Furthermore, there is constant fear of litigation that might ruin us in financially or reputationally. And so, it is not surprising that so many of us are burned out.

Emotional awareness (how are you feeling, how does what you are feeling impact your behavior, and how does what you are feeling impact those around you)

All is not dark, however. There are ways for us to be well and resilient. They require both individual effort and culture change. Importantly, they demand emotional awareness. When we understand how we are feeling impacts both our perceptions and our actions, we can act in a way that props us up rather than gets us down.

I was heartened this past week that the American College of Surgeons chose to put surgeon wellness and resiliency on equal footing with the likes of “what’s new in hernia repair” or “ethical challenges in geriatric surgery.” There were a number of educational panel sessions tackling burnout head on. Whether is was about bouncing back in the face of personal loss, gender discrimination, pathways to help surgeons recovering from alcohol abuse back into clinical practice, or managing fatigue, the program was replete with informative sessions on burnout avoidance. Mindfulness, time management, kinship, and down time were emphasized as was physical fitness.

And for the first time ever, the College had a fitness program. As that youngish female academic trauma surgeon with two kids who has struggled with tending to herself after spending her youth, college, medical school, residency, fellowship training, and early years on faculty essentially ignoring personal wellness, I was delighted that this change was happening at my profession’s annual meeting. It was something of a pilot test offering only a very early morning Zumba and a Yoga class, but it was a start. Sure many surgeons at this meeting probably went to the hotel gym or hit the lakefront running path but these efforts happened without the largest surgical professional organization’s imprimatur (hey I even got an American College of Surgeons yoga mat!) or beckoning. These surgeons are likely the 6 in 10 of us who aren’t burned out. But that doesn’t mean we should ignore the self-neglect of our brothers and sisters in the occupation. So this simple step of organizing these fitness events indicated to all attendees that the College both encourages and supports surgeons taking care of themselves. Embed from Getty Images

Making time for fitness has been shown to reduce burnout so I hope the College expands their offerings this time next year. I invite the College to challenge us surgeons to find time for wellness within the already overwhelming conference that offers 5 days of educational sessions geared at making us better surgeons technically and intellectually. The annual Clinical Congress of the American College of Surgeons has essentially had this format the entire time that I have been attending (every year for the past 12 years). With the pilot fitness program the College chose hours and days specifically to not interfere with this typical format. However, given that all the data shows that prioritizing wellness is a key factor in combatting burnout and that wellness takes on many forms, the College should offer multiple offerings–whether it is meditation, or high intensity interval training, or barre, or a knitting circle, or Zumba, or TRX, kick boxing, or spinning, or running– at different times throughout the conference thereby forcing us to prioritize just as I was forced to prioritize between “surgical jeopardy” and “what’s new in body contouring.”

Slide1It will be hard for us to make these choices but we need the practice. I figure its easier to choose wellness when there are no cases to be done or patients waiting in the ER or clinics to be staffed, when there are no lives at risk other than our own.

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Dear Friend, It is Zumba

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Dear Friend,

I can relate. You have made it to middle age (Gasp! Yes it is true, we are more than half way to 80) and you have spent a quarter of that lifetime (Yes, the past twenty years! My god, have we really known each other that long?!) neglecting yourself.

I get it. You were busy training for a lifetime of work in one of the most demanding careers around. You trained and you studIMG_3940ied and then you trained and you studied more (Do you really have three degrees after college?!? Was being valedictorian of your elite college not over-achievement enough for you?!) Alas, none of that training was of the “personal trainer” or “training for an Ironman” kind. No. You didn’t have time for that (Okay, neither did I; yes, I confess that’s my office wall).

I know why. There were the 120 hour work weeks, then there were the babies, and now there is life with a busy career and growing kids (They really have to have sooooooo many needs! Darn food and shelter! But, why so many school events? And for the love of god, why so many extracurriculars that eat up every weekend that we are lucky enough to be off?) I know there is a spouse involved (I mean how else would those kids get clothed and fed everyday while you work from dusk to dawn, or frequently from dawn to dawn or dawn to the dusk 40 hours later?). In the midst of all this working and raising babies you are busy doing your best to be a good wife too.

So I can totally see why putting you on the bottom of the list was easy. You would feel too guilty to do to otherwise (You know that guilt trip is totally in your head, right?  Everyone around you, who you feel you don’t give enough time to, would really rather you put some time into yourself.) You deserve it. You need it. It will make you a better wife, a better mother, and a better doctor. But it needs to be something that gives you pure joy so you don’t beat yourself up about not writing that grant instead, or missing bedtime, or skipping that after dinner glass of wine with your husband. I too used to struggle choosing it on the precious few nights I home from work and not in a post-call coma. But I am so glad I found it.

Solid_gold_dancers_mediumAnd, I am writing to tell you that it is Zumba. You see, I remember the days when if it was a Friday night you were spritzing on the Aquanet and heading to Sh-booms to dance the night away (In retrospect both the hairspray and the venue was questionable but you were young). I have a vivid picture in my mind of you rockin’ out to It’s Raining Men at your wedding (Why you would be delirious about it raining men having just married the man of your dreams is also somewhat questionable but it is a great song). And, I know your childhood dream was to become a Solid Gold Dancer (Okay, in retrospect the hairspray and the venue totally make sense even though it was no longer the 80s by then!)

I love Zumba and so will you (Zumba’s motto is “ditch the workout, join the party.” Doesn’t everyone want to party more as they age and trick the body into feeling younger, hipper, and cooler?). Zumba burns calories and builds core strength through super fun dance moves. Many are Latin inspired but there is a range so you can salsa, or charleston, or plain old old-school aerobics style grapevine your way to an effective workout (Come on. Surely you have seen the infomercial? Yes, it’s true you really do have that much fun doing Zumba. Not everyone there is as hot as on the infomercial but that’s fake TV and not real life). There are some variations like Zumba toning that focus more on muscle definition (In Zumba toning you use a double sided maraca thingy and who doesn’t love that–like shaking a martini without the alcohol and calories but the dancing leaves you buzzed in a calorie deficit.) Also, as if channeling your childhood aspirations there are cool Retro 80s Zumba parties (Seriously, if this isn’t s sign what is?!?).  You can see how the Core Connection‘s clients danced “Like a Maniac” here.

So instead of trying to coordinate our schedules to meet up over a cosmo let shake at Zumba together.  You love to dance; getting a groove on is in your biologic makeup (I know because I am a doctor) so I guarantee that Zumba will bring the pure joy that it seems you need to justify being able to find some way to squeeze physical fitness into your life in a way that reading journal articles on a recumbent bike decidedly cannot.

It may be the answer to your mid-life fitness woes my dear, dear friend and former aspiring Solid Gold Dancer.

Love,

Your ungraceful, uncoordinated, booty does not dissociate from her spine but still gets her ass to Zumba friend,

@surgeoninheels

zumbalogo

Sexy None None: Letting Go of the Dream of Zumba

Anyone who has ever gone to a Zumba class has probably jumped and gyrated to that song Sexy Bam Bam. A simple Youtube search will yield any number of differing Zumba routines to this song. I know this because I find the lyrics hard to discern so felt the need to Google them after my last Zumba class when all I kept thinking was “Sexy None None.”

Zumba brings sexy to a single workout combining hip hop, latin dance, aerobics, and plyometrics. Have you seen the infomercial? The sexy is the seller. You can not only be thin and fit, you can be SEXY. You can do a grapevine or a v-step (come on you if you’re a woman in my age group you know you remember this from your step aerobics days, don’t deny it) and still exude sexiness if it is part of a Zumba routine (these moves are decidedly un-sexy on a pastel pink step stacked on purple blocks). It’s as if every move is a flirtation of the human body. I think this is why I can never turn away from the informercial. I only watch DVR’d television, so I don’t accidentally get sucked into a Zumba commercial that leaves me digging deep into my soul thinking “Can I ever be that sexy?”

And so, a large part of a Zumba participant’s motivation is to achieve sexy. You lose weight, you tone muscles, and you exude sexiness. That is the Dream of Zumba.

It took me a long time to live that dream. I love to dance and did ethnic dancing throughout my adolescent and college years. Back in the day during one of my fits and spurts of embracing health and fitness, I enjoyed a few step aerobics classes when there was nothing else that could motivate me to get to the local gym. So I really wanted to try Zumba expecting that based on shared principles alone, I would enjoy it as I had the bhangra, raas, and aerobics. But I couldn’t do it. I just couldn’t face up to my complete and utter lack of sexiness. I have no concept of how to flirt with my body. I did not want to embarrass myself in front of a group of strangers with my ungraceful, uncoordinated flailing of the limbs and torso.

I finally found the courage a year ago when, within the confines of my local pilates studio, I finally felt safe enough to try living the Dream of Zumba. (This is really a testimony to what a great judgment free place my local studio is. The owner, the staff, and many of the students I now count as friends). I had been working with the pilates instructors for nearly 6 months. I was feeling better about myself. I finally had the courage to try to bring the sexy. I listened to that Justin Timberlake song to get my head in the right place (not really ‘back’ though given I lacked any sexy to begin with).

It is a year later. I LOVE Zumba. I go as often as I can (which sadly, due to my crazy schedule, is only about 3 times a month on average) But the other night when “Sexy Bam Bam” came on, I still thought to myself “Sexy None None” as I watched myself in the floor to ceiling mirrors behind my completely amazing and incredibly sexy Zumba instructor.

This woman exudes more sexy in her pinky toe than a whole room full of Victoria’s Secret models. It’s really remarkable. Her hips, they way they move, they have a life of their own. I have taken Zumba now from a few other instructors, and there is truth to the Dream. Even if the instructor knows the moves and teaches them well, it’s just not fun if they don’t bring the sexy. I mean, I seriously hated the few classes I have taken with non-sexiness exuding instructors. They never put them in the infomercials, do they? There’s a reason. Zumba would not be the world wide fitness phenomenon that it is without the sexy. Of this, I am certain.

So, while I have bought into that phenomenon, it hasn’t made me sexy yet. Who knows, I might not ever be an infomercial ‘after’ candidate. But what the heck, as someone trying to somehow get all the pieces of her life in place to be mentally and physically well while succeeding at work and at home, burning some calories and toning some muscles even if I am a “Sexy None None” isn’t that bad, as long as my instructor brings the “Sexy Bam Bam.”