Antoinette Hildwein, DO

Recent studies indicated that more than half of percent of the world’s physicians have burnout! That’s incredible and incredibly sad. I know there have been many times in my career where this has been the case for me. 

Why is this happening?  The main reason is the world of medicine has been changing at a very quick pace, with added requirements from government and third-party payers. It has added a burden of work to the physician as well as her clinical and clerical staff. Charting is taking hours to finish.  I wake early and work before going to work. I see patients all day and in between seeing patients, answer phone messages, emails, and address labs.

I come home late, even after skipping lunch. I have dinner with my family and then often go back on the computer to finish the day’s messages or labs or complete even more charts. With the onset of the EHR, our time spent documenting has increased significantly. The systems are not user friendly and in addition, there are more and more pieces to document each year. We have to enter all the codes, put in the orders, and even do the billing, not to mention adhering to Meaningful Use guidelines.

Physicians have become coders, billers and transcriptionists along with the duties of being a doctor and caring for patients. We are given multiple new initiatives and this makes it difficult to keep up to date with each one. It increases the time in patient charts for what are non-medical reasons. We also have to keep up on our clinical medicine in addition to the politics of medicine.

We are working on care teams, care management, medical homes, and doing welcome to Medicare physicals all while still seeing patients. Couple that with open access, evening and weekend hours and it’s easy to see the sources of burnout.  Where is the work-life balance? It's so important to have this balance. Without it, people get resentful and this impedes compassion, empathy and care.

Now that we know what feeds the burnout, what do we do about it?  First, you have to recognize it, in your partners and in yourself. Being irritable, fatigued, anxious, withdrawing from family and friends or even over depression can be signs of burnout. 

“Physician heal thyself.”  Realize that no matter how hard you work, the task box will always have unchecked boxes. Help your staff to work to the top of their license so you can work to the top of yours. Delegate duties where and when appropriate. Put boundaries in place and follow them. Follow the instructions you provide to your patients - Get your sleep, get your exercise, and eat healthy. It sounds so simple but it’s not. You have to make yourself a priority. After all, an unhappy, stressed out physician is not going to serve or care for patients well. 

Don’t fall into the trap of having to grab a quick bite for lunch and eating fast foods. Don’t put off exercise because you are too busy. Make time for yourself and for your family. One of my life mantras is, "Treat yourself like you would your best friend."  You only get one body in this lifetime, treat it with respect. This includes your mind. Practice yoga, read, meditate, work on mindfulness, and dance like no one is watching.

Do things you know help reduce your stress. Take a five minute break in the morning and in the afternoon when seeing patients. Close your eyes and just breathe. Carve out time for exercise. I feel so much better when I do get my exercise, even if it is at the wee hours of the morning. Take 10-20 minutes daily to just read. This too can make all the difference.

Work on being positive. Your attitude directs your mindset and with it, how you react to situations. No matter what happens, you do have control. You do have a choice. Too often, our work dictates our lives but we can and should re-assert our control over our own lives.  We have a tendency to think we have to do it all - that is just not realistic, true or fair.  It sets us up for feeling inadequate.

Find a new hobby, join a club, sing in a choir, coach a kid's team… these new life projects can infuse a spark of energy and allow you to grow in other ways. It means you are not defined by your title and this too can break the negativity of burnout.

Whatever it takes, do it and do it often. You need to do this. Your family, your patients and your staff need you to do this too.  Take care of you.  After all, another of my life mantras…"You can’t take care of others if you don’t take care of yourself."

Articles

One doctor looks at what causes burnout and how she thinks physicians can cure themselves of it. 

The Cause of and Cure for Physician Burnout

18 years ago. I remember it like it was yesterday. It was early morning rounds and I had just come off night call. My attending looks at me and says, “Which one are you?”  He sees the perplexed look on my face and continues, “You have to choose. You can’t be a good mother and good doctor so which one are you?”   

I was very upset but too shy to say anything, too scared to upset the attending! How dare he!

For years, I have been proving myself to the doubters. To my math teacher who felt girls didn’t do well with math, college professors who didn’t think women belonged in medicine, and now this. When I was pregnant at 38 weeks, I RAN the stairs to a code to prove myself.

Present day.  I am enjoying a warm cup of coffee, it’s 5:30 a.m. and I just returned from a cold, peaceful early morning run. The house is quiet and I contemplate how far I have come as I turn on my computer to check my work for the day. I look over the list of patients and prepare their charts. I answer labs and get my day organized. At 6:30 a.m., I wake my husband and our four boys. I help them get ready for the day. Yes we are busy but I wouldn’t have it any other way.  

I see my first patient at 7:45 a.m. The morning runs relatively smoothly until I get the bad news. A patient has advanced ovarian cancer. I have her come in to discuss. We talk, we cry, we hug and then we say “Let's get this” and we work on a plan of attack.

Lunch is filled with answering phone messages and tackling more labs with a quick bite of food to sustain me. I open my mail and read a very heartfelt thank you note. My afternoon is full and I have to stay on time so I get to my son's soccer game. I see several patients including a newborn baby girl. Being the first baby for the parents, there are a lot of questions but she is thriving and the parents are doing a superb job, they just need reassurance. Next up is an older patient and we discuss assisted living as his memory is failing. I meet with him and his family to help them make a very difficult decision.

At the end of the day, I answer more phone messages and address any critical labs. I pack up and head to the soccer game. They play well and we head home. My husband and I make dinner and help the kids with homework. We talk about their day and what things are happening in their lives. I do a bit more work from home and put the kids to bed by 10 p.m. As I close the door to my youngest son's room , I tell him “ I love you buddy” he replies,  “ I love you more”  I smile and think-I choose both. I am a   good mom and a good doctor.  

Antoinette Hildwein, DO is a family medicine physician in Muskegon, Mich

Someone once told this doctor she couldn't be a good doctor AND a good mother. She has proven that person wrong. 