Short Wave - The Toll Of Burnout On Medical Workers — And Their Patients

Episode Date: October 4, 2021

Burnout has long been a problem among health care workers. The pandemic has only made it worse. Some were hopeful COVID vaccines would provide some relief, but that hasn't been the case. Now, health care workers are leaving the industry — and they're taking their expertise with them. Plenty of surveys say that burnout hurts patient care. NPR correspondent Yuki Noguchi spoke to medical workers who agree, the burnout they see on the job means that sometimes patients are not getting what they need.Listen to our conversation with Dr. Arghavan Salles about burnout: https://n.pr/3CYimbqReach the show by emailing [e-mail] pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hi, everyone, Ritu Chatterjee here. For many of us, including myself, the start of the pandemic in March of last year, feels like ages ago, almost like another era altogether. But for Matthew Chrysilius, it's like he's still trapped in that time in a cycle that started in the spring of 2020. Because he's a travel nurse, but he's been going to all these parts of the country where the pandemic just keeps going.

You face your own mortality every day. And I think there's only so many times you can do that and then not be affected, right? You see it every day and you're wondering, am I going to get this? I'm going to take this home to my wife. Everybody I know who I work with up here has gotten it. A coworker of mine in Ohio who had it back in March last year,

same age as me, he's probably like 33 or something. He ended up having a stroke. work anymore. He's on disability now. So those are the things like you come face to face with that and like what am I willing to risk for a paycheck? And working through 19 months of the pandemic has taken a toll, not just on Matthew, but many healthcare workers. They are burning out. And that means they're leaving the industry. Today on the show, how burnout is harming healthcare workers and patients. I'm Rituthaji. And I'm Yuki Naguchi. You're listening to Shortwave.

the Daily Science Podcast from NPR. So, Yuki, most of us use the term burnout to mean this sort of extreme exhaustion, but really, burnout is more than that, right? It is more than that. It's a popular term, you know, that's kind of synonymous with being tired. But it's actually also connected to being overwhelmed and sort of cynical about your work, you know, feeling deeply unmotivated. And that negativity can kind of erode your ability to. to do work over time. Yeah. And now people also talk about burnout as an individual problem, like I'm burnt out or you're burnt out, but it's really tied to work-related stress. That's right. It's not like sort of a mental health issue or a personal problem. You know,

officially, the World Health Organization defines it as a workplace condition. And the source of it really is the job. Job stressors that just haven't been managed over time, like short staffing and dealing with paperwork, which is, you know, the things that you hear probably most often from health care workers as a source of their burnout. Right, right. And, you know, lots of workplaces have these sort of risk factors of burnout. But obviously with medical professionals, their jobs have to do with the lives and the health of other people, which is an additional stressor. Right. It makes it all the more intense.

Right. But I'm wondering, are there some jobs? in medicine that have had it worse than others? Well, I think obviously the people who are taking direct care of COVID patients, you know, hospitals and acute care facilities, those are the ones, obviously, that would see a lot of strain from the surges. And, you know, burnout ran rampant in health care even before the pandemic. Surveys show now that's like half or more of people who are struggling with it. So it is a very acute issue. And in terms of the kinds of jobs where you're seeing the effects of burnout, that seems to be across the board in medicine.

you know, lab techs, respiratory therapists, even receptionists. The truth is, employers of all stripes are having trouble finding workers. So hospitals are, of course, dealing with that and then some. But it's not just hospital stuff were burnt out, right? Yeah. I mean, it's also true of medical staff who don't work in the hospital. Like this woman, Lindsay Moore Osby, who's a Indianapolis primary care doctor I talked to. And, you know, she told me she'd been obsessed about being a doctor since she was a kid, but actually being a doctor, you know, even before the pandemic, it felt so full of paperwork and administrative tasks that really sucked up all her time. So she felt like she had to limit basically all the time that she spent talking to patients.

I can cut out that little bit of time connecting with the patients. But that's what they like. That's what they need and deserve. And it's what I love about medicine. So there's nothing else to trim that doesn't matter. matter. You know, it got to the point where she started crying on her morning commute routinely, but then one day it really scared her. The thought just popped in my head, you know, it'd be really easy to drive off the road with my visions of all glory from crying. And then the next thought that

just spontaneously came from nowhere scared the heck out of me. And it was, well, if I drove off the road and didn't get hurt too badly, I could get a break. I mean, I don't want to get hurt too bad. but just a little hurt. And at that point, you know, I compartmentalized, I pushed through like doctors do, and I got myself to work, pulled myself together, then kind of took 30 minutes, 40 minutes to get myself calm, and I proceeded to go on and see 19 patients that day.

But I compartmentalized and kept going through and did the best I could for my patients that day because I wasn't going to make them suffer for my, what I felt at the time, my weakness. Wow. I mean, her story. makes it so clear, you know, you see the stats about physician burnout tied to depression and physician suicide. And it's easy to see how she might not have been able to pull herself back there. Well, she describes a cycle that, you know, she was caught in. But she says that that was a wake-up call for her. And she ended up switching practices and reducing her patient load. But she also said that she started admitting she felt that way to other friends in medicine. And they all gave her this look of recognition, like they understood on a personal level what that felt like. And, you know, these are people who've endured years of training and sleeplessness. And now they're saying they feel even more broken by the pandemic.

Yeah. And it seems like that would affect patient care as well, right? Yuki, what have you learned from your reporting about how this burnout affects patient outcomes? Well, there's, you know, so many surveys that show how burnout does lower quality of care. And that's not easy to quantify. Like this one researcher I talked to, Carolyn Dewa, made this interesting point. You know, it's not like you can say burnout has contributed X percent of medical accidents or patient deaths. Medicine, it's a team sport. So can you be attributed it to one clinician?

How many clinicians need to be experiencing burnout until we see an effect in quality? Carolyn told me that when her father was hospitalized for cancer this past spring, she felt the staff just didn't have the time to talk to him or his family and give them a kind of attention that they might have before coached. I know while my dad was in hospital, there were some excellent nurses and they took good care of him. And then others just kind of dismissive. And in her father's case, she thinks he ended up dying months earlier because the staff was burnt out. You know, they didn't have time to talk to her, so they didn't know he should still be on anti-stroke medication.

He died of his stroke because they weren't giving him his meds because they said he couldn't swallow. His swallowing had not changed when he went to the hospital. and he was taking his medication while he was at home. But no one asked me. But she also really recognizes how burnt out health care workers are. And when more of them are burnt out, that leads to more problems for patients. You know, in one ER, a doctor I talked to told me that wait times had ballooned in more than 10 hours. And studies show that wait times like that can double the mortality rate.

But as you discussed earlier, Yuki, burnout is a systemic problem. And so to address it, employers will have to implement. implement systemic solutions. Yeah. What did you learn about what kinds of solutions can help? Actually, what's surprising to me was how easy and practical some of the solutions to burnout can be. You know, these are things that are doable on a budget in, you know, in hectic environments. And the specific ways to address burnout, you know, often sound kind of small or minor.

So, for example, one big complaint for health care workers, a very common one, is not. not having a working copier. You know, we've all been there. It's out of being. I know you know what I'm talking about, Ritu. Right. I mean, does it, does fixing copiers really address burn out? They have to be a little skeptical here. Yeah, yeah, exactly. It doesn't sound like that big of a deal. But, you know, when a big and painful part of your job, like a primary pain point is lots and lots of medical paperwork, having to then also fight the copier can just feel like the last straw. You know, so some doctors I've to pointed out that, you know, recent changes that seem minor like this can make a big difference for them. Like a lot of hospitals have empty visiting rooms because, you know, COVID restricts when

you can go visit the hospital. You know, so some of them have converted those into staff lounges or, you know, rooms for peer counseling. And a lot of these ideas, you know, come from the people who are doing the work themselves because they understand where their pain points are, right? And there was this great example from Massachusetts General Hospital, early in the pandemic, you recall that rubber gloves were critically low across the board. And, you know, a triage nurse came up for an idea of like a plexiglass wall at a patient's bedside. She suggested cutting arm holes into it and then like attaching these long sleeve-like rubber gloves to those holes. So you could just kind of slide your hands through and adjust a patient's oxygen and check a pulse. You know, it's. You know,

It's both quicker and safer without using a new set of gloves. So, you know, just even the act of the hospital adopting that encouraged more ideas that make their lives easier and give them a sense of control, you know. Solving these problems and encouraging a kind of collegiality was also something that I heard made a big difference. Yeah. Now, the pandemic has, of course, been going on for over a year and a half. But vaccines are available now. How has that affected burnout? Well, I think, you know, vaccines really seem like a finish line for a lot of medical workers.

And it was like a beacon of hope that the pandemic was going to end. And, you know, things would kind of slowly creep back to normal. But obviously, with so many people still unvaccinated, that hasn't been the case. And many critical patients these days are unvaccinated people with COVID. You know, in Florida, one ER doctor told me it was like two-thirds of the patients that come in. So it's difficult because for a lot of these health care workers, the problem that is creating the burnout, a lot of it seems preventable. And so Matthew Chryslius, you know, that intensive care nurse from the top of the episode, you know, he's a fifth generation nurse and he's now thinking of quitting. Now that there is a vaccine and people aren't getting it, my sense of duty, you know, it's changed for me.

like, no, I'm not interested anymore. You know what I mean? Like I risk my life. I put my wife at risk. You know, we, no, I'm not interested anymore. You know, and I hear that, R2, and it just sort of fills me with fear, right? Because none of us know when we might need urgent care or a trip to the ER, you know, and I worry for all of us prospective patients out there that this, the fact that our healthcare workers are so burnt out and quitting is going to be an enduring public health crisis. Yuki, thank you so much for bringing this incredible reporting. Really appreciate your time. Thank you, Ritu. I appreciate it. If you want to hear more about burnout, we did another episode back in May with Dr. Argovan Salas. We'll leave a link to it on our episode notes. This episode was produced by Rebecca Ramirez, edited by Sarah Saracen and fact-tracked by Indy Kera.

Alex Drewenzkis was the audio engineer. I'm Ritu Chatejee. Thanks for listening to Shortwave, the Daily Science Podcast, from NPR.