By Gerrit Van Wyk.
Fiddling while Rome burns.
The phrase fiddling while Rome burns comes from a story about Emperor Nero played the fiddle while watching Rome burn in 64 CE. The meaning it took is doing nothing while a disaster unfolds.
Boudreau’s study amongst a large number of Canadian physicians showed 45.7% of them were in an advanced state of burnout. That was 22 years ago. Multiple studies confirmed this finding amongst both physicians and nurses, and after the COVID-19 pandemic, the number escalated. While this fire burnt ever higher, our federal provincial, and professional leaders listened to music to make it go away.
They argue burnout is a diagnosis and therefore a disease, which places the onus on individuals to get treated for it. Unfortunately for them, burnout is a social, not a medical disease. The symptoms associated with burnout are the consequence of a very sick social system, and the one thing our leaders won’t do is acknowledge they are overseeing the sickness and take accountability for it.
The Ottawa Citizen reported as recently as November 25, 2022 on a memo from the Director of Primary Health Care at Ontario’s Ministry of Health to family health teams, asking them to provide services 7 days a week and take after hours call until further notice. The report says Ontario’s Health Minister and Chief Medical Officer of Health made similar calls. This coming from bureaucrats with 8 to 5 jobs and full benefits going to their cottages over weekends.
According to the Ontario Medical Association, team-based physicians now work 235 days a year, which leaves them with 3 weeks holidays to deal with their burnout caused by the broken system they work in. Physicians interpret these messages as saying they and patients are to blame for the mess, and disrespects the effort they put in during the COVID-19 pandemic and continue to put in.
The causes of burnout are overwork, the growing number of policies and procedures taking away control from professionals, insufficient reward, an unfair system in which political infighting rules, a breakdown of community and lack of support, and a value gap between what physicians and nurses signed up for and the reality they experience on the ground. It’s a miracle anyone still want to work in this industry.
To fix the problem is relatively easy. If our leaders acknowledge the problem and move on it. The treatment of burnout as a social problem is to collectively deal with systemic issues and it hasn’t happened for at least 22 years. Time is running out.
Because burnout is a social problem, it has consequences for patients and the quality of work. Burnt out physicians and nurses become disengaged from their jobs because it became unpleasant and meaningless, they suffer emotional symptoms of anger, anxiety, and depression, and feel they are to blame for a problem that in fact is a toxic workplace. They become physically exhausted, cynical, and ineffective, to which more and more frustrated and demanding patients respond, not with compassion and understanding, but with negative reviews on Rate Your Doc, which worsens the problem.
To deal with their symptoms, physicians and nurses have no effective resources to turn to, can expect no sympathy from many of their colleagues, and end up medicated with tranquilizers and anti-depressants in order to cope, which leaves them numbed to reality from a pharmaceutical lobotomy.
Any physician or nurse blowing a whistle to alert us to the problem is quickly and efficiently silenced by our health care leadership; they want to listen to the music, not face it.
By diverting attention to burnout and pretending it’s a physical problem, the serious consequences for health care as a system are ignored. Fact is, burnout affects the bottom line. It leads to a loss of productivity and financial losses. Worker’s Compensation claims increase, health care benefits are drained, there is more absenteeism, sick leave, losses from mistakes, and deteriorating work quality.
Like all service industries, salary makes up around 80% of the health care budget. Leaders and managers keep increases to a minimum to save money, which makes physicians and nurses feel they are insufficiently rewarded. Those who can, quit, which in practice means the most experienced and knowledgeable people, which leaves no-one to train new workers, increasing their stress and quickly resulting in burnout. Those who can’t, silently quit on the job.
There is an existing pervasive lack of trust between health care leadership and management, and physicians and nurses, which has been widely reported on. Waves of failed change initiatives do nothing to rebuild trust, which results in a complete breakdown of one of the very basic components of our human social world, cooperation. Instead, it becomes everyone for themselves, which leaves no-one to talk to and no resources to access for those suffering from burnout.
Leaders and managers, based on their economic perspective of health care as manufacturing health, are only interested in cost saving, efficiency, and productivity. It comes as no surprise that employees game the system to meet targets and keep managers happy. In such a system, both financial and non-financial rewards are not distributed fairly, increasing cynicism and burnout, which leaves physicians and nurses without internal rewards to compensate for a lack of financial reward.
Finally, the values of corporatized medicine and the health care professions are diametrically opposite. Young professionals quickly become disillusioned and research shows staggering numbers of physicians would not choose to be doctors again, or quit if they could. That they find themselves in this predicament is an indictment of health care as a system and its leadership.
I challenge any health care leader; political, of the ministerial bureaucracy, or professional, to step up, look me in the eye, and tell me burnout amongst physicians and nurses is not burning down the health care system. History didn’t treat Emperor Nero kindly, and neither will it our current crop of leaders who fiddle while the farm is burning down, unless they act now.