Tincture of time


Submitted: 18 July 2017
Accepted: 18 July 2017
Published: 31 December 2017
Abstract Views: 851
PDF: 375
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

In this article (part two of a two-article piece), I, Erin Nissen Castelloe, meditate on long-standing frustrations originating from my personal experiences in clinical medicine. My exit from clinical medicine can most succinctly be attributed to burnout, burnout triggered by inadequate time to address my patients’ needs and complete the tasks mandated by the healthcare delivery system in which I worked. Self- and system-imposed pressures to meet my professional obligations led to chronic overwork, reduced personal time, sleep deprivation, exhaustion, and ultimately, recognition that my work situation was unsustainable. For more than ten years, I have questioned my decision to leave clinical medicine, hashing and rehashing the circumstances leading up to it. I am ready to let go of the questions that have haunted me, but I want to do so deliberately, considering them carefully before I release them. Therefore, with high hopes – to understand my past, accept it, and move boldly into my future in medicine – I searched the literature, focusing on burnout in physicians and physicians-in-training; the role of time pressures in burnout; and the value of physicians spending adequate and high-quality time with patients.

Castelloe E. Finding myself in medicine. Qualitative Research in Medicine & Healthcare. 2017;1(1):1-5. DOI: https://doi.org/10.4081/qrmh.2017.6301

Maslach C, Schaufeli W, Leiter M. Job Burnout. Annual Review of Psychology [Internet]. 2001;52(1):397-422. Available from: http://www.wilmarschaufeli.nl/publications/Schaufeli/154.pdf DOI: https://doi.org/10.1146/annurev.psych.52.1.397

Mindfulness. Newsweek Special Edition. 2017:18.

MEDLINE Fact Sheet [Internet]. Nlm.nih.gov. 2017 [cited 23 May 2017]. Available from: https://www.nlm.nih.gov/pubs/factsheets/medline.html

PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2017 [cited 8 May 2017]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/

Google Scholar. 2017 [cited 18 May 2017]. Available from: https://scholar.google.com/

Shanafelt T, Swensen S, Mohta N, Gittlen S, Lee T, Strongwater S et al. Physician Burnout: The Root of the Problem and the Path to Solutions [Internet]. Boston: NEJM Catalyst; 2017 p. 1-52. Available from: http://join.catalyst.nejm.org/events/leadership-leading-physicians-event2017-nejm/register/?utm_source=nejmlist&utm_medium=email&utm_content=email1_nejm&utm_campaign=leadership-leading-physicians-event2017

NEJM Group [Internet]. NEJM Group. 2017 [cited 7 June 2017]. Available from: http://nejmgroup.org/

NEJM Catalyst - Home - Practical Innovations in Health Care Delivery [Internet]. NEJM Catalyst. 2017 [cited 7 June 2017]. Available from: http://catalyst.nejm.org/

Lee T, Campion E, Morrissey S, Drazen J. Leading the Transformation of Health Care Delivery — The Launch of NEJM Catalyst. New England Journal of Medicine [Internet]. 2015 [cited 7 June 2017];373(25):2468-2469. Available from: http://www.nejm.org/doi/full/10.1056/NEJMe1515517 DOI: https://doi.org/10.1056/NEJMe1515517

Latest Medical News, Clinical Trials, Guidelines – Today on Medscape [Internet]. Medscape.com. 2017 [cited 16 July 2017]. Available from: http://www.medscape.com/

Linzer M, Poplau S, Babbott S, Collins T, Guzman-Corrales L, Menk J et al. Worklife and Wellness in Academic General Internal Medicine: Results from a National Survey. Journal of General Internal Medicine. 2016;31(9):1004-1010. DOI: https://doi.org/10.1007/s11606-016-3720-4

Wislawa Szymborska - Nobel Lecture: The Poet and the World [Internet]. Nobelprize.org. 2017 [cited 17 July 2017]. Available from: http://www.nobelprize.org/nobel_prizes/literature/laureates/1996/szymborska-lecture.html

Wisława Szymborska [Internet]. Poetry Foundation. 2017 [cited 16 July 2017]. Available from: https://www.poetryfoundation.org/poets/wisaawa-szymborska

Gross T. How U.S. Health Care Became Big Business [Internet]. NPR.org. 2017 [cited 23 May 2017]. Available from: http://www.npr.org/sections/health-shots/2017/04/10/523005353/how-u-s-health-care-became-big-business

Rosenthal E. An American sickness. 1st ed. New York: Penguin Press; 2017.

RVUs: A valuable tool for aiding practice management [Internet]. Medical Economics. 2017 [cited 23 May 2017]. Available from: http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/calculating-relative-value-units/rvus-valuable-tool-aiding-practice-m?page=full

Braddock C, Snyder L. The Doctor Will See You Shortly. The Ethical Significance of Time for the Patient-Physician Relationship. Journal of General Internal Medicine [Internet]. 2005. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1497.2005.00217.x/epdf DOI: https://doi.org/10.1111/j.1525-1497.2005.00217_1.x

Csikszentmihalyi M. Flow. New York [u.a.]: Harper [and] Row; 2009.

Csikszentmihalyi M. Finding flow in everyday life. New York: BasicBooks; 1997.

Dr. Danielle Ofri: Author and Associate Professor of Medicine at NYU [Internet]. Danielle Ofri. 2017 [cited 23 May 2017]. Available from: http://danielleofri.com/

Ofri D. The Conversation Placebo [Internet]. Nytimes.com. 2017 [cited 30 March 2017]. Available from: https://www.nytimes.com/2017/01/19/opinion/sunday/the-conversation-placebo.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=0

Lidia Schapira, MD, FASCO [Internet]. Cancer.Net. 2017 [cited 7 June 2017]. Available from: http://www.cancer.net/about-us/cancernet-editorial-board/associate-editors/lidia-schapira-md-fasco

Schapira L. The essential elements of a therapeutic presence. Cancer [Internet]. 2013;119(9):1609-1610. Available from: http://onlinelibrary.wiley.com/doi/10.1002/cncr.27946/pdf DOI: https://doi.org/10.1002/cncr.27946

The IHI Triple Aim [Internet]. Ihi.org. 2017 [cited 17 July 2017]. Available from: http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx

Bodenheimer T, Sinsky C. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. The Annals of Family Medicine [Internet]. 2014 [cited 17 July 2017];12(6):573-576. Available from: http://www.annfammed.org/content/12/6/573.full DOI: https://doi.org/10.1370/afm.1713

Broyard A. Doctor Talk to Me [Internet]. Nytimes.com. 2017 [cited 8 May 2017]. Available from: http://www.nytimes.com/1990/08/26/magazine/doctor-talk-to-me.html?pagewanted=all

Shanafelt T, Boone S, Tan L, Dyrbye L, Sotile W, Satele D et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Archives of Internal Medicine. 2012;172(18):1377. DOI: https://doi.org/10.1001/archinternmed.2012.3199

Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, West CP. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clinic Proceedings. 2015; 90(12):1600-1613. DOI: https://doi.org/10.1016/j.mayocp.2015.08.023

Improving physician resiliency - STEPS Forward [Internet]. STEPSforward.org. 2017 [cited 18 May 2017]. Available from: https://www.stepsforward.org/modules/improving-physician-resilience

ACGME Home [Internet]. Acgme.org. 2017 [cited 17 July 2017]. Available from: http://www.acgme.org/

ACGME Common Program Requirements [Internet]. Acgmecommon.org. 2017 [cited 17 July 2017]. Available from: https://acgmecommon.org/announcement

Dwyer C. Rookie Doctors Will Soon Be Allowed To Work Up To 28 Hours Straight [Internet]. NPR.org. 2017 [cited 7 May 2017]. Available from: http://www.npr.org/sections/thetwo-way/2017/03/10/519662434/rookie-doctors-will-soon-be-allowed-to-work-up-to-28-hours-straight

Asch D, Bilimoria K, Desai S. Resident Duty Hours and Medical Education Policy — Raising the Evidence Bar. New England Journal of Medicine. 2017;376(18):1704-1706. DOI: https://doi.org/10.1056/NEJMp1703690

Allen M, Pierce O. Medical Errors Are No. 3 Cause Of U.S Deaths, Researchers Say [Internet]. NPR.org. 2016 [cited 18 April 2017]. Available from: http://www.npr.org/sections/health-shots/2016/05/03/476636183/death-certificates-undercount-toll-of-medical-errors

American College of Physicians | Internal Medicine | ACP [Internet]. American College of Physicians. 2017 [cited 7 June 2017]. Available from: https://www.acponline.org/

Erickson S, Rockwern B, Koltov M, McLean R. Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians. Annals of Internal Medicine [Internet]. 2017 [cited 18 April 2017]. Available from: http://annals.org/aim/article/2614079/putting-patients-first-reducing-administrative-tasks-health-care-position-paper DOI: https://doi.org/10.7326/M16-2697

Patients Before Paperwork | Where We Stand | ACP [Internet]. American College of Physicians. 2017 [cited 18 April 2017]. Available from: https://www.acponline.org/advocacy/where-we-stand/patients-before-paperwork

Hobson K. New Medical School Programs Help Students Battle Burnout. US News & World Report [Internet]. 2013 [cited 9 June 2017];. Available from: https://www.usnews.com/education/best-graduate-schools/top-medical-schools/articles/2013/03/21/new-medical-school-programs-help-students-battle-burnout

Daye D. Student Wellness Initiatives (compiled from the American Association of Medical Colleges' Organization of Student Representatives) [Internet]. American Association of Medical Colleges (AAMC). 2013 [cited 9 June 2017]. Available from: https://www.aamc.org/download/351946/data/studentwellness.pdf

Noori S, Blood A, Meleca J, Kennedy V, Sengupta D. Current Directions in Medical Student Wellbeing: A Primer for Students [Internet]. American Association of Medical Colleges / Organization of Student Representatives. 2017 [cited 9 June 2017]. Available from: https://www.aamc.org/download/450164/data/medstudentwellbeing.pdf

Vassar L. How one program achieved resident wellness, work-life balance [Internet]. AMA Wire. 2015 [cited 9 June 2017]. Available from: https://wire.ama-assn.org/life-career/how-one-program-achieved-resident-wellness-work-life-balance

Okanlawon T. Physician wellness: preventing resident and fellow burnout - STEPS Forward [Internet]. STEPSforward.org. 2017 [cited 9 June 2017]. Available from: https://www.stepsforward.org/modules/physician-wellness

Eckleberry-Hunt J, Van Dyke A, Lick D, Tucciarone J. Changing the Conversation From Burnout to Wellness: Physician Well-being in Residency Training Programs. Journal of Graduate Medical Education [Internet]. 2009 [cited 9 June 2017];1(2):225-230. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931235/pdf/i1949-8357-1-2-225.pdf DOI: https://doi.org/10.4300/JGME-D-09-00026.1

Kiersz B. Promoting Wellness in a Family Medicine Residency Program [Internet]. Society of Teachers of Family Medicine (STFM). 2016 [cited 9 June 2017]. Available from: http://www.stfm.org/NewsJournals/EducationColumns/September2016EducationColumn

Tai-Seale M, McGuire T, Zhang W. Time Allocation in Primary Care Office Visits. Health Services Research. 2007;42(5):1871-1894. DOI: https://doi.org/10.1111/j.1475-6773.2006.00689.x

Wible P. Ideal Medical Care [Internet]. Idealmedicalcare.org. 2017 [cited 17 July 2017]. Available from: http://www.idealmedicalcare.org/

Wible P. The weird reason why “wellness programs” won’t work [Internet]. Pamela Wible MD. 2017 [cited 9 June 2017]. Available from: http://www.idealmedicalcare.org/blog/weird-reason-wellness-programs-wont-work/

Aird P. Peter Aird | The BJGP Blog [Internet]. Bjgpblog.com. 2017 [cited 17 July 2017]. Available from: https://bjgpblog.com/tag/peter-aird/

Aird P. Health – it'll be the death of us: institutional arrogance in the health service?. British Journal of General Practice [Internet]. 2012 [cited 17 July 2017];62(599):317-318. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361107/ DOI: https://doi.org/10.3399/bjgp12X649223

The Official Leonard Cohen Site [Internet]. Leonardcohen.com. 2017 [cited 17 July 2017]. Available from: http://www.leonardcohen.com/

A Responsibility to Light: An Illustrated Manifesto for Creative Resilience and the Artist’s Duty in Dark Times [Internet]. Brain Pickings. 2017 [cited 17 July 2017]. Available from: https://www.brainpickings.org/2017/05/15/focus-wendy-macnaughton-courtney-martin-poster/

Kuhn C, Flanagan E. Self-care as a professional imperative: physician burnout, depression, and suicide. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2016;64(2):158-168. DOI: https://doi.org/10.1007/s12630-016-0781-0

Muller D. Kathryn. New England Journal of Medicine. 2017;376(12):1101-1103. DOI: https://doi.org/10.1056/NEJMp1615141

Hill A. Breaking the Stigma — A Physician’s Perspective on Self-Care and Recovery. New England Journal of Medicine. 2017;376(12):1103-1105. DOI: https://doi.org/10.1056/NEJMp1615974

We need to start talking about what comes after physician burnout [Internet]. KevinMD.com. 2017 [cited 16 July 2017]. Available from: http://www.kevinmd.com/blog/2017/02/need-start-talking-comes-physician-burnout.html

Phillips A. Missing out. 1st ed. New York: Farrar, Staus and Giroux; 2012.

Kübler-Ross E, Byock I. On death & dying.

Tolstoy L. Anna Karenina.

Harvard Business Review - Ideas and Advice for Leaders [Internet]. Hbr.org. 2017 [cited 17 July 2017]. Available from: https://hbr.org/

The Busier You Are, the More You Need Quiet Time [Internet]. Harvard Business Review. 2017 [cited 16 July 2017]. Available from: https://hbr.org/2017/03/the-busier-you-are-the-more-you-need-quiet-time

BBC World Service | Learning English | Moving Words [Internet]. Bbc.co.uk. 2017 [cited 17 July 2017]. Available from: http://www.bbc.co.uk/worldservice/learningenglish/movingwords/shortlist/laotzu.shtml

Castelloe, Erin Nissen. 2017. “Tincture of Time”. Qualitative Research in Medicine and Healthcare 1 (3). https://doi.org/10.4081/qrmh.2017.6925.

Downloads

Download data is not yet available.

Citations