Harnessing the Neurobiology of Empathy and Compassion to Alleviate Burnout in Neurology.

1. Paria M. Wilson, MD, MEd* 2. Maneesh Batra, MD, MPH† 3. Kathi J. Kemper, MD, MPH‡ 4. John D. Mahan, MD‡,§ 5. Betty B. Staples, MD¶ 6. Janet R. Serwint, MD** 1. *Division of Emergency Medicine, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA 2. †Department of Pediatrics, Division of Neonatology, Seattle Children’s Hospital and the University of Washington, Seattle, WA 3. ‡The Ohio State University, Columbus, OH 4. §Department of Pediatrics, Division of Nephrology, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH 5. ¶Department of Pediatrics, Duke University Medical Center, Durham, NC 6. **Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD * Abbreviations: EHR: : electronic health record OR: : odds ratio SMART: : Stress Management and Resiliency Training > Every once in a while in Pediatrics in Review , Editors-in-Chief Bob Haggerty and Larry Nazarian would advise readers to care for themselves. They offered commentaries on such subjects as how to transition to retirement or part-time practice, taking time to reflect on the joy of pediatrics, and stepping out of the office to partake in community events. In the spirit of Dr Haggerty’s and Dr Nazarian’s hope that readers take care of themselves, Pediatrics in Review offers the following review. > > —JZ Clinicians and trainee physicians should be aware of the components of wellness and how to foster them in their daily practice. Interventions have been aimed at the individual and organizational levels. After …

Reducing Burnout in Primary Care: A Step Toward Solutions.

We believe that this study represents an innovative approach to clarifying the definitions of routine, empathic and compassionate health care, as well as of sympathy. We emphasize the importance of affective empathy and its intensification in the context of patient suffering (compassion), without abandoning the ideal of clinical equanimity. We develop a pedagogical model for clinicians and trainees who are weaker in their empathic skills that includes four levels of growth. We clarify representative obstacles to empathic and compassionate care in education and clinical practice. We summarize the four beneficiaries of empathic and compassionate care (clinicians, patients, trainees, institutions). We suggest areas for future research, including the development of a compassion scale and conclude with a statement on how the conceptual and professional confusion we address adversely impacts patients and trainees. The article represents the consensus work of a group of health care professionals and students at Stony Brook University Hospital and School of Medicine who have been engaged in this project for several years through the Center for Medical Humanities, Compassionate Care, and Bioethics, established in August of 2008. We discern a shift away from concepts of clinical empathy and compassionate care that deny a significant place for an affective component and that idealize 'detachment'.

The impact of physician-patient relationship factors, such as physician empathy and burnout, on antibiotic prescribing has not been characterised. To assess associations between physician empathy and burnout and antibiotic prescribing for acute respiratory infections (ARIs) in primary care. Cross-sectional study of primary care practices in the Cleveland Clinic Health System in the US. Patient and prescribing data were obtained from the medical record. All patients with primary diagnoses of ARIs from 1 January 2012 to 31 December 2013, except those with chronic obstructive pulmonary disease (COPD) or who were immunocompromised, were included. Physician empathy was measured using the Jefferson Scale of Empathy while physician burnout was measured using the Maslach Burnout Inventory. The relationship between empathy and burnout and antibiotic prescribing, adjusted for patient and provider characteristics, was analysed using multiple linear regression. In 5937 ARI visits to 102 primary care physicians, the median proportion resulting in antibiotic prescribing was 48.6% (interquartile range [IQR] 24.1% to 70.0%). Neither physician empathy (correlation coefficient [β] 0.005, 95% confidence interval [CI] = -0.001 to 0.010, P = 0.07) nor any burnout measures were significantly associated with antibiotic prescribing: emotional exhaustion (β 0.001, 95% CI = -0.005 to 0.006, P = 0.79), tendency to depersonalise patients (β -0.009, 95% CI = -0.021 to 0.003, P = 0.13), and sense of personal accomplishment (β -0.004, 95% CI = -0.014 to 0.006, P = 0.44). The authors found no significant association between empathy or burnout measures and antibiotic prescribing for ARIs in primary care. Other physician characteristics should be investigated to explain individual variation in antibiotic prescribing.

There is emerging literature about possibly inceasing rates of burnout and stress among doctors from all specialties (Gerada, 2017), and in various regions of the world, though it has been studied more in the developed world. For instance burnout has been linked to higher rates of prescribing (Shanafelt and Noseworthy, 2016). Burnout can adversely affect quality of clinical practice and decision making and therefore there is a moral and ethical imperative to address this issue (Imison, 2018). In this session, the various reasons why burnout may lead to overdiagnosis and subsequent overtreatment are discussed, with examples, and with relevant literature references. I also suggest that overdiagnosis (if associated with large volume and speed of working) can in turn lead to burnout in doctors. It is hoped that this will generate debate among the audience and we can collectively discuss strategies to address this. A case is made for a systems approach involving an open and kind culture, early identificaton of doctors with problems, easy access to help and support for those affected including mentoring, coaching, supervision and re-training if required. It is also important to work closely with patient and carer representatives and collect data linking physician and organisational health to clinical practice. Nurturing those who care can ensure that they can then care in a compassionate and efficient manner, thus ensuring good outcomes for patients, staff and organisations. Objectives to understand the correlation between physican burnout and overdiagnosis and over treatment to understand the mechanisms by which it can occur to discuss ways of addressing this issue and redressing the balance in diagnosis. Method Literature review Anonimised and hypothetical case scenarios Reflection on a system approach Group discussion Results At the end of the session I hope there will be increased understanding of the link between physician burnout and overdiagnosis and how we can individually and collectively play a role in resolving this. Conclusions Burnout among caregivers is an important mechanism by which overdiagnosis can take place.

The Wicked Problem of Physician Well-Being.

Introduction: Physician burnout resulting from personal and professional distress has been increasingly reported among practicing physicians, the consequences of which can be pervasive for both physicians and the patients they treat. We hope that employing initiatives within our gastroenterology (GI) division's faculty development program can work to: (1) prevent physician burnout, (2) reinvigorate engagement with the provision of patient-centered care, and (3) promote personal and professional well-being among faculty physicians. Methods: We created a survey for GI faculty physicians to garner information about attitudes towards physician burnout, and strategies that may help physicians combat burnout through faculty development initiatives. Results: Twenty-eight GI faculty completed the survey. The number of years in practice among participants was: 43% for 1-5 years, 21% for 6-10 years, 4% for 11-15 years, and 32% for 15+ years. Eighty-two percent (23/28) reported having interacted with a colleague who they believed to be experiencing burnout. Forty-eight percent reported experiencing at least 1 of 3 criterion of physician burnout sometimes or always (emotional exhaustion, depersonalization toward patients, or low personal accomplishment), with emotional exhaustion being most commonly experienced (71%). An unhealthy work-life balance and increased patient volume and patient-care responsibilities were considered to contribute most heavily to burnout (75% and 68%, respectively). 57% (16/28) strongly agreed that physician burnout may adversely impact patient care and patient-care outcomes. 86% (24/28) believed that faculty development initiatives specifically focusing on combating physician burnout would be worthwhile, and 64% (18/28) believed that initiatives, including OSCEs (objective structured clinical examinations), focusing on enhancing patient-centered care skills are valuable. Sixty-eight percent (19/28) of faculty would like to participate in faculty development initiatives that focus on issues related to physician burnout. Conclusion: Promoting faculty development initiatives that focus on identifying, managing, and preventing physician burnout would fill a void for faculty physicians. Faculty felt that it is crucial to have a program with a dedicated focus on enhancing their patient-centered care skills. This report may better inform GI faculty development programs wishing to marry personal and professional well-being with the provision of effective patient-centered care skills.

Physician burnout is an ongoing epidemic; electronic health record (EHR) use has been associated with burnout, and the burden of EHR inbasket messages has grown in the context of the COVID-19 pandemic. Understanding how EHR inbasket messages are associated with physician burnout may uncover new insights for intervention strategies. To evaluate associations between EHR inbasket message characteristics and physician burnout. Cross-sectional study in a single academic medical center involving physicians from multiple specialties. Data collection took place April to September 2020, and data were analyzed September to December 2020. Physicians responded to a survey including the validated Mini-Z 5-point burnout scale. Physician burnout according to the self-reported burnout scale. A sentiment analysis model was used to calculate sentiment scores for EHR inbasket messages extracted for participating physicians. Multivariable modeling was used to model risk of physician burnout using factors such as message characteristics, physician demographics, and clinical practice characteristics. Of 609 physicians who responded to the survey, 297 (48.8%) were women, 343 (56.3%) were White, 391 (64.2%) practiced in outpatient settings, and 428 (70.28%) had been in medical practice for 15 years or less. Half (307 [50.4%]) reported burnout (score of 3 or higher). A total of 1 453 245 inbasket messages were extracted, of which 630 828 (43.4%) were patient messages. Among negative messages, common words included medical conditions, expletives and/or profanity, and words related to violence. There were no significant associations between message characteristics (including sentiment scores) and burnout. Odds of burnout were significantly higher among Hispanic/Latino physicians (odds ratio [OR], 3.44; 95% CI, 1.18-10.61; P = .03) and women (OR, 1.60; 95% CI, 1.13-2.27; P = .01), and significantly lower among physicians in clinical practice for more than 15 years (OR, 0.46; 95% CI, 0.30-0.68; P < .001). In this cross-sectional study, message characteristics were not associated with physician burnout, but the presence of expletives and violent words represents an opportunity for improving patient engagement, EHR portal design, or filters. Natural language processing represents a novel approach to understanding potential associations between EHR inbasket messages and physician burnout and may also help inform quality improvement initiatives aimed at improving patient experience.

Physician burnout is an increasingly prevalent issue affecting many physicians across all specialties and, by proxy, their patient outcomes. One key factor is associated with excessive medical record documentation. Maintaining patient records can be time-consuming, cumbersome, and complicated for some physicians. As such, artificial intelligence (AI) such as ChatGPT or newer programs may provide an effective solution, which may provide reduced human work efforts, including administrative tasks such as documentation. With advances in natural language processing (NLP) tied to AI approaches, the medical field has been open to adopting AI to improve efficiencies tied to documentation and other repetitive clerical duties. This scoping review aimed to examine the impact of AI on physician burnout in the context of medical charting and administrative tasks, excluding its role in diagnosis or patient treatment. Specifically, it aimed to explore existing research to understand the influence of using AI on physician burnout and determine how AI has influenced the experiences of physicians. A thorough search of the peer-reviewed literature, following Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) guidelines, was conducted across three databases (EMBASE, Ovid Medline, and Web of Science) for articles published in English between 2014 and 2024, focusing exclusively on physicians using AI technologies in clinical settings. The initial search yielded 663 articles, which were refined to eight articles after a systemized, rigorous search and selection process. The findings indicate a potential for AI to mitigate physician burnout by decreasing documentation time, improving physician-patient interactions, and enhancing clinical workflow efficiency. Challenges such as overreliance on AI and insufficient familiarity with technology may be tied to misinformation or misuse. These issues highlight areas of further development and research to advance AI technology integration into clinical practice.

Background: Compassionate care represents a foundational value in healthcare education, essential for cultivating empathy and holistic patient engagement. Despite its recognized significance, integrating compassionate care into educational curricula remains complex. We systematically explored its conceptualization, implementation, and pedagogical strategies within health education to inform curriculum development and professional training. Methods: Scoping review using the Arksey and O’Malley framework. Literature search in Dec 2024 in the Scopus, Emerald Insight, and Wiley Online Library databases, English publications from the last 10 years, focussing on compassionate care in health education. Flow diagram for the PRISMA review scoping shows the search and selection procedures. Tools from the Joanna Briggs Institute (JBI) for thematic analysis. Overall, 4,119 articles were screened, and 21 studies met the inclusion criteria. Results: Compassionate care enhances empathy, communication, and professional behaviour among students. Development is carried out through experiential learning, narrative reflection, clinical practice, and the role of mentors. Programs like the Kind Care Bundle and empathy training have proven effective. However, implementation faces obstacles such as academic pressure, a rigid educational culture, and a lack of communication training. A structured curriculum approach and an inclusive learning environment are necessary to sustainably cultivate compassion competence in health education. Conclusion: Compassionate care is an essential component in healthcare education that contributes to the formation of empathetic attitudes and patient-centered care. The integration of compassion values into the curriculum through reflective approaches, clinical practice, and mentorship guidance is important to produce competent, humanistic healthcare professionals who are ready to face the challenges of professional practice.

Physician Burnout: Fix the Doctor or Fix the System?

Surgeon Wellness and Burnout

Compassion has long been advocated as a fundamental element in nursing practice and education. However, defining and translating compassion into caring practice by nursing students who are new to the clinical practice environment as part of their educational journey remain unclear. The aim of this study was to explore how Chinese baccalaureate nursing students define and characterize compassionate care as they participate in their clinical practice. A descriptive qualitative study design was used involving a semi-structured in-depth interview method and qualitative content analysis. Twenty senior year baccalaureate nursing students were interviewed during their clinical practicum experience at four teaching hospitals. Permission to conduct the study was received from the Institutional Review Boards and the participating hospitals. Baccalaureate nursing students defined and characterized compassionate care as a union of "empathy" related to a nurse's desire to "alleviate patients' suffering," "address individualized care needs," "use therapeutic communication," and "promote mutual benefits with patients." Students recognized that the "practice environment" was characterized by nurse leaders' interpersonal relations, role modeling by nurses and workloads which influenced the practice of compassionate care by nursing personnel. Compassionate care is crucial for patients, nurses, and students in their professional development as well as the development of the nursing profession. In order to provide compassionate care, a positive practice environment promoted by hospital administrators is needed. This also includes having an adequate workforce of nurses who can role model compassionate care to students in their preceptor role while meeting the needs of their patients.

How I Became Active in Fight For Trainee Wellness

Broad System Factors Influence Physician Wellness, Patient Care