The Uncomfortable Truth: The Burnout Epidemic & our Cancer Care Teams

By Heather Hylton, MS, PA-C, DFAAPA

In reflecting upon my attendance at the 2018 ASCO Annual Meeting, I was genuinely surprised (and concerned) at how often I heard the words “burning out,” “burned out,” “burnout,” and “burnt” inextricably woven into so many faculty presentations and attendee narratives.

Burnout, as defined by Christina Maslach and colleagues, is a syndrome of emotional exhaustion or depletion, cynicism or depersonalization, and a sense of low personal accomplishment.  Although the Maslach Burnout Inventory is a leading measure of burnout, I believe the perception of one’s own well-being is a very powerful indicator in this domain, as our perceptions often are our reality.  

You might be questioning why this topic is in this particular blog space.  The uncomfortable truth is that burnout is a problem with touchpoints that can affect every facet, whether personal or professional, of our being.  The far-reaching implications are tremendous.  Great strides have been made in recent years in acknowledging and recognizing burnout as well as lifting the stigma on this condition; however, much work remains to be done.

Burnout has been shown to have significant consequences of both a personal and professional nature, including:

  • Relationship difficulties

  • Substance abuse/dependency

  • Suicidal ideation

  • Diminished quality of care

An in-depth review of the impacts of this condition is outside the scope of this post, but I wonder—is the gravity of the burnout problem truly understood?  In her book In Shock, Dr. Rana Awdish notes, “Medicine is not oriented to recognize trauma in its own.”  How can we as health-care professionals be more attentive to recognizing and preventing burnout not only within ourselves but also within our colleagues?

Drs. Christine Sinsky and Michael Privitera propose clinician well-being be established as a health system metric.  I would advocate taking this a step further and looking at this across the interdisciplinary team.

The work effort of each member of the cancer care team is directed toward shared goals for the care of each patient.  If an individual member’s well-being is impacted by burnout, how could we expect optimal functioning of the team?  And is not caring for each other just the right thing to do?

Addressing burnout requires not only implementing change in oneself but also in the environment in which one works.  The latter, arguably, may be more challenging, but there is opportunity. 

In my conversations with health-care professionals across the country who feel burned out, most identify at least one element of workplace culture as a driver. What if we, as stakeholders in workplace culture, champion team well-being as a critical component of the work environment? Without meaningful cultural change as part of a comprehensive strategy to address burnout, it will be difficult to move the needle on this problem.  The time for concerted action is now; we must come together to establish the wellness of our interdisciplinary teams as a priority so that we can both sustain the workforce and provide opportunity for it to flourish.  

I will end with a Maori proverb shared by Dr. Edmond Ang at the 2018 ASCO Voices session: What is the most important thing in the world?  It is the people, it is the people, it is the people.