Healing the burn
Burnout is one of the biggest threats to health care workers, but it can be managed with the right steps.

Burnout, especially in the realm of health care, carries with it complications, barriers, and stigmas. This leaves those suffering from it often drained of the energy and resources required to process the elements of burnout and move forward.
In “Talking About Painful Cases: Addressing the Burn AND the Burnout,” attendees will take part in an Ethics M&M—a type of Morbidity & Mortality event that provides a starting point and space for burned-out clinicians to talk, learn, and collaborate. They will also get the opportunity to design one for themselves and their institutions. Hemal N. Sampat, MD, FHM, who helped to create Ethics M&M, will lead the workshop. Dr. Sampat is an instructor of medicine at Harvard Medical School, and a medicine/pediatric hospitalist at Massachusetts General Hospital in Boston.
Prior to Converge, we asked Dr. Sampat about the importance of addressing burnout in approachable ways.
SHM: Why is the topic of burnout important to address, especially in today’s climate?
Dr. Sampat: Burnout is one of the biggest threats to health care workers and the sustainability of our health care system. Even before the pandemic, health care had one of the highest rates of burnout among any profession. This has skyrocketed since the pandemic, especially for hospitalists, who took a great deal of the brunt of caring for patients with COVID-19.
Some studies show more than 50% of health care workers feel burned out. Burnout creates a vicious cycle that worsens the system. Burned-out providers find it harder to provide high quality care, which leads them to leave the already understaffed health care system, which puts even more burden on the system, which burns out more providers, which leads to more attrition, and so on. We also see the mental health of health care workers suffer greatly. We need to break this cycle.
SHM: In your experience, what are the biggest causes of burnout in the health care field?
Dr. Sampat: The short answer is not being able to provide the kind of care that we want to provide. The longer answer is that there are many systemic problems that hinder our ability to provide patients with the highest quality of care. This includes intense time pressures from a system that is understaffed, has too few hospital beds and accessible clinics, and has not enough affordable services to care for all the patients who need help.
Burdensome administrative requirements rob physicians of time that could be spent caring for patients, and many system improvements have fundamental flaws that make the problems worse (e.g., electronic health record systems that can't communicate with each other and require more time to document than paper charts).
Onto this backdrop, flashpoints are more prone to arise when dealing with difficult or painful patient encounters, conflict involving other staff members or administration, or cases that are ethically challenging.
SHM: What makes burnout hard to discuss and act on—both individually and institutionally?
Dr. Sampat: Not having enough bandwidth (individually and institutionally) for self-care is both a cause of burnout and a barrier to addressing it. When we’re trying to stay afloat, we often put aside discussing why burnout is occurring or how we can deal with it. On top of that, the factors that lead to burnout can be emotionally triggering and even lead to conflicts over root causes as well as what should have priority. Bridging these kinds of disagreements and conflict is hard to do without somebody who can help people see the whole picture, as there is seldom a single right answer for any of these issues.
It’s also hard to address burnout because many of the contributing factors are beyond the control of the individual and require substantial change on the part of the institution or the system as a whole.
SHM: How did you create the Ethics M&M, and what are the key points?
Dr. Sampat: Ethics M&M (or Dilemmas, as we call it) is based on a simple idea: Painful cases are something we all go through, and having a forum for discussing them can be a great way for us all to learn from each other and become better at dealing with them. Just as with a standard M&M, where we find the learning points in each other's experiences, Dilemmas helps us find key learning points in each other's experiences.
The goal of any Dilemmas is three-fold:
- Identify and discuss the difficult and painful elements of patient care that contribute to ethical challenges and provider burnout
- Provide a protected forum to discuss ethically challenging cases
- Through collaborative discussion, develop a collective framework for addressing such cases.
SHM: Are there any other messages that you want attendees to take away from this session?
Dr. Sampat: In our session, attendees will get a chance to experience an Ethics M&M firsthand and then get started designing one for themselves and their own institutions. They'll learn not only how to identify the painful elements of patient care that contribute to ethical challenges and burnout, but also learn how to lead and navigate the nuances of a discussion involving these cases. This includes learning about managing expectations, handling disagreement, and developing strategies to overcome institutional barriers.
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