Burned Out? So Sue Me.

Medical resident burnout has reached epidemic levels. Of course, in the land of crisis, this is not the first we've heard of this. We would prefer to stick our heads in the sand, but this pesky little problem just won't go away.

Medical resident burnout has reached epidemic levels. Of course, in the land of crisis, this is not the first we've heard of this. We would prefer to stick our heads in the sand, but this pesky little problem just won't go away. You might not care. But, if you are a patient or someone involved with resident education and training, you should.

Does the name Libby Zion ring a bell? Now almost 10 years later, the case forced sweeping changes in resident hour work rules. Unfortunately, despite the best intentions, it turns out that these expensive, bureaucratic rules don't improve quality of care after all.

My guess is that it will take a high-profile lawsuit to get the attention of those in the hot seats. Graduate medical education is filled with liability landmines. Vicarious liability. Failure to supervise. Now, perhaps, we need to add to the list failure to provide an educational system that treats and prevents physician burnout and the harm to patients it can cause.

We need to PISS on burnout.

1. Prevention: It's been demonstrated that burnout prevention interventions work best when there are personal and organizational tools brought to bear. However, the outcomes fatigue, so it takes ongoing vigilance and monitoring. Changing the warrior mentality of medical workers would also help, but that means changing the culture of medical education and training.

2. Innovative ways to detect and treat burnout. Some have hired in-house corporate chaplains or counselors. Others use behavioral health apps or telepsychiatry.

3. Surveillance. Self-reporting does not work. Snitching does not work either. We need better ways to keep track of who is in trouble or likely to be.

4. Stewardship. Stop piling on administrivia, rules, regulations, red tape, and bad bosses who simply get between the patient and their doctors and add little or no value to patients.

We all know by now that a crisis is a terrible thing to waste. The first step in change leadership is to create a sense of urgency such that followers are willing to unfreeze existing patterns of behavior and systems and change them for the better. However, the cautionary lesson from the Zion case is that rushing into what seems intuitively right, may result in no improvement despite the best efforts of well-meaning change agents.

Lawsuits may not be the best way to change things, but, after all, it is the American way.