Background: Physician burnout impacts job satisfaction and turnover with significant financial and operational costs in addition to the negative impact on patient care. Organizations are increasingly focused on methods to improve physician resilience. Our study aims to explore the impact of difficult patient encounters on hospitalist resilience to inform future individual and organizational efforts to improve physician resilience.
Methods: We conducted a descriptive, qualitative study using semi-structured, face-to-face interviews to explore hospitalist perspectives on difficult patient encounters and the effect on physician resilience. We interviewed physician hospitalist faculty (N=15) at a tertiary academic hospital and a safety-net hospital. Interview guide questions were developed using a conceptual framework for physician resilience that included 4 domains: internal variables, external variables, and career and organizational resilience. These correspond to personal resilience, culture of wellness, and efficiency of practice, respectively. A mixed deductive/inductive analysis was completed using a team-based iterative approach.
Results: Two themes emerged around how hospitalists define difficult patient encounters: encounters that elicit a feeling of helplessness and time-consuming encounters. Feelings of helplessness were associated with systems issues such as being unable to provide an expected service, misaligned patient/provider goals in which the provider was unable to meet patient expectations, and violence toward the provider, including fear of physical harm. Encounters were considered time-consuming due to systems issues such as lack of resources or support staff, misaligned goals requiring communication for re-alignment of patient and provider expectations, and patient factors such as requiring a translator for communication. Hospitalists described how internalizing feelings of helplessness and perceived lack of institutional support for managing these factors contributed to provider burnout. As a result providers felt an internal sense of responsibility to identify solutions to manage difficult encounters and personal resilience through 1) developing empathy and teaching empathy to learners; and 2) seeking expert opinion through debriefing, peer-to-peer interactions, and through external sources such as literature.
Conclusions: Organizational strategies to enhance physician resilience among hospitalists in the context of difficult patient encounters require a multifaceted approach including: improved system processes, fostering a local culture of empathy-building, and providing support for peer-to-peer relationships and feedback mechanisms. Further, institutional focus on personal resilience strategies, such as mindfulness techniques, without enhancing the culture of wellness or efficiency of practice through systems changes may not be sufficient to mitigate physician burnout.