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Today, we'll explore how medical anthropology can help us better understand how cultural factors contribute to healthcare providers' burnout, and how addressing these factors is essential to support their well-being and improve patient care outcomes.
In our previous post, we discussed the critical role of cultural understanding in reducing Japan's high suicide rates. While a patient-centric approach was key to this effort, addressing the complex challenges facing healthcare today requires a more holistic, human-centric approach that takes into account the well-being of all stakeholders. One group that is often overlooked in these discussions is healthcare providers themselves. The well-being of HCPs is crucial not only for their own sake but also for the quality of patient care they provide. So, let's dive into how a human-centric approach to healthcare can support the health ecosystem by prioritizing the well-being of HCPs.
Challenging the myths of inherent resilience and burnout as an individual issue.
Suicide rates and burnout among physicians have been found to be higher than among the general population [1]. To tackle these issues, one initiative offered to HCPs is resilience training, with the aim of increasing their ability to cope with the stressors of their work environment. Resilience training, however, is not solving the underlying issue.
Good doctors are perceived –not least by themselves– as heroes
HCP burnout has been identified as resulting from understaffing and overwork, unsafe working conditions, and a hostile work environment, among other factors [2]. Many have noted that these working conditions ‘would be considered unsafe, unprofessional, and even illegal in other safety-critical industries.’ [2].
Beyond the system, HCPs have culture too. As Card puts it: ‘both healthcare administrators and doctors themselves operate within a culture that pretends physicians are mythic beings who are, or at least should be, supernaturally resilient, infallible, and omnipotent.’ [2]. Good doctors are perceived –not least by themselves– as heroes. The cultural expectation is that they persevere, do not complain, and do not get ill –and much less mentally ill [3].
[…] We teach them that they should always defer self-care and personal relationships as long as needed to meet professional demands […]
These cultural expectations are passed on to future generations of doctors. In the words of Shanafelt and colleagues: ‘We inculcate future physicians with a mindset of perfectionism, lack of vulnerability, and low self-compassion. We teach them that they should always defer self-care and personal relationships as long as needed to meet professional demands. Mistakes are the fault of the individual and are unacceptable. To err is human, but we are superhuman. We espouse the importance of prevention, selfcare, and personal behaviors to promote health for our patients, but often do not engage in these behaviors ourselves. We prioritize professional life above all, even if it means we are working in a manner that is not sustainable or that renders our medical decision making suboptimal.’ [4].
It has been argued that the mechanistic reductionism inherent in biomedicine is to blame for doctors viewing and treating themselves in the same way, resulting in the ‘medical self’ that does not seek help [3]. This mentality and culture of the biomedical institution as a whole – which is realized on a physical level in how work is conducted – results in burnout and a higher-than-average suicide rate for physicians, markedly more for women.
Burn-out doesn’t end with doctors: caregivers do suffer too.
Last year, one of our anthropologists at A Piece of Pie, Juliana Saldarriaga, argued that our society tends to overlook the structural causes of mental illness and instead conceives it as an individual, biochemical problem [5]. Several anthropologists have discussed this topic, arguing that an uncritical view of resilience necessarily shifts the blame and thus the responsibility for healing the burnout on the individual [6]. Like for doctors, this conception also assumes that caregivers are inherently resilient; that their identity (especially assumed to be women) as such naturally grants them abilities constituting continued resilience in the face of an ever-challenging healthcare system and disease.
Building the foundations to reduce burn-out in the healthcare system
Through today’s article, we have shown how medical anthropology has unveiled that HCP and caregiver burnout are not an individual issue; rather, they are the result of systemic, structural problems pervading our healthcare systems.
Both HCPs and caregivers are an essential part of our healthcare systems, and taking their wellbeing seriously necessarily has positive implications down the line for better patient care, including their own. But as we have seen, to diminish burnout it is necessary to tackle its structural causes. And to do so, more ethnographic observational studies unveiling the ‘culture of medicine’ and its implications in particular healthcare systems are needed. Ultimately, as Juliana points out, this needs to be translated into advances in public policy, working closely not only with healthcare providers, but also with public bodies and NGOs [5].
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