Why a focus on the health and wellbeing of clinicians in appraisal is always warranted WONCA 2022

When your goal is better patient care, and you only have one intervention that reaches every doctor every year, you need to make it count!

If you have worked in healthcare anywhere in the world, at any level, since the beginning of the COVID-19 pandemic, you will know that we are all moving towards, or are already in, the danger zone of too much pressure. There was a mismatch between capacity and demand in healthcare before the global crisis, and it has only grown worse. Safe and effective clinical care depends on an appropriate amount of pressure to achieve high quality performance. Too little challenge and stimulation can lead to a lack of attention and mistakes. Too much, and individuals get increasingly tired, before eventually slipping into a state of acute sympathetic arousal. Adrenaline driven fight, flight or freeze responses, are all unhelpful in delivering good patient care. Push us over the tipping point and we end up in a state of burnout, where we become incapable of care-giving and cannot continue to work.

Burnout is not an illness; it is an occupational hazard - particularly of the caring professions.

It is defined by the World Health Organisation in ICD-11 as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed, …characterized by three dimensions:

●feelings of energy depletion or exhaustion;

●increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and

●reduced professional efficacy.”

https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases (accessed on 14th June 2022)

So what can we do to shift the tipping point? Performance psychologists tell us that the science of elite athletic performance – incorporating regular disciplined and systematic recovery routines into their training for peak performance - can also be applied to leadership. As long ago as 2001, Loehr & Schwartz recognised that: “When people feel consistently strong and resilient—physically, emotionally, mentally, and spiritually—they perform better, with more passion, for longer. When this happens, they win, their families win, and the [organisations] that employ them win.” We can also add that patients win.

Well trained and supported appraisers can raise the self-awareness of doctors. They can help them realise when they are trapped in a toxic culture of self-sacrifice and need to learn new self-care habits. We all need to recognise that we are humans as well as doctors, and that self-care isn’t selfish. We all need to build disciplined and systematic recovery into our daily routines.

Too many healthcare workers are burning out. Appraisal is one place where timely intervention can offer everyone the chance to improve their health and wellbeing. Good appraisals empower us to make positive changes, regaining a sense of joy and the ability to flourish at home and at work.