Physician Burnout

Cultural implications were evaluated from the Hmong perspective, using the book “The Spirit Catches You and You Fall Down.” The assessment was based on the Hmong people and followed the Geiger and Davidhizar’s transcultural assessment model. Five areas were focused on in particular from their model: Environmental Control, Social Organization, Communication, Space, and Time Orientation. The result reaffirmed that there is a huge cultural divide that caused many errors in the care of young Lia Lee, including many miscommunications that could have been prevented. I briefly touch on the importance of cultural awareness in the health care industry and why it is important to be sensitive to the culture of others.

Cultural competency aids in closing the “disparities gap” in health care. ("OMH," 2012, para. 2) In doing so, health professionals and their clients are better able to discuss concerns without cultural differences getting in the way of effective communication and problem solving. Being respectful of and sensitive to the client’s health beliefs, culture, values, and diverse needs can bring positive outcomes within treatment and patient care. After all, is it not the main job of the health care provider to ensure patient trust? Open forms of communication when dealing with client issues can only be provided if the patient is comfortable with his provider and believes his

Many live under the assumption that those who come to the United States want to become Americanized and assimilate to the melting pot our culture has formed into. This is the populations ethnocentric belief, which is the belief that the ways of one’s culture are superior to the ways of a different culture, that wants others to melt into the western ways. In Ann Faidman’s The Spirit Catches You and You Fall Down, Faidman fails to completely remain objective when demonstrating how cross-cultural misunderstandings create issues in the healthcare field, specifically between the Hmong and western cultures that created dire consequences between the Lee’s and their American doctors. Faidman uses her connections with the Hmong and the doctors who cared for them in order to disclose the different views, beliefs and practices the Hmong and Western cultures practiced. With her attempt to be culturally relative to the situation, Faidman discusses the series of events and reasons as to why the Lee’s faced the fate that they did and how it parallels to the ethnocentrism in the health care system.

The Spirit Catches You and You Fall Down, by Anne Fadiman, is the story of two very different cultures lacking understanding for one another leading to a tragedy due to cultural incompetence. Today in America there are very many different cultures. Health care providers need to be aware of cultural diversity and sensitivity when caring for patients. If a health care provider is not sensitive towards a patient’s culture it can cause a relationship of mistrust to form, lead to barriers in the plan of care, and increase health care cost. The current guidelines to promote cultural competence in the clinical setting include completing a cultural diversity self-assessment, identify the need of the population served, evaluate barriers in the community and practice, educate staff to cultural diversities, schedule longer appointments, clarify limitations, and identify alternatives offered (Cash & Glass, 2014).

My decision to pursue a career as a physician was not a blinding revelation, being the daughter of two immigrant parents the thought of becoming a physician seemed distant. In high school I pursued to obtain what for me was then the highest education I perceived I would be able to achieve which was going to college and obtaining a bachelor’s degree. As the quote by Ralph Ellison highlights, “When I discover who I am, I’ll be free”. This quote resonates with the start of my second year in college, as I have been able to find my passion for medicine. More specifically, I explored my values and how I wanted to shape my future. I reflected upon the encounters and dramatic effects that physicians have had with my own family. The most impactful

A vital foundation for a high-quality care delivery is an efficacious communication between the patient and the healthcare providers (Gengler & Jarrell, 2015). Fadiman (1997) recounted the conflict between a refugee family from Laos and a small hospital in California over the care of Lia Lee, a Hmong girl with severe epilepsy, in her book The Spirit Catches You and You Fall Down. Despite both sides wanting the best care for Lia, the lack of cross-cultural communication between her Hmong family and her American doctors, lead to her tragedy (Fadiman, 1997). Awareness regarding the disparities in culture and language of our patient with ours and how to address them should be taken into account when providing healthcare since the life of a

In “Asian Americans’ Reports of Their Health Care Experiences,” Ngo-Metzger conducts a study on satisfaction levels between whites and Asian Americans and whether this element is a product of clinical encounter issues or patient demographics. Results show that Asian

This individual/family reports that she regularly speaks to her family in Taiwan via Skype, Facebook and cell phone. She grew up as a Buddhist but does not attend any religious services on a regular basis but does admit to occasionally meditating. Meditating is a central Buddhist practice; it is a “form of mental concentration that leads to enlightenment and spiritual freedom.” (religionfacts.com). Although this individual didn’t fully scribe to traditional beliefs on health and illness, she did give a few insights to the interviewer. Reputations are very important to Asians, being embarrassed or having something personal told to an outsider is a huge deal. Confidentiality is very important and medical-health issues are not discussed with outsiders. (Centers for Disease Control and Prevention [cdc], n.d., ∂ 4)). Asian culture beliefs include the mind-body-spirit balance or yin and yang.” Yin and Yang are dynamic and complementary, not oppositional forces, for every action there is an equal and opposite reaction, one can’t exist without the other and imbalance leads to illness.” (cdc,n.d). Traditional types of Chinese medicine include herbs, massage and acupuncture and acupressure; these remedies offer preventative and restorative properties. Acupressure is believed to “manipulate the flow of energy or Qi”; it is believed to be both preventative and restorative. (acupuncture benefits). In addressing health protection, promotion and restoration, this

In 2014, the Asian American population accounted for nearly 5.4% of the total United States (U.S) population and is projected to increase to 9.3% by the year 2060.1 Currently, the cities with the largest populations of Asian Americans include the major metropolitan and surrounding areas of Los Angeles, New York, San Francisco, Chicago, Washington D.C. and Honolulu.1 In this report, the Asian American population was defined as individuals who reported their race as Chinese, Japanese, Korean, Asian Indian, Vietnamese, Filipino and/or other Asian to the U.S. Census Bureau in 2010. As the second fastest-growing ethnic group in the U.S., appropriate outreach and access to health care services, such as mental health is more critical than ever.

Cultural competence, or the ability of health care providers to function well in different cultural contexts [7], has increasingly become a focus in U.S. medical schools. More schools are recognizing the growth in national diversity and the importance of having a health care workforce armed with knowledge of how to remain culturally sensitive and aware to provide the best possible care for all patients. According to Kripalani et al., research shows that cultural competence can improve communication and collaboration efforts between the patient and physician, thereby improving clinical outcomes, and eventually reducing health disparities [14]. Additionally, cultural competency has been shown to correlate with quality care to minority populations [15]. However, the strides made towards cultural competence of physicians have not been consistent across all medical schools as some medical students are trained extensively in this field while others are not trained at all. It would not be an easy task as it would require changing the entire curriculum and getting support from administrators [13], but the hope is to integrate cultural competence into all medical school curricula to arm future physicians with the tools they need to care for those of all different

Miscommunication, medication errors, and lack of compliance commonly occur in the healthcare field. These are just a few of the errors that occur due to the patient being from a different culture than the physician or healthcare worker. Those three errors alone have a huge impact on our healthcare today. If we could have a better understanding of other cultures that are different from our own we could have a dramatic decrease in errors and a great increase in healthcare participation. Training must be completed and must be done in more than one way. The first step is to make sure that all physicians and health care workers get the same nationwide training that focuses on improving cultural competence. How this is completed must be done in more than one way (Horwitz, 2001).

My experience as a medical assistant in different culture backgrounds (Chinese and Jewish) was the epitome of diversity that comes with working as a PA in the United States. While health care issues remain the same, the approach to treating patients vary from doctor to PA. During my time in both clinics, I observed and recorded the duties of the PAs. While shadowing, I noticed they not only treated their patients, they provided genuine advice and interacted with the patient beyond the scope of their job description. It was truly inspiring to see a PA spend hours searching for a specific medicine covered only by the patient’s insurance, or staying on the phone speaking to a worried mother about her fussy baby. On busy days, the PAs would often see up to one hundred patients. Treating one hundred patients can be extremely tiring but I noticed that every patient was thoroughly evaluated and treated whether they were the first or the last patient of the

The ability to conduct therapy effectively with racially and ethnically diverse populations is becoming increasingly relevant. In assessing the mental state of patients, clinicians need to take into account cultural variations of psychopathology and they should be aware of the manner in which empathy and communication can be profoundly influenced by racial and ethnic differences between patient and therapist. For this research paper we define eastern culture as including Asian countries and the countries in east of Europe.

Micheal, thanks for your post, I agree with you that physicians are burned out from the guidelines set by Centers for Medicare & Medicaid Services, Physician Quality Reporting System, Clinical Quality Measures, Electronic Medical Records and the new ICD-10 codes, when do they have time to be a physician. It is enough to drive one out of the seat of wanting to practice medicine when most of your time is dealing with the paperwork. Physicians are not wanting to accept new Medicare or Medicaid patients, it requires too much of their time. Many of our physician here the Mount Pleasant area have changed their practice to concierge medicine, which is a private service to private pay patients. This is where the physicians charge a flat rate to

Whilst students experience the education and learning course, they might pick out diverse situations linked to academic activities as worrying. Consequently, it is likely that they employ coping strategies to reduce the effects of stress. On the other hand, when these strategies are unsuccessful stress ruins and may lead the students to experience burnout.24 In the current study burnout was found in 79.9% and the burn out subscales among studied students, were 56.8 % and 60% personal burnout and work related burnout respectively. whereas 38.2% and 28.9% suffered teacher and colleague burnout correspondingly. In another study done by Chin RWA.2016, in Malaysia using CBI on medical students (67.9%) medical students experienced burnout. Personal burnout was the highest (81.6%), followed by work-related burnout (73.7%) and client-related burnout (68.6%).25 The prevalence of burnout amongst medical students has been found to be comparatively high, between 45% and 71% of students affected in different studies.20,26,27,28 In the current study work related burnout(academic activities) higher than personal burnout this may be explained as burnout in those students is mainly due to academic overburden more than emotional exhaustion. Thus immediate intervention should be done by college administrator to relieve the load on students regarding academic activities.