To better understand physician disengagement, discouragement, and burnout, we can turn to the work of Alfred Adler and the foundational concept of Adlerian theory, Gemeinschaftsgefühl, loosely translated as “Social Interest,” the belief that humans have a primary need for social connectedness and to feel that they are contributing to the wellbeing of others.
Adler taught that Social Interest is crucial to establishing and maintaining emotional and cognitive equilibrium. Depression and anxiety result when this primary human drive is frustrated or blocked.
Physicians and healthcare workers in general tend to have elevated levels of Social Interest.
Some colleagues of mine and I facilitated 7 physician focus groups and conducted scores of healthcare executive one-on-one interviews. With Adler in mind, consider these physician and administrator quotes:
Physicians
- Insurance companies make it so some of our patients can’t come to see us.
- There are too many outside entities having input on how we practice medicine.
- We’re doing work we shouldn’t be doing. We’re being pulled down into the weeds too much.
- EMRs are starting to manage the patients.
- We feel like pawns. We feel like we’re doing more work for less reward.
- We’re not being allowed to be doctors.
- We’re doing “click-box medicine.”
Administrators
- We feel that we’re being demonized for the decisions we have to make.
- Physicians don’t understand why we make the decisions we do.
- They don’t understand the underlying principles of the issues.
- Physicians have a baseline expectation of business as usual, but these days things simply aren’t usual.
I suspect Adler might have compared physicians and healthcare administrators to married couples who share common purpose far beyond any differences but have differences often based in misunderstanding, ill-informed assumptions, and lack of communication.
Almost certainly he would advise us to step back from any granular observations and conclusions about our hospitals and healthcare systems. He would advise us pay attention to the ways we create moral hazard for some of the most crucial members of our society.
Brad Fern is an adaptive-change coach who specializes in working with physicians and healthcare executives.