Who’s Responsible for Our Health; Individuals or Institutions?

Who is responsible for my health?

Is it I? My family? My doctor? My employer? The Health Care or Public Health System? All of the above?

What if I am burned out, a doctor, or a burned-out doctor? Who then, is responsible for my health? Is the answer the same? Are doctors alone responsible for their own health? Or is it a systems issue? If the impact of burnout in health professionals extends beyond the individual to the system and to the health of the population then isn’t this a public health crisis- and aren’t we all then responsible to lead change?

This debate is front and center across academic centers and hospital systems nationwide, with strong opinions on both sides. Physicians who place health and wellness above all values are insulted to be accused of not caring for themselves. They maintain that they have the knowledge and skills to promote health and wellness in others, but they push back, stating that self-care in a toxic environment is not humanly possible. They point fingers at the prevailing “do more” culture and the “revenue driven” medical system for not supporting them…no breaks, no time to eat, sleep, exercise, socialize, or reflect, let alone complete the daily workload. They claim that the endless bombardment of tasks – now mostly electronic- diminishes personal accomplishment, exhausts human compassion and devalues the innate senses of meaning in medicine.

Is the organization to blame? Who is the organization?

Are institutions not just a collection of individuals? We as individuals are the patients, the employees, the frontline workers, the directors, the learners, the teachers, the doctors, the nurses and the president? Can empowering individuals be the simple essence of creating a culture of wellness? If empowerment occurred at all levels: the individual, the frontline team members and the organizational champions could we change the outcomes?

Individual level empowerment must be geared toward understanding chronic stress, adaptation to change and obtaining personal skills and tools. These must be embedded in education early in life, not just in medical training, but beginning in undergraduate or even high school. Strategies must be reinforced and monitored throughout one’s career and entire life if chronic stresses persist. Those working in groups need training to maximize team trust, effectiveness and efficiency and those with power and authority in organizations must have incentives to align wellness within the core mission, strategies, policies and metrics for all members of their institution. Empowering individuals is necessary to change culture.

The hardest thing to change is our minds. A major paradigm shift in thinking around self-care is the first task. Reframing our belief that personal performance is linked to internal wellbeing is a must. Shifting thinking away from external achievement, and away from the belief that caring for self is a sign of weakness, failure or laziness and moving towards the concept of self-care as a sign of commitment and strength. My health is core to my effectiveness as a physician, teacher, student, researcher, employee, parent, spouse or colleague. This cognitive reframing is necessary for all those, including health providers who insist they must do anything and everything for others, even when at their own expense. Physicians who come to the belief that caring for themselves allows better care for patients, (and we now have sufficient evidence to support this notion) take back control and are empowered to prioritize personal health. Those who additionally master strategies to sustain and model personal health give others permission to do the same and ultimately change culture.

Perhaps how we define leadership in organizations should be less linked to titles but attributed to those who model health by walking the walk. Healthy individuals contribute to healthy communities.

So, WHO is responsible for our wellness?

We are - as we are the system - we are the culture! There is no them! If we acknowledge personal performance is linked to personal health, and we master strategies to prioritize our wellness, we can care for ourselves just as we expect of others - no more and no less! In doing so, each of us also becomes a leader of wellness and impacts the health of others. Institution must invest in individuals, but ultimately it is the individual who leads an institution and who is responsible for our health.

Catherine Florio Pipas October 2018