Got Physician Burnout? You Aren’t Alone.

By Karin Krisher

physician burnoutEvidence that an American productivity schedule (8 to 5) isn’t ideal for maintaining productivity or motivation has been piling up for years. Now, the results of a survey of 7,288 physicians from June 2011 proves that doctors have it the worst: Physician burnout is reported at a much higher rate than the general  population, with nearly 1 in 2 physicians reporting symptoms.

I use the word symptom loosely. We’re not saying that every one of us who gets burned out has a malady that manifests in daily life. We are saying that doctors are being taxed—emotionally and physically.

The physicians surveyed were asked to fill out a questionnaire about burnout symptoms, such as emotional exhaustion, cynicism and loss of enthusiasm in work. The burned out are at risk for personal problems like addiction and depression, as well as professional problems, such as compromised care quality.

Writes Alexandra Sifferlin for, “The data showed that rates of burnout were high: 45.8% of doctors experienced at least one symptom of work-related burnout. When each symptom was considered separately, 37.9% of the physicians had high emotional exhaustion, 29.4% had high depersonalization and 12.4% had a low sense of personal accomplishment. U.S. doctors are burning out ‘at an alarming level,’ the authors write.”

Front-line care practitioners, such as emergency physicians, internal medicine and family medicine, had the highest burnout rates, while doctors of pathology, dermatology, pediatrics and preventative medicine had the lowest rates.

There’s more: Physicians work an average of 10 hours more per week than other people. While only 10.6 percent of the general population admits to working 60-hour (or more) weeks, 37.9 percent of physicians (the same percentage that reported emotional exhaustion) said the same.

The authors of the study published in the Archives of Internal Medicine proposed no real solutions for the issue of burnout. But we’re wondering if you have any tips.

Are you personally experiencing physician burnout, or burnout from another profession? What have you found to help you deal with these feelings? Share your story in a comment.

Talk to Your Patients Like you Mean it: How Doctors Lead by Example

By Karin Krisher

doctors lead by exampleA recent John Hopkins University study of physicians’ health behaviors led this writer to take a nice little walk down medical memory lane, pausing at each pivotal doorstep to recall the true nature of the encounter. Reading the study brought me to a lingering question: were my doctors telling me to do as they say, or as they did? Do doctors lead by example?

Because I didn’t delve into a reciprocal questioning process with any one of my many physicians, the answer escapes me. But there is a more important series of questions whose answers seem more clear: is consistency in personal health and recommendation a must? Is it even important? Why?

First, some background: The study was comparative, and noted some positives, like the fact that physicians are less likely to smoke, drink, or engage in other risky behaviors than the average American. However, when it comes to the hidden stuff, like cholesterol, BMI, frequency of exercise or quantity of vegetable consumption, physicians, as a group, seem to fall slightly short. Perhaps most disturbing is the fact that suicide and depression rates among physicians and medical students are higher than average.

So, is that important? When my doctor tells me how to deal with depression, or that my cholesterol should be lower, does she or he have to be healthier than I in order for me to understand and comply? It’s likely that most patients never question their doctor’s health. But for those few that do, of course it’s important. Of course one is less likely to comply with a hypocritical instruction. Though I hesitate to directly compare the authority or motive of doctors to mothers, my hyper, yellow-toothed doc telling me I shouldn’t drink coffee can be likened to a mother who smokes a pack a day telling her child never to pick up the habit: Somehow, the advice seems less poignant.

To maximize a patient’s chance of compliance, you don’t have to lie. You also don’t have to necessarily ignore the health issues that concern them simply because you aren’t compliant. Instead, to lead by example, simply start taking your own advice. While many patients won’t be acutely aware you’ve made this change, those that pay attention to your general demeanor, and not just what you say, will appreciate the level of sincerity that’s unveiled in the process. Plus, if you believe what you say, and you say what you believe, chances are your health is going to improve right along with your patients.

We’re all in this together. Tell us about your experience confronting a patient’s health issue with which you personally struggle. Did you reveal the truth or try to give advice without including your experience? Why did you choose that path? Share in a comment!

How to Manage Online Doctor Reviews

By Karin Krisher

doctor reviewRemember that patient with the back pain whom you helped set up a supplement regimen last week? She gave you four stars. Remember that patient who came in yesterday to get his ears checked right after your wife called and told you the dog was missing? He’s giving you just two.


Remember that patient who you could have tomorrow, but won’t because they only read the second doctor review? Wait a minute….

Because doctors provide a service that people expect to be comforting and effective, the average person will ask their coworkers or neighbors for a recommendation before choosing a practitioner. In a virtual environment, any information is up for grabs—especially opinion. Reviews of doctors are becoming wildly popular, and you should be prepared for influx or backlash. How?

1. Know the common online doctor review sources. Check them. Often.

Angie’s List (a paid service),,, and are among the top sites for medical practitioner reviews. Health grades focuses on large data groups, but your name (or practice, or hospital) probably has a spot reserved.

2. When you do see yourself on a site, pay attention.

It’s normal to get upset at a bad review. (We’re not saying you’ll get them, but it’s important to be prepared.) But instead of getting upset, make a positive change. Take steps to ensure the patient’s concerns are addressed. Of course, this doesn’t mean that you should change everything based on one patient’s assessment, only that if you see a trend, you adjust accordingly. If ten patients hated your waiting period, it might be time to adjust your hours so you have enough wiggle room to ensure you see people in a timely manner.

3. Prevention is key.

You want good reviews. If you trust a longtime patient, let them in on the virtual review secret. Chances are, they’ll take the lead and give you a great review.

If you’re not comfortable with that idea, simply talk to them about what you can do to improve your services. Take the good advice. It’s important to listen to your patients from the beginning, so bad reviews are few and far between. Remember—the Internet is a constantly evolving archive. While you do have the ability to change your ratings through actual improvement, you also don’t have the ability to take back what one ornery patient wrote. Don’t let that happen—give good service all the time.

4. Field questions.

If a patient brings up a bad review with you (this assuming he or she chose to ignore it enough to make it to your office) ensure him or her that you’re taking steps to improve that aspect of your practice. Then follow through. If a patient asks for the reason for the complaint, it’s ok to admit a fault of your own. It’s also OK not to. People can generally sense sincerity.

5. There are things you shouldn’t do.

Unless the circumstances are dire (e.g. someone insists you used a rusty tool during surgery—and it’s a lie) don’t subpoena the names of your bad reviewers, stop providing services to people whom you know have given you a poor review, or make your patients sign contracts that say they won’t submit a bad review. It’s tempting to cover yourself, but it’s also unfair.

Opinion-based speech is still speech, regardless of platform. You would not ask your patients to sign a contract that says they will never tell a friend about the quality of your appointments—the Internet is now a space where the same type of interaction occurs. The only real difference is proximity. Further, suing or blacklisting implies you have something to hide—and that, surely, will end up in a review somewhere.

Have you had experience with patients submitting to doctor review sites? What were your results?

Talk to Your Patients About Allergies: The Follow-up

By Karin Krisher

After detailing the big concepts of allergy conversations, we were sure we had painted a reasonably complete picture.

But then this article about children’s allergies arrived in our inboxes, and we thought we had better take a moment to share that there are even more obvious allergy dangers to discuss with your patients.

One warning is so important, it earned itself an entire blog post.

Remember reading this?  “Begin with the idea that allergies are malleable. They change. That doesn’t mean your patients should ignore signs of allergic reaction—only that they should understand that allergies can develop and conversely disappear through changes in time and environment.” I wrote it, I meant it, and I still do.

However, information that came to light in the highlighted study tells me that there needs to be a caveat to this conversation: The fact that allergies can fade and develop does not give your patients the green light to experiment at will—especially with children. The study found that a significant percentage of children’s allergies are caused by intentional ingestion of the known allergen. Whether these are provided to the children in the name of experimentation or harm in each case is not clear, but researchers suspect the former.

Tell your patients not to allergy test at home. If a child has a known allergy and hasn’t been introduced to the allergen since the previous reaction, despite any length of time passed, to reintroduce the allergen is to ignore medical advice at your patients’ peril.

Tell your patients to just see an allergist, or to come to you (if allergy testing is available at your office) and avoid taking unnecessary risks. No peanut should be tempting enough to put a child in a potentially harmful situation.

That said, your patients shouldn’t be forever terrified of the allergen. The best advice, again, is simple. Get professionally tested. Have the children tested. Don’t spend life on either end of the allergy spectrum—hypochondriatic or thrill seeking. Share this information with your patients, so that their next reaction can be their last, and so that children in this position may remain both safe and informed.

Have you ever cared for a patient who had intentionally induced his or her own or children’s allergies? What advice did you give them for the future? Tell us in a comment!

Doctor/Patient Relationships: Who is Responsible

By Karin Krisher

This blog post around, a strong opinion is just what the doctor ordered. The idea of the doctor ordering anything is the topic behind my not-so-subtle opinion. General perceptions/interpretations of a well-written article about doctor/patient relationships– and the conversation surrounding it– have me steamed. And here’s why:

It’s easy to point out the obvious, which is that doctors can act in an authoritarian rather than an authoritative manner that doesn’t allow their patients to feel comfortable having an honest conversation. Of course, this statement is general—and neither the fact of this possibility nor the ease of pointing it out is my criticism of the article.  In fact, the article itself does a lot in the way of exploration.

Here’s my real problem. The article lends itself to a misinterpretation that renders the resulting conversation moot. Most commenters make some sort of sweeping statement about how they agree that the whole system of doctorhood should change. Some make suggestions about what current practitioners can do to ease their patients into conversation.

Teaching the Doctor/Patient Relationship

But few comments, if any, suggest what they as patients can do—and even fewer make statements about how our educational system can make this change before seeking out medical advice on one’s own is even a concern.

My mind immediately flashed to my high school health class, which sufficiently outlined the dangers of drug use and unprotected sex. Completely absent, though, was any mention of general healthcare and the overwhelming responsibility of taking it into one’s own hands.

How? Isn’t learning to communicate with healthcare professionals and solidifying the doctor/patient relationship part of continuing health? Isn’t that facet of health as, if not more, important than an oft-repeated and wildly authoritarian summary of normal teenage risks?

What if the discussion of health as a continuing process became a standard of public education?  Similarly, what if communication classes and a basis in psychology became a standard for medical education programs? Judging from the comments of an educated population on such a well-researched article, this concept really has been so long ignored that we now have only one option: give authority to those that we are saying have too much of authoritarian attitude to fix something broken.

The sheer scope of suggestions about how to fix the system clearly tells us that creating something functional in the first place isn’t on the public’s radar. But it’s in my nature to trace something to its roots, and mine run deep in a public education system that grossly ignores the power of learning how to communicate effectively.

Educating students about communication strategies in public school health classes should not simply be relegated to a one hour session about how important it is to say no to peer pressure. Educating medical students about communication strategies shouldn’t be relegated to a few weak examples of how one will feel the first time they must give an unfortunate diagnosis. We need to dig deeper.

What about teaching the value of general openness and how to achieve it? What about placing that responsibility on both ends, giving both the question asker and the responder the power to effect an open relationship? Currently, we’re stuck asking for less authority and at the same time demanding more. And I use the word stuck for a reason.

Let’s move forward, together. If you are someone who has the power to discuss health education in any sort of forum, do so. And tell us about your efforts in a comment.

Talk to Your Patients About Virtual Care

By Karin Krisher

virtual care











Maybe virtual care isn’t a topic you approach often.

Maybe that’s because of your own thoughts on the doctor/patient relationship, or maybe it’s because you feel your patients won’t be receptive. Whatever the reason, virtual diagnoses and treatments are an up-and-coming phenomena of which you, and your patients, should be aware.

Many insurance companies, including Aetna and Cigna, have made the leap to cover telemedicine. Many patients are searching for an economically sound solution for their health care issues. Many doctors are responding by taking their practices to the web. What can you do?

Simply discussing the possibility of virtual care with your patients will give you a better gauge for telemedicine’s potential.

It may seem counterintuitive at first—after all, isn’t the point of working in a practice that it allows you to develop a relationship with your patients that gives you better, personal knowledge to respond to their medical needs?

But in a changing global communication environment, that relationship can be developed over a vast space. Proximity shouldn’t dictate our ability to give and receive information. Further, doctors enjoy the ability to open up their schedules for appointments that require face-to-face examinations, and patients get the same freedom. The cost is also less for both parties.

Writes Phil Galewitz of Kaiser Health News, “One major obstacle has remained, however: Many state medical boards make it difficult for doctors to practice telemedicine, especially interstate care, by requiring a prior doctor-patient relationship, sometimes involving a prior medical exam.”

This stipulation could be reassuring to your patients, though, and isn’t necessarily a negative concept to hold onto for a moment as we ease our way into this new era of medicine. After we become comfortable with the idea, and telemedicine is a more widespread practice, this stipulation will likely fall to the wayside, giving way to a world in which your patients can choose their care from a wider range of practitioners, and you can expand your clientele to include more patients concerned with your specialty.

Whatever your feeling on the changing medical communication landscape, your patients should know that the option exists. Ask them for their opinion and their concerns to further your understanding of patient desires, and share your opinion and concerns with us– in a comment!

Understanding Depression: Talk to Your Patients About New Information

By Karin Krisher

understanding depression

We know—the conversation about understanding depression is overdone—now.

But 20 years ago, depression was still relatively under the radar, and it took humble admissions from several prominent figures (most notably, Tipper Gore) for American society to recognize and generally accept that depression concerns a chemical imbalance, rather than a lifestyle choice.

Today, there persists a strong dichotomy in the treatment process: depressed people can either A) attempt to correct their chemical imbalance with prescription drugs, or B) change their lifestyle via therapy and personal effort, and wait for mood changes to come about naturally, depending on chosen environment.

But what if neither of these proposed solutions are actually solutions at all? What if depression is a fact about someone’s physical makeup, like blue eyes or big hands, and an attempt to “correct” it is doomed from the start? A newly published study suggested that might be the case.

depression pills

Understanding Depression in Chemical Terms

The study showed that those with higher releases of dopamine in the striatum and ventromedial prefrontal cortex are more willing to work hard for rewards. In other words, a dopamine flood to the areas of the brain that play roles in motivation and reward will motivate those people, regardless of the reward.

“On the other hand, those who were less willing to work hard for a reward had high dopamine levels in another area of the brain that plays a role in emotion and risk perception, the anterior insula.” (Janice Wood, PsychCentral) That lack of motivation persisted even when the participants had knowledge that the resulting reward would be less.

Though the study explicitly refers to motivation as it relates to effort, its implications for mental health are staggering. For so many years, we’ve been “treating” depression, anxiety, schizophrenia and ADD/ADHD as if dopamine was a transmitter whose powers could be harnessed and regulated. Now, the truth is becoming clear: Location, location, location.

If one’s brain were hardwired to release dopamine to certain areas, redirecting it would be a massive task that employed the powers of geneticists, neurologists and psychologists alike—perhaps so massive that we should reconsider the very fact of any effort to “correct” chemical imbalances, and change the way we talk about depression.

depression brain

Motivation is a huge factor in depression. If a person truly desires a reward, they’ll take the necessary initiative. In a world chock full of over-achievers, if a person isn’t willing to work hard because he or she doesn’t actually want the reward that badly, s/he is often faulted in a way, and relegated to a diagnosis of depression.

Or, taking it one step further, the reward the person wants might be different, as the release is in the area of the brain associated with emotion and risk. Perhaps (and this is speculative, but seems intuitive) s/he would be more motivated to take a large emotional risk for an emotional, rather than monetary, reward. But does that make that person, who the rest of society might label “unmotivated,” clinically depressed?

Talk About It

Talking to your patients about depression can be tough. Certainly, you don’t want to negate the reality of its existence. Certainly, what they feel is very real, and in this fast paced, whole-lot-of-work-for-little-reward world, stifling. Certainly, support is needed for that person to function happily amongst those who are in the striatum camp.

But what kind of support is the issue. Maybe we should focus on making the things we can’t change work for us, instead of trying, often without result, to change them. With that thought in mind, talk to your patients about depression and anxiety. It’s a reality that negatively impacts one in ten American adults—and now, we are learning, one that might never change.

That doesn’t mean there is no hope for overall happiness—only that hope needs a new direction.

Tell us about your experiences with understanding depression. Will this new information change how you view that conversation? In what ways?

Talk to Your Patients About Pet Health

By Karin Krisher

cat and human healthVeterinarians and doctors have a few things in common.  The most obvious, of course, is that both are helpers. One group focuses on pet health, one focuses on human health. Both vaccinate, (generally) know how to check vitals, carry stethoscopes, and don’t get the heebie-jeebies when blood shows up unexpectedly (or expectedly).

But for all the things they have in common, veterinarians and doctors remain fundamentally separate in one aspect: their patients. Your human patients seem worlds away from their animal counterparts, especially because your office might be a pet-free environment where your patients can remain comfortably compartmentalized into a separate medicinal realm. They might stay there, too, until they have a health issue directly associated with an animal, like an allergy to their new puppy or a serious kitten scratch.

But the truth is, the health of the human species is unquestionably related to the animal species with whom we choose to spend our time. That’s why DaVinci carries a line of pet health support supplements designed to support total health in cats and dogs. We know that the relationship between two species is incredibly important, and that discussing healthy options for supplementation for pets can go a long way, for several reasons.

Discussing pet health with one of your patients shouldn’t be difficult, and you definitely won’t be barking up the wrong tree. (People love their pets!) Begin humbly, conceding that their veterinarian might have already discussed with them the subject of animal/human relationships and health. Then share with them some of the reasons for your concern.

pet health

Not only can certain illnesses be transmitted from pet to owner, but attitudes can be transmitted from owner to pet, and similarly, when one of the two is stressed (or unhealthy), the other will most likely be under the weather as well.

First, we can catch illnesses from our pets, either through an infected scratch, a fungal spread from mere petting, or through getting some nasty litter box dirt underneath our nails. But the less obvious health benefits of having a pet should be your true focus throughout the conversation. From improving human cognition to lowering human stroke risk, pets have proven their far-reaching beneficial effects again and again. In fact, National Public Radio recently reported that recently, “studies have been focusing on the fact that interacting with animals can increase people’s level of the hormone oxytocin.”

The conversation about these benefits doesn’t arise because you want your patient to run out and buy a dog, but because if he or she already owns one, s/he may not realize just how much pet health affects his or her own health, either positively or negatively. And s/he probably also doesn’t realize that there are tools to support the positive effects.

For example, when a cat is stressed out, he might get aggressive or participate in excessive urine marking, consequently causing his owner stress, which we all know can be detrimental to health. Cats get stressed out for a variety of reasons, from sickness to minor environmental irritations. Supporting their total health with multivitamins or a calming complex is a great way for patients to come to understand feline health needs while meeting their own.

Final thoughts on pet health

pet health and runningBringing the topic of pet health to light for your patients will show them that you’re truly paying attention to all aspects of their health and what affects it on a day-to- day basis. Offering them healthy alternatives, like DaVinci pet supplements, will not only show that you care, but it will also make their lives more simple, as your office will have become a one stop shop, so to speak, for health.

Check out our line of supplements to support pet health at And remember, a healthy, happy pet means a healthy, happy patient.