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Published Nov. 3, 2017 Integrative

The American work culture has recently come under scrutiny for the notorious long hours expected of employees, leaving them little or no time for a proper work/life balance. My practice is rife with millenials who come after work seeking relief of all manner of stress related tensions in body/mind/spirit, only to put on their shoes and run back to the office for more.

Overworked Americans, written by ABC editor Dean Schabner, are a new phenomenon born of a confluence of socio-economic factors. The slumping economy gave rise to an ever-increasing number of companies downsizing their workforce. The remaining workforce was faced with workloads that were previously handled by two or three employees. The expectations of performance and accomplishments remained the same.

With job scarcity came job insecurity, and workers shouldered the brunt to keep their jobs. According to Schabner, “Not only are Americans working longer hours than any time since statistics have been kept, but now they are also working longer than anyone else in the industrialized world.”

A contributing factor is the human need to please the boss that some people possess. They work overtime to prove their worth in hopes that they will be rewarded with job security, more money, or promotions. Overachievers are at high risk for burnout, and yet this attitude fuels them.

Historically, this attitude seems to hold water. A boss of a very large business empire and former New York City Mayor, Michael Bloomberg, certainly thinks it is true. In a November 2011 article published in TechCrunch, Bloomberg boldly states, “ Make sure you are the first one in there every day and the last one to leave.”

Overwork leads to burnout, and burnout leads to acute, fatal, and chronic diseases. Schabner implicates road rage and workplace shootings as potential outcomes.

The New York Times article, Death Draws Attention to Wall Street’s Grueling Pace, chronicles the ascent of young hopefuls in the finance business to their leaps to death under the pressure of inhumanly long hours, lack of sleep, and pressure to perform constantly without a break.

America is not the only place where the culture of overwork has turned deadly. On October 4, 2017, Miwa Sado, a 31-year-old national broadcaster in Japan, was reported to have died of heart failure after after clocking nearly 160 hours of overtime in a month.

“Karoshi,” meaning death by overwork in Japanese, is the grim reaper of the reality of a culture that aggrandizes work over life. We, as healthcare practitioners, will see patients who are suffering from karoshi, in the slow death of chronic diseases, in the mental torture of anxiety and depression, and in the Burnout Syndrome faces of autoimmune diseases, family, and work-life disruptions.

Indeed, we may have the makings of karoshi in our own lives as we own, manage, or work in the high stress occupations of healthcare and juggle a family life as well. Dike Drummond, MD, an expert on burnout in the workplace, says on his blog that burnout is more common among physicians than among other U.S. workers. Physicians in specialties at the frontline of care, in emergency departments and in critical care, are at the greatest risks.

This is true for nurses as well. Shame and blame often prevent both of these practitioner classes from reporting burnout or from seeking help. There is a stigma attached to their perceived inability to be able to handle the pressures of their job, and the threat of losing their job if they were deemed incompetent to carry out their duties.

According to Fiercehealth, burnout syndrome and stress can be linked to a number of factors in the workplace, including a hectic environment and the workload tied to electronic health records and other administrative duties that take them away from direct patient care.

I interviewed many nurses for my presentation on Burnout Syndrome for the upcoming Integrative Healthcare Symposium, in New York City on February 22-24, 2018, and they consistently told me that the biggest factor in Burnout Syndrome for them is the nurse-patient ratio of 4:1. Both nurses and doctors tell me that they suffer from being unable to care for their patients due to the paperwork and administrative overload. They tell me that this is due to the hospital administration honoring profit over practitioners and, ultimately, patient care.

Karoshi, death by overwork, can be stopped, if not by administrative changes, then by legislative changess. Nurse nationwide are lobbying for the 2:1 patient ratios that will allow them to work smarter, give the tender loving care for which they went into this profession, and to be able to return home at the end of the day with job satisfaction and some energy left for the family.

Anti-karoshi–type legislation, such as The Fair Labor Standards Act, was signed into law by President Franklin D. Roosevelt in 1938. It established a minimum wage, outlawed child labor, and defined the regular work week of 40 hours to protect workers from intolerable workdays and starvation wages, prevent the health and safety risks associated with long hours, and encourage employers to hire more people to decrease unemployment. Effective legislation to follow up on this is needed now—legislation that compels employers to find the ways to reduce the hours spent by physicians and nurses on administrative tasks, to hire more employees to satisfy normal patient ratios, reduce overtime, and introduce penalties for non-compliance.

On behalf of our patients, it behooves us all to make a fair assessment of the aspect of suffering from overwork when a patient presents. A brief questionnaire about work-life balance may yield valuable information to follow up on. I use The Maslach Burnout Inventory, considered to be the Gold standard in the industry. There is a self-test version available as well. It is wise to understand that the same element of shame and blame that doctors and nurses feel is applicable to the overachiever, too. With the proper amount of compassion and finesse, I have found that one can reorient a patient to a perspective that is educational as to their complaints and offers creative options to stay healthy in work life and in family/relationship life.

The simplest strategies that one can immediately begin to utilize are found in Mindfulness Meditation. An uptick in popularity that I attribute to the plethora of studies emanating from universities like Stanford University and Harvard Unviersity, have brought the practice of mindfulness to the mainstream. The stigma of meditation as “woo-woo” medicine has been alleviated and patient compliance improved with the use of apps and spa studios that offer a variety of ways to practice.

As integrative practitioners, practicing loving kindness and mindfulness for ourselves and others, we may be able to shift the paradigm of karoshi to “wabi-sabi,” a world view recognized by the Japanese centered on acceptance of imperfection, impermanence, and incompleteness. From which point, hope springs eternal. Newly re-formatted cultural values emerge when stagnation causes degradation of life force and spirit. When one values these as assets in a culture that contributes to a viable and productive whole, when leadership is able to view the imperfection and incompleteness of the status quo, then the society is capable of transformation. Nowhere is impermanence more clearly understood than in the healthcare professions.

Death by overwork can be eradicated at this level in the hierarchy with a little soul-searching and a lot of best interest at heart.

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