MD, MBA, FRCPC, CPDC, MOT
Disclosure of Conflict of Interest
Conflicts to Declare:
• No affiliation with a pharmaceutical,
medical device or communications
• President and CEO – PEAK MD
• Understand why we are vulnerable to
stress in medicine
• Recognize the early warning signs of
• Define burnout
• Identify strategies to manage stress and
Knowing what we should be doing
means that we are doing it.
COMMON PERSONALITY TRAITS
Sense of Responsibility and Guilt
Need to control others
Chronic self doubts
Uncomfortable with love, approval
Ability to delay gratification
THIS IS SOCIALLY VALUABLE
PERSONALLY VERY EXPENSIVE.
ISSUES ARISING FROM PAST
Establish sense of self as children
Believe three main assumptions
Develop “Personal Historian”
Perception: We are not good enough.
We do not measure up.
IN ALL OF THIS,
THE PERSONAL NEEDS OF THE
PHYSICIAN ARE LAST, AND
FIVE EARLY DANGER SIGNS
• Increase in physical problems and
• More problems with relationships.
• Increase in negative thoughts and
• Significant increase in bad habits.
A syndrome of emotional exhaustion, chronic
-Distinct work-related syndrome – demands exceed
-Not a psychiatric diagnosis
-Most likely to occur in jobs that require extensive
care of others
-Common among practicing physicians
Three Stages (Maslach Burnout Inventory):
• Emotional Exhaustion
• Reduced Personal Accomplishment
Review of Burnout Studies
• Emotional exhaustion = 46-80%
• Depersonalization = 22-93%
• Low Personal Satisfaction = 16-79%
Starts early in our training
• Burnout prevalent during medical school
• Major US multi-institutional studies estimate
at least half of all medical students may be
affected by burnout
• Persists beyond medical school – between
20-60% of practicing physicians
• Highest prevalence reported in residents (4076%)
• Demands of the workplace exceed individual
resources – way of life for many physicians
• 2001 CMA PRQ:
64% have workload too heavy
58% felt family and personal life suffered
57% felt patients’ expectations too high
29% felt on call too often
33% felt lack of locums and could not take holidays
64% felt difficulty getting referrals for patients,
46% felt limited in changing specialty/career path
Possible Risk Factors
• High Workload - demands exceed resources
• Age - inverse relation between age and
burnout. ? Survivor bias.
• Spousal support – inverse relation between
emotional exhaustion and support from
• Personality traits
Impaired job performance and
Changing jobs, reducing work hours
Difficulty with Relationships – home
Psychiatric Illnesses – Anxiety,
Even the healthiest and strongest of
us can become unhealthy
in an unhealthy environment.
• General Strategy
• Specific Strategies
– Work related
• The number one cause of stress
leading to burnout:
THE PERCEPTION THAT WE HAVE
NO CHOICE, NO CONTROL.
• The number one skill in dealing with stress:
CHALLENGE YOUR PERCEPTION.
STEPS IN MANAGING STRESS
• Identify the stressor
• Recognize that you have more control than
you think you do
• Identify what parts you do, and do not,
• Focus on what you do control, and learn to
cope with what you do not control
Recognize that you have choices
Focus on what you can control.
Set priorities - self, family, work.
Accept that you will not be perfect.
“Good enough is good enough.”
• Phases – A Work in Progress
The Five Balls
The Work Ball
The Home and Family Ball
The Relationships Ball
The Friends Ball
The Self Care Ball
Take Away Messages
• The very traits that help us succeed can
make us vulnerable to stress and burnout
• None of us are immune
• We can look for warning signs of stress in
ourselves and our colleagues
• Prevention is key. Take care of yourself first
• There are things we can do to be resilient;
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