A primer for burnout, residency, psychiatry. My presentation at the european federation of psychiatry residents. European Federation of Psychiatry Trainees (EFPT, organized a summer school for the young residents in psychiatry in Istanbul. I was one of the speakers who had the chance to address the European members of the young generation of our profession. My talk focused on emotional reslience in the face of increasing burn out in medicine, though psychiatrists are among the least affected. My proposition is that helping other medical colleagues may be one of the ways to deal with the increasing burden physicians will be taking, in an age of decreased autonomy and feelings of loss of status.

1. Emotional Resilience
from Med School to Residency to Retirement
Yanki Yazgan, M.D.
Istanbul
Professor
(ret.) Marmara UF Med, (adj.) Yale Child Study
Center
www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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2. “Oh Anatomy, You are finished, but you
finished me, too”
www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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3. In and at an age of uncertainty
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4. www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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A Neural Basis for Development of
being Oneself: self-control

5. www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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“risk preference”

6. Risk Blindness: a developmental
problem?
www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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7. www.yankiyazgan.com
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Lewinsohn et al., 1999
Mood is most vulnerable

8. Suicide among physicians
• 300-400 suicides in
the US
• (depression, bipolar
disorder, alcohol/
substance)
• No direct
relationship with
work/job stress
• Female physicians
have 250 %
increased risk
relative to non
physician females
(70 % in males)
www.yankiyazgan.com
@yankiyazgancom @YazSganYanki
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9. Take good care of yourself
• “A physician who does not take good care
of her/him-self would not be able to meet
his/her patients’ needs” (Galenos of
Pergamon, (A.D. 130-200)
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@yankiyazgancom @YazganYanki
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10. • US physicians suffer more burnout than
other American workers. [A national
survey, published in the Archives of Internal
Medicine, 2012 ]
• Medscape Physician Lifestyle Report of
2015, 46% of all physicians responded that
they had burnout, (39.9 % in 2013 Lifestyle
Report).
www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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11. Burnout
• loss of enthusiasm for work,
• feelings of cynicism,
• a low sense of personal accomplishment
(may not be directly associated).
www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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12. Simply asking whether:
• "I feel burned out from my work”
• "I have become more callous toward people
since I took this job”
www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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13. By specialty
• the highest burnout rates found in:
• critical care (53%)
• emergency medicine (52%),
• family physicians, internists, and general
surgeons (50%)
– (Medscape Report 2015)(parallelled in Europe 2011,
BMC PH)
www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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14. The least..
• The least burned-out physicians according
to our survey are dermatologists (37%),
psychiatrists (38%), and pathologists (39%)
www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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15. By Gender
• More women
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@yankiyazgancom @YazganYanki
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16. Among the burned out
• Orthopedic (female), plastic and urologic
surgeons in addition to front line and
generalist/PCP branches.
• “Will choose medicine again, but not this
specialty”
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@yankiyazgancom @YazganYanki
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17. MMM, Postmortem
• We have learned our lessons from death and
suffering, and our mistakes and
misunderstandings.
• reinforcing dichotomic thinking styles.
www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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18. Dichotomic thinking
• Rational
• algorithmic
• Logical
www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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19. Medicine is about Practical
Reasoning
• phronesis (practical reasoning) – rather than
episteme (science), or techne(art, craft),
• or some putative amalgam of episteme and
techne – offers a paradigm of clinical
rationality (according to Aristotle as
proposed by Pellegrino and Thomasma,
19919
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@yankiyazgancom @YazganYanki
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20. www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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Requires intelligence and
psychosocial maturity

21. www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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Social and emotional skills are decisive
for both professional performance and
keeping one’s self intact
Skuse 2009

22. Default systems take over
when under pressure
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@yankiyazgancom @YazganYanki
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Yazgan et al, 1995

23. www.yankiyazgan.com
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Not all brains identical

24. Going beyond “default”
necessary
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@yankiyazgancom @YazganYanki
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25. Helping Our Nonpsychiatrist
Colleagues
• In developing their emotional intelligence
skills
• To reduce their burn out and risk of
developing a mental disorder
• May be a way to enhance our own resilience
www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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26. www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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27. www.yankiyazgan.com
@yankiyazgancom @YazganYanki
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“Ey teşrih bittin ama beni de bitirdin..”
M.Seyfettin Yazgan, 1935