Gastric Cancer: Сlinical Implementation of Artificial Intelligence, Synergeti...
Physician burnout
1. Consider each dimension in turn, write down the amount of
attention you’re currently devoting to that area of your life.
Family /
Friends
Home / physical
environment
Partner / Love
/ Relationship
Health /
Fitness
Learning /
Education
Work / Career
Money /
Finance
Fun / Travel /
Spirituality
0
2
4
6
8
10
2
2 2
4
4 4
66
6
8
8
8
1010
10
4. Objectives
1. Understand why burnout occurs
2. Examine the consequences of burnout
3. Differentiate burnout from depression
4. Recognise burnout in a colleague
5. Formulate strategies to prevent burnout
15. Alternatives
• “A state of fatigue or frustration brought
about by devotion to a cause, way of life, or
relationship that failed to produce the
expected reward.”
• “An erosion of the soul caused by a
deterioration of one’s values, dignity, spirit
and will.”
18. 1. Practice of clinical medicine
2. Your specific job
3. Having a life
4. Conditioning or brainwashing
19. 1. Practice of clinical medicine
2. Your specific job
3. Having a life
4. Conditioning or brainwashing
20. 1. Practice of clinical medicine
2. Your specific job
3. Having a life
4. Conditioning or brainwashing
21. 1. Practice of clinical medicine
2. Your specific job
3. Having a life
4. Conditioning or brainwashing
POSITIVE
VALUE
NEGATIVE
POTENTIAL
BURNOUT FACTOR
Service Deprivation
of self
Emotional
exhaustion
Excellence Invincibility Personal
accomplishment
Curative
competence
Omnipotence Personal
accomplishment
Compassion Emotional
isolation
Depersonalization
22. • Imagine a respected member of staff walks up
to you and says: “You look really tired. Is
everything okay?”
25. Implications
• Medical error
• Reduced career satisfaction
• Reduced career longevity
• Physical and mental illness
• Substance abuse
26.
27. Is this depression?
• Significant overlap
• Most problems are job-related
– Negative thoughts and feelings about work.
• Depression
– Low self-esteem
– Hopelessness
– Suicidal tendencies
29. Break
1. What are the things you care about in your
personal life?
– What does it look like for you to live in a way that
demonstrates those are the things you care
about?
2. What are the things you care about in your
professional life?
– How are you devoting and spending your time to
align with those things?
30. Consider each dimension in turn, what would the ideal level of
attention be for you in each life area?
Family /
Friends
Home / physical
environment
Partner / Love
/ Relationship
Health /
Fitness
Learning /
Education
Work / Career
Money /
Finance
Fun / Travel /
Spirituality
0
2
4
6
8
10
2
2 2
4
4 4
66
6
8
8
8
1010
10
36. STOP
THINK WHY
INITIATE
Are you suffering from burnout?
• Emotional exhaustion
• Depersonalization
• Sense of underachievement
Personal
• Stress Mx
• Vulnerable
traits
Work-life
balance
• Goals
• Optimise
meaning
• Resilience
• Wellness
Organisation
• Workload
• Control
• Injustice
Medical bodies
& organisations
• Staffing
• Support/help
/guidance
• Fair policy
and practice
Patient
• Expectations
• Deterioration
• Aggression
Patients’
understanding
• Realistic
expectations
37. Objectives
1. Understand why burnout occurs
2. Examine the consequences of burnout
3. Differentiate burnout from depression
4. Recognise burnout in a colleague
5. Formulate strategies to prevent or overcome
burnout
What led me to present “burnout” as a topic for hospital grand round?
I began internship in Hereford in 2012; fortune of starting in Anaesthetics & ICU
First job, steep learning curve
Surrounded by highly motivated, friendly, impressively knowledgeable staff
http://blogs.bmj.com/bmj/2017/12/14/kate-harding-i-have-lost-my-husband-could-not-be-more-accurate-it-feels-like-a-carelessness/
What is burnout? Where did the term burnout come from?
JFK ignited a vision of public service. LBJ launched “the war on poverty” – large influx of idealistically motivated young people into human service professions
- struggled to combat poverty for a decade, became increasingly disillusioned.
- systemic factors perpetuated a problem and nullified and frustrated their efforts.
First used as an informal, everyday term
1970s USA – Dr Herbert M Freudenberger borrowed it from ilicit drug scene – coloquially referred to devastating effects of chronic drug abuse
- applied it to describe gradual emotional depletion, loss of motivation and reduced commitment in drug support volunteers
Dr Christina Maslach & colleagues in Cali noticed noted human service workers often became emotionally exhausted, developed negative perceptions and feelings about patients, and experienced crises in professional competence as a result.
Battery = bad metaphor; if a toy runs out of battery, it stops working. When did we ever stop working?! Negative effect on career if we do!
Flame = smothering of a fire or extinguishing of a candle; cannot continue burning without resources being replenished, otherwise smoulders
-> uneventful and inconsequential – they accomplish less.
Bank balance / energy account = positive or negative balance; withdraw for activities of our life and work; deposit energy during times of rest and rebalance
-> negative balance okay for short periods; if prolonged, become a shadow of the doctor you are when in the black.
-> physical energy, emotional energy
-> SPIRITUAL ENERGY – personal sense of purpose; patient interaction; “this is why I became a doctor!”`
“I’m not sure how much longer I can keep going like this.”
Cynicism, sarcasm, the need to vent
Compassion fatigue.
Ignore qualities that make patients unique and engaging people.
Doubt the meaning and quality of your work. Incompetence, inefficiency and inadequacy.
“What’s the use? My work doesn’t really serve a purpose anyway!”
Worry about medical errors.
Beyond Blue: National Mental Health Survey of Doctors and Medical Students. October 2013. 42942 doctors and 6658 medical students: 27% response rate = 12000 doctors + 1800 students.
I don’t really care what happens to some patients
I’ve become more callous towards people since I took this job
I feel patients blame me for some of their problems
I worry that this job is hardening me emotionally
ICD-10 characterises as “a state of vital exhaustion.” But is considered as a form of chronic workplace stress.
No healthy distance from work, individual gives everything
Insidious onset – alienation, impatience, negativism, resenting work and people at work
Hostile feelings and negative attitude towards profession and patients, reduced personal engagement, feelings of guilt, self-pity and helplessness
Depleted energy, shutdown numbness, insulation and loss of care.
WHY DO STAFF BURNOUT? Causes of burnout
Dealing with hurt, sick, scared, dying people, and their families. Transference; burnout rates higher among medics than non-health professionals.
Plethora of emotions; need to rescue a patient, failure and frustration when illness progresses, powerlessness against illness, grief, fear of becoming ill oneself, facing uncertainty.
Workload, on-calls, rostering, hospital politics, fishbowl of the hospital, leave approval, parking permits
Bureaucracy : patient time = 2:1
Ideally personal life is where you “recharge”; problems:
Teaching of life balance skills – training teaches us the opposite; work until you drop, then keep working
To do otherwise could be seen as a sign of weakness
What if problems arise in home life that eliminate the opportunity to recharge
Many doctors are defined by doubt, guilt and an exaggerated sense of personal responsibility; also make us good physicians
- > thorough, committed, leave no stone unturned, what am I missing, how could we be better
- > double-edged sword - > dedication proportional to risk of being consumed by work.
Workaholic – your only response is to work harder
Superhero – every challenge or problem sits on your shoulders and you must come up with the answers
Perfectionist – can’t stand the thought of making a mistake – ever – and hold colleagues to the same standard
Lone-ranger – end up doing everything yourself and micromanaging!
Plus 2 prime directives: the patient comes first, and never show weakness.
How many of us would immediately answer “yeah, fine”? Never show weakness
WHY IS BURNOUT IMPORTANT TO ADDRESS?
Lower patient satisfaction and care quality
Higher medical error rates and malpractice risk
Higher staff turnover
Alcohol/drug abuse and addiction
Physician suicide
One study, 37% of physicians reported looking forward to retirement as an effective wellness strategy – not just those getting loser to retirement!
Attitude of “work now, have a personal life when I retire”
Beyond Blue: National Mental Health Survey of Doctors and Medical Students. October 2013. 42942 doctors and 6658 medical students: 27% response rate = 12000 doctors + 1800 students.
People with burnout don’t always have depression. But burnout may increase the risk of someone getting depression.
Very work-related and situation-specific
Depression is more general and context-free.
May exist on a spectrum from compassion fatigue, to burnout, to depression.
1. What are the things you care about in your personal life?
2. What does it look like for you to live in a way that demonstrates those are the things you care about?
What are the things you care about in your professional life?
How are you devoting and spending your times to align with those things?
Things on the two list are very likely to be incompatible.
Need to integrate these things / compromise.
Busy schedules, higher productivity expectations, more documentation – less interaction with each other
Mayo clinic study:
- time allocated for catching up on admin or leaving work earlier - > return to baseline burnout.
- group meetings with a curriculum around sharing experiences/challenges and virtues of being a physician -> more lasting improvement in burnout and increased sense of purpose.
Mayo clinic added paying for groups of colleagues to go for fortnightly restaurant dinners; 1000/3000 signed up! Provided with topics:
1. Think about one of your most satisfying days at work over the last month. What made this day so professionally satisfying? Share with your colleagues.
2. Brainstorm ways to promote collegiality in your hallway or work unit.
3. Choose one stressor that you can control, come up with two concrete ways you can reduce it, and commit to trying one approach within the next week.
Resilience is defined as the ability to bounce back or recover from stress
Personal: Optimism, flexibility, tolerance, organisation, compartmentalise, self-worth; sleep diet & exercise.
Regular rest. Nutritious meals. Spend time with family. Engage in broad interests. Socialise with non-medical friends. Manage stress. Regular exercise.
Mindfullness and meditation?
Engage in professional development
Focus on teamwork and collegial attitude
Value the doctor-patient relationship
Find a mentor
Debrief regularly
