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Physician burnout
Burnout is a state of physical, emotional and mental exhaustion caused by prolonged stress and a lack of work-life balance. It is characterized by feelings of exhaustion, depersonalization, and a reduced sense of personal accomplishment. Burnout can lead to medical errors, reduced career satisfaction and longevity, physical and mental illness, and substance abuse. While there is overlap with depression, burnout is primarily caused by job-related stressors rather than personal issues. Strategies to prevent burnout include gaining insight into one's values, addressing feelings of isolation, building resilience through self-care, and reserving time for non-work activities and relationships.
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Physician burnout
- 1. Consider each dimensionin 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
- 2. Physician Burnout Dr FMorris ED Education Registrar
- 4. Objectives 1. Understand whyburnout occurs 2. Examine the consequences of burnout 3. Differentiate burnout from depression 4. Recognise burnout in a colleague 5. Formulate strategies to prevent burnout
- 5.
- 6. “Ask not whatyour country can do for you, but what you can do for your country.”
- 9. What is burnout? 1.Exhaustion 2. Depersonalization 3. Ineffectiveness
- 15. Alternatives • “A stateof 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.”
- 16. Classical stages 1. Over-commitment 2.Beginning exhaustion 3. Increasing exhaustion 4. Feeling burned out
- 17.
- 18. 1. Practice ofclinical medicine 2. Your specific job 3. Having a life 4. Conditioning or brainwashing
- 19. 1. Practice ofclinical medicine 2. Your specific job 3. Having a life 4. Conditioning or brainwashing
- 20. 1. Practice ofclinical medicine 2. Your specific job 3. Having a life 4. Conditioning or brainwashing
- 21. 1. Practice ofclinical 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 arespected member of staff walks up to you and says: “You look really tired. Is everything okay?”
- 24.
- 25. Implications • Medical error •Reduced career satisfaction • Reduced career longevity • Physical and mental illness • Substance abuse
- 27. Is this depression? •Significant overlap • Most problems are job-related – Negative thoughts and feelings about work. • Depression – Low self-esteem – Hopelessness – Suicidal tendencies
- 28.
- 29. Break 1. What arethe 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 dimensionin 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
- 31. Strategies 1. Insight 2. Identifyvalues 3. Address isolation 4. Build resilience 5. Reserve time
- 32. Resilience • Flexibility • Tolerance •Organisation • Compartmentalise • Self-worth • Sleep / exercise / diet • Humour!
- 33. Organisational • PowWow • Rostering •Holidays • Workload • Community / team culture • Mentors and role models
- 34. Organisational • Excellence awards –Recognise the good stuff more! • Departmental social activities
- 36. STOP THINK WHY INITIATE Are yousuffering 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 whyburnout 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
- 38.
Editor's Notes
- #3 What led me to present “burnout” as a topic for hospital grand round?
- #4 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/
- #6 What is burnout? Where did the term burnout come from?
- #7 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.
- #8 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.
- #9 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!”`
- #10 “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.
- #11 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.
- #14 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
- #16 ICD-10 characterises as “a state of vital exhaustion.” But is considered as a form of chronic workplace stress.
- #17 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.
- #18 WHY DO STAFF BURNOUT? Causes of burnout
- #19 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.
- #20 Workload, on-calls, rostering, hospital politics, fishbowl of the hospital, leave approval, parking permits Bureaucracy : patient time = 2:1
- #21 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
- #22 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.
- #23 How many of us would immediately answer “yeah, fine”? Never show weakness
- #25 WHY IS BURNOUT IMPORTANT TO ADDRESS?
- #26 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”
- #27 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.
- #28 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.
- #30 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.
- #32 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.
- #33 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?
- #34 Engage in professional development Focus on teamwork and collegial attitude Value the doctor-patient relationship Find a mentor Debrief regularly