3. Condition in which person's capacity to withstand the
perceived demands becomes more than he can cope
up.
Situation where a person feels tense, anxious, nervous,
restless, and has difficulties in sleeping.
EW. The Stress of Life. New York: McGraw-Hill Book Company, 1956
4. Highly skilled professional
Makes quick decisions and perform complex
procedures under pressure
Khetarpal, R., Chatrath, V., Kaur, J., & Verma, A. (2015). Occupational Stress in Anesthesiologists and Coping
Strategies : A Review. International Journal of Scientifi c Study, 3(6), 188–192.
https://doi.org/10.17354/ijss/2015/420
5. Work
Lack of control
Work overload
Professional relationship
Pressure of managerial responsibility
Administrative
Administrative responsibility
conflict between the demands of
work and home/family
Speciality
Poorly understood speciality
Nyssen, A. S., Hansez, I., Baele, P., Lamy, M., & De Keyser, V. (2003). Occupational stress and burnout in anaesthesia. British
Journal of Anaesthesia, 90(3), 333–337. https://doi.org/10.1093/bja/aeg058
Larsson, J., Rosenqvist, U. 2007. Enjoying work or burdened by it? How Anaesthetists experience and handle difficulties at
work: A qualitative study. Br J Anaesth., 99:493-9
7. Long shifts
Consecutive working days without a break
Working on weekends
Working at night
Work strain in acute work hours
Packed workday (clinical round , documentation)
World Health Organization. Burn-out an “occupational phenomenon”: International Classification of Diseases.
https://www. who.int/mental_health/evidence/burn-out/en/. Accessed July 15, 2019.
8. The Yerkes-Dodson law
Performance increases with physiological or
mental arousal (stress) but only up to a point.
When the level of stress becomes too
high, performance decreases.
Yerkes RM, Dodson JD (1908). "The relation of strength of stimulus to rapidity of habit-formation". Journal of Comparative Neurology
and Psychology. 18 (5): 459–482
9. Global condition related to chronic exposure to
professional stress and it is characterized by
emotional exhaustion, low sense of personal
accomplishment and depersonalization.
Sanfilippo, F., Noto, A., Foresta, G., Santonocito, C., Palumbo, G. J., Arcadipane, A., Maybauer, D. M., &
Maybauer, M. O. (2017). Incidence and factors associated with burnout in anesthesiology: A systematic
review. BioMed Research International, 2017. https://doi.org/10.1155/2017/8648925
10. The short answer is
YES
Everyone in every workplace is at risk.
The healthcare environment is especially stressful
because of the nature of the work, the nature of the
clients.
11.
12.
13. Every day is a bad day
Exhausted all the time
You feel that nothing you do is making
difference or is appreciated
14. Too many work hours
Insufficient income
Increased computerization of practice
Feeling like a cog in a wheel
Too many patients
Difficult colleagues
Compassion fatigue (over exposure to death)
Difficult employer
15. Emotional exhausion
Subjective work-related sense of fatigue
High depersonalisation
Defense mechanism in the attempt to separate
oneself from work
Low self accomplishment
Feeling of frustration with work-related
achievements.
S. Devi, “Doctors in distress,” The Lancet, vol. 377, no. 9764, pp. 454-455, 2011
16. Exhaustion you are tired on (Energy, Emotion,
Spirit)
Cynicism lost ability to care, empathize, and
connect with your patients, staff and co-workers.
You may even blame, shame people you are
charged to care for.
Doubt doubt that your work really makes any
difference or question the quality of what you do
17.
18. Almost 50% of French intensive care physicians and 31% of
Portuguese ICU workers reported high levels of burnout
Teixeira C, Ribeiro O, Fonseca AM, Carvalho AS. Burnout in intensive care units: a consideration of the possible prevalence and frequency
of new risk factors: a descriptive correlational multicentre study. BMC Anesthesiol 2013; 13:38.
More than half of a group of Egyptian anaesthesiologists met the
criteria for all burnout components.
Shams T, El-Masry R. Job stress and burnout among Academic Career Anaesthesiologists at an Egyptian University Hospital. Sultan Qaboos
Univ Med J 2013; 13:287–295
19. Phase I
Physician Burnout and stress vary from day to
day and you never become symptomatic (feel
trashed)
20. Phase II a
Physician Burnout Symptoms are only
intermittent and you are feeling fine more
often than not.
22. Phase II c
It has been a long time since you felt at full
strength …
23. Phase III a
Your baseline is chronic symptomatic physician
burnout … you dip occasionally into the
danger zone
24. Phase III b
You are circling the drain here. Something is
going to break very soon.
25. LOWER
Patient satisfaction
Quality of care
HIGHER
Medical errors
Malpractice risk
Physician turnover
Tucker P, Byrne A. The tiring anaesthetist. Anaesthesia. 2014;69:1-13
28. The forces that cause physician burnout never
rest …
Physician burnout management is a practice … a
regular set of habits you were not taught in
medical school or residency …
29. The Three R’s approach
Resist
Restore
Reduce exposure
30. Minimize the drain while you are on the job.
MINDFULNESS
The ability to stay centered and calm, focused
and present no matter what might be going on
around you.
Take a deep breath, allow yourself a full minute
of mental relaxation, positive thoughts and
refocus
33. Sleep, good nutrition and regular exercise are a
great start.
What relationships, activities, hobbies, experiences
build you up
Creating boundaries between work life and your
large life
34. Keep doing what you are doing now … just less
of it.
Change the stressors that lead to physician
burnout (administration and team leader roles)
Less stressful speciality inside or outside
medicine
35. Promote a positive culture and climate
Support
Communication
Interpersonal interaction
Motivation and appreciation
Participation
Ricou B, Merlani P. Burnout in intensive care units. Rev Med Suisse 2012; 8:2400–2402.
36. Reduce time pressure, increase work control
Measure climate in the workplace by questionnaire or
personal communication
Improve organizational justice
Reduce negative perception of injustice
Chenevert D, Jourdain G, Cole N, Banville B. The role of organisational justice, burnout and commitment in the understanding
of absenteeism in the Canadian healthcare sector. J Health Organ Manag 2013; 27:350– 367.
37. Establish an adequate work-life balance
Identify your stressors and think whether or not you
should eliminate some of the things you do
Choose healthy lifestyle choices (nutrition and
physical fitness), take breaks, say sometimes
‘no’, practise self-reflection, release emotions
Harrison J. The ailing anaesthetist. Anaesthesia 2014; 69:9–13
38. Learn and practice resiliency(bounce back)
Try to differentiate self-knowledge (what we believe
to be true about ourselves) and self-awareness
(seeing ourselves as others see us)
Look for excellence not perfection
. Oreskovich M, Anderson J. Physician personalities and burnout. Bull Am Coll Surg 2013; 98:40–42.
39. Burnout is a real world problem
No one is immune
40. Chronic exposure to stressors without adequate
management is associated with burnout, a
syndrome with negative consequences for the
physicians, the patient and the healthcare
system.
Collaborative intervention institutionally and
individually is crucial
41. EW. The Stress of Life. New York: McGraw-Hill Book Company, 1956
Khetarpal, R., Chatrath, V., Kaur, J., & Verma, A. (2015). Occupational Stress in Anesthesiologists and Coping Strategies : A Review. International Journal
of Scientifi c Study, 3(6), 188–192. https://doi.org/10.17354/ijss/2015/420
Nyssen, A. S., Hansez, I., Baele, P., Lamy, M., & De Keyser, V. (2003). Occupational stress and burnout in anaesthesia. British Journal of Anaesthesia,
90(3), 333–337. https://doi.org/10.1093/bja/aeg058
Larsson, J., Rosenqvist, U. 2007. Enjoying work or burdened by it? How Anaesthetists experience and handle difficulties at work: A qualitative study. Br J
Anaesth., 99:493-9
Sanfilippo, F., Noto, A., Foresta, G., Santonocito, C., Palumbo, G. J., Arcadipane, A., Maybauer, D. M., & Maybauer, M. O. (2017). Incidence and factors
associated with burnout in anesthesiology: A systematic review. BioMed Research International, 2017.
S. Devi, “Doctors in distress,” The Lancet, vol. 377, no. 9764, pp. 454-455, 2011
Shams T, El-Masry R. Job stress and burnout among Academic Career Anaesthesiologists at an Egyptian University Hospital. Sultan Qaboos Univ Med J
2013; 13:287–295
. Oreskovich M, Anderson J. Physician personalities and burnout. Bull Am Coll Surg 2013; 98:40–42.
Tucker P, Byrne A. The tiring anaesthetist. Anaesthesia. 2014;69:1-13
Chenevert D, Jourdain G, Cole N, Banville B. The role of organisational justice, burnout and commitment in the understanding of absenteeism in the
Canadian healthcare sector. J Health Organ Manag 2013; 27:350– 367.
Ricou B, Merlani P. Burnout in intensive care units. Rev Med Suisse 2012; 8:2400–2402.
stress amongst anesthesiologists owing to their demand. Pressure at the workplace is unavoidable
Infections and radiation
1 overtime , work planning affected by others , competition , lack of resources, exposure to infection and radiation
2 lack or misdistribution of anesthiologists, need to arrive early , need to do list on time, need for rapid turnover , ch sleep deprivation
3 surgeon , lack of communication , disagreement clinically, lack of clinical autonomy , bad news
4 Time management, decisions in critical sitiuations , legal responsipility
(1 financial conflicts, cost management, malpractice and legal issues
(2 poor social climate, imbalance between family and work
Travers V, Watrelot A, Cuche H. Evaluation of the level of stress and indicators in physicians working in the operating room [in French]. Presse Med 2012; 41:e577–e585
A French investigation reveals high levels of stress in 29.8% of professionals working in the operating theatre
NIGHT WORK night—either physical in-hospital work or answering sleep-disrupting phone
Calls
Strain acute in admission and unstable
Every Single Day you work … there is a withdrawal from this Physical/Emotional/Spiritual Energetic Bank Account. The amount of the withdrawal is different from person to person and day to day.
the belief that a person is unable to express his or her values and achieve his or her goals.
depression is a decreased magnitude of motivation even when the appropriate direction of action is known
Demoralisation there uncertainty
1 lacking the energy to provide the services required
2 A state wherein individuals distance themselves from their work distance response to distress
3 occurs when individuals work with high standards of care and performance, which they are not able to meet.
348 physicians ,,,, Maslach Burnout Inventory (MBI)
73% indicated that their family life were negatively affected by their current job; 86% suffered from sleep deprivation (≤6 hours/day)
65% had back pain
Real world problem Divatia JV. Burnout in the ICU: playing with fire? Indian J Crit Care Med 2014; 18:127–128
0501682080
In Phase three you are falling into the Danger Zone. Your physician burnout is now having major impact your career and your quality of life outside of medicine
3 b you are near to quit medicine or already quitting + consequences
There is no zero state because there is no way to spend even a half day at work without resulting in a withdrawal from your energetic bank account.
In Phase three you are falling into the Danger Zone. Your physician burnout is now having major impact your career and your quality of life outside of medicine
3 b you are near to quit medicine or already quitting + consequences
There is no zero state because there is no way to spend even a half day at work without resulting in a withdrawal from your energetic bank account.
Medical errors due to impaired concentration, vigilance, short-term memory, retention capacity, motor skills and ability to detect significant changes in clinical variables
y prevention and treatment of burnout requires an integrated response from the institution (implementation of proper organizational changes) and the workers
Resist is about building up your self defenses against physician burnout while on the job
Restore is about rebuilding the energy lost while at work
Reduce Exposure is about lowering the stress present in your workplace
Minfulness allow you to control intentions , attentions and awareness
The supervisor’s response will be important because it will influence the employees’ perception of injustice
The role of organizational justice on burnout suggested by this survey should encourage healthcare managers to look for strategies to increase participation of the employees on the decision making process
