Burnout in Physicians

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Burnout in Physicians

• Hakan YAMAN, MD, MS

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• Dr. Hakan YAMAN is Assistant Professor in Sports
  Medicine at Süleyman Demirel University, Medical
  School, Isparta,Turkey.
• He has finished a residency in Family medicine
  and has a master of science degree in sports
  sciences.
• Since his residency he is involved in the study
  of burnout of health professionals.
• He has published and presented several papers on
  burnout in physicians working in Turkey.

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Learning Objectives

• To understand the concept of burnout
• To describe sources of stress
• To determine coping behavior
• To understand possible interventions

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Performance Objectives

• Understand the importance of burnout in
  physicians
• Be aware of symptoms of burnout
• Be able to determine sources of stress
• Be aware of intervention approaches

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Introduction

• Practice of medicine is stressful
• Physicians must interact with intense emotional
  aspects of life
• Physicians are called on to cope and adapt with
  stress charecteristic of their job

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Introduction-2

• Burnout in physicians has many important
  implications for -persons experiencing it.
  -recipients of health care.
• Knowledge on how stress and burnout develops is
  important.
• This understanding will help how to prevent
  burnout.

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The Concept of Burnout

• Burnout is a reaction to chronic, job-related
  stress.
• A literal collapse of the human spirit (Storlie
  1979).
• The loss of concern for the people with whom one
  is working(Maslach 1976).
• psychological withdrawal from work in response
  to excessive stress and dissatisfaction
  (Cherniss 1980).

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The Concept of Burnout-2

• Degrees of burnout
• - first degree failure to keep up and gradual
  loss of reality
• -second degree accelerated physical and
  emotional deterioration
• -third degree major physical and psychological
  breakdown

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The Concept of Burnout-3

• Five stages of disillusionment
• - enthusiasm
• -stagnation
• -frustration
• -apathy
• -intervention

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The Concept of Burnout-4

• Three stage transactional model of burnout
• -Stage 1 demands exceeding emotional resources
• -Stage 2 attempts to balance between demands and
  resources
• -Stage 3 maladaptive coping mechanisms develop

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Three stage transactional model of burnoutStage
3-Burnout

• Maladaptive coping mechanisms
• Responses
• Physical Emotional

• Adaptive coping mechanisms
• balance restored
• responses resolved

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Sources of Stress

• House officers syndrome
• - long training hours
• - excessive work loads
• - sleep deprivation
• - changing work conditions
• - peer competition
• - self denial

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Sources of Stress-2

• Senior Physician find new stresses waiting for
  them
• - work faster and longer hours
• - mountains of paper work and threat of
  malpractice suits
• - economic security prove elusive

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Sources of Stress-3

• - difficulties to keep up to date
• - challenge to explain and defend work
• - daily confrontation with sickness and death

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Coping behavior

• working harder and longer
• sense of entitlement
• belief on immunity to difficulties
• failure of self recognition of mental problems

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Coping behavior-2

• alienating family members and friends- three
  explanations
• - anger and frustration are vented to family and
  friends
• - unability to share troublesome experiences
• -family and friends are another source of demand

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Coping behavior-3

• Avoiding to be with family
• - Physician Dawdler
• - Electronic Physician
• - Out-of-town Academician

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Intervention

• Initiation of programs to alert physicians to
  stresses
• Re-evaluation and restructuring medical training
• Offering programs and conferences dealing with
  burnout

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Intervention-2

• Learning of new adaptive coping mechanisms
• - self-assesment and determination of stressors
• - specification of life priorities
• - sharing and expressing feelings

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Intervention-3

• Aleviating stres at work
• - focusing on positive aspects and small success
• - setting daily and weekly goals
• - breaks and variation in daily schedule
• - utilizing a team approach

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Conclusion

• Burnout among physician is a serious problem,
  with a risk for suicide.
• Programs and conferences are needed to alert
  physician against burnout.
• Medical training should be re-evaluated and
  restructured to prevent burnout.
• Physicians suffering of burnout need to learn new
  adaptive coping mechanisms.

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References

• 1. Deckard GJ, Hicks LL, Hamory BH. The
  occurrence and distribution of burnout among
  infectious disease physicians. JID1992165224-8.
• 2. Schneider J. Self-care Challenges and rewards
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• 3. Fawzy FI, Fawzy NW, Pasnau RO. Burnout in
  health professions. In Judd, Burrows, Lipsid,
  eds. Handbook on general hospital psychiatry.
  1991.p.119-130.
• 4. Storlie FJ. Burnout The elaboration of a
  concept. Am J Nurs. 1979122108-2111.
• 5. Maslach C. Burned-out. Hum Behav 1976516-22.

• 6. Cherniss C. Staff burnoutJob stress in the
  human services. Beverly Hills SagePubl.1980.
• 7. Simendinger EA, Moore TF. Organizational
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  prevention and change. RockvilleAspen Syst
  Co.1985.
• 8. Edelwich J,BrodskyA. Burned-outStages of
  disillusion ment in the helping profession.
  NewYork Human Sciences Press.1980.
• 9. Small G. House officer stress
  syndrome.Psychsomatics 1981 22 860-864.
• 10. Martin CA, Julian RA. Causes of stress and
  burnout in physicians caring for the chronically
  ill. Hospice j 19873121-147.