Burnout

1
Burn-out

• When Survival Skills Fail You

2
Food for Thought

• How healthy are physicians/students compared to
  the general population?
• Do we as physicians have a specific obligation to
  avoid getting sick?
• How can you recognize in yourself and others when
  burnout is occurring?
• What is your responsibility to report a physician
  at risk?

3
How healthy are physicians/students compared to
the general population?

• No difference in divorce rates compared to the
  general population.
• Many studies report physicians are older at death
  than the general population.
• Partly contributed to by effect of socio-economic
  status and healthy worker effect
• Suicide rates are not above the national rates
  for males, but the mean age of suicide is younger
• For female physicians the rate is similar to male
  physicians thus being higher than the national
  rate for females.
• Male physician suicides account for 3 of deaths
  female physician suicides account for 6.5 of
  deaths

4
Its a good thing that we are generally healthy
because-

• Despite their knowledge about symptoms that they
  develop it is common for physicians to react in
  ways they would never suggest to others.
• The decision to seek care can be affected by
• fears about what will be discovered and what the
  course of the illness will be
• interacting with the health care system in a very
  different role from what you are used to
• concerns related to the physicians practice
• fear that ones worth will be diminished by other
  physicians
• practical concerns related to income loss, call
  coverage,remaining licensed for example

5
How do medical students do?

• First year
• Am I going to make it?
• Second year
• Do I really want to do this?
• Third year
• Will I ever know enough?
• Fourth year
• Will I ever know enough?

6
First year

• Mastery of large amounts of complex material
• Competitive learning environment
• Recognition that one cant learn it all
• Learning how to study efficiently
• Feeling overwhelmed
• Making new friends
• Not caring for self
• Struggle with spending time on school vs. family
  vs friends vs self

7
Second year

• Commitment to remaining a medical student
• Contracting the disease being discussed in class
• Marathon dealing with massive volume of material
  and comprehensive exams
• Apathy and indifference
• To attend or not to attend class

8
Third year

• Death and hopelessness
• Patients not getting better or dying
• Dealing with other medical personnel (bottom of
  the pile)
• Concern with specialty choice decision making
• Lack of control over time, schedule, life
• Not being treated as a professional by nursing
  personnel
• Development of cynical and jaded attitude in
  treating patients
• Difficulty asking for time off

9
Fourth year

• Dealing with loss
• CaRMS
• Geographic relocation
• Finances
• source Gaensbauer and Mizner, 1980

10
Do we as physicians have an obligation to avoid
getting sick?

• First do no harm
• we can do harm by
• transmission of infectious diseases
• lapses in quality of care related to personal
  unwellness
• physician impairment is defined as the inability
  to practice medicine with reasonable skill and
  safety because of physical or mental illness.
• There is evidence that physicians personal health
  habits may strongly affect their clinical
  practice, those who engage in healthy personal
  habits are more likely to report counseling their
  patients on those issues.

11
How can you recognize in yourself and others
when burnout is occurring?

• Burnout
• resulting from prolonged chronic stress, usually
  paired with high expectations and emotionally
  taxing work
• cumulative process that occurs over time
  resulting in physical, emotional and mental
  depletion.
• Physical -somatic manifestations associated with
  chronic stress
• Emotional-nature of predominant feelings and
  behaviors expressed in life/work/career
• Mental-problematic predominant thoughts,
  maladaptive coping behaviors and techniques,
  decreased sense of personal accomplishments

12
What can you do to prevent burnout?

• Pay attention to clues from yourself, others in
  the workplace, people who are important in your
  life outside of the workplace, to identify when
  you are experiencing burnout.
• Develop a continuous personal and professional
  development plan that addresses
• self-awareness of core values, interests and
  passions, preferences and strengths, and
  limitations (knowing where and when you can do
  your best work)
• personal/life career development needs
• personal factors that may predispose to burnout
• the fit among self, the nature of your work and
  the workplace

13
Think of it this way

• Survival of the fittest ( the John Wayne School
  of Medicine)
• VS
• Survival of that which fits best
• (taken from The Handbook of Physician Health
• published by the American Medical Association
• Chapter 14, written by Dr. Todd Pearson)

14
What is our responsibility to report physicians
at risk?

• Estimates of physician impairment range from
  7-10.
• The most common impairments are those caused by
  dependence on alcohol or other substances.
• Many of those experiencing chemical dependency
  also have a co-morbid psychiatric disorder.

15
What is our responsibility to report physicians
at risk?

• Practice of medicine is a privilege, not a right
  conferred on us by obtaining the appropriate
  training.
• To protect the public from unprofessional,
  improper, and incompetent practice of medicine,
  the College of Physicians in each province is
  licensed to regulate the practice of medicine in
  their province.
• If you are aware of an impairment to practice it
  is your responsibility to report it.

16
Food for Thought

• How healthy are physicians/students compared to
  the general population?
• Do we as physicians have a specific obligation to
  avoid getting sick?
• How can you recognize in yourself and others when
  burnout is occurring?
• What is your responsibility to report a physician
  at risk?