Dr.farzad Shirazian,anesthesiologist & intensiviste of valiaser GH© 2002 ATGCI

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Burnout among physicians

S.M.R. Seyed Ahmadian (MD.PHD)

BURNOUT• Burnout is the index of

dislocation between what people are and what they have to be. It represents erosion in values, dignity, spirit, and will an erosion of the human soul (Maslach & Leither)

• A particular negative psychological state especially in health care workers

BURNOUT• Is a metaphor that is commonly used

to describe a state or process of mental exhaustion

in dictionary:to fail, wear out, or

become exhausted by making excessive

demands on energy, strength, or resources

BURNOUTHistory: Freudenberger in the mid-1970s: a

psychiatrist in treatment center for drug addicts

Christina Maslach: a social psychological researcher. Researching on health care workers

Two approaches to Burnout

More than:6000 articles, hundreds of book, physicians (34%),

teachers (27%), nurses (17%)

BURNOUTConclusions from history:I. Burnout emerged as a social

problem and not as a scholarly construct

II. From the outset, burnout was strongly associated with people work in the human services

III. a clinical approach and a research approach to burnout have developed and coexist more or less independently

BURNOUT• Includes:1.Emotional exhaustion:(manifests through the loss of enthusiasm for

work, feeling helpless, trapped, and defeated)

2.Depersonalization:(occurs when physicians treat patients

indifferently, objectify them, and develop a negative attitude toward their colleagues and profession)

3.Low personal accomplishment:(Inefficiency, or the lack of a sense of personal

achievement, is characterized by the individual’s withdrawal from responsibilities and detachment from the job)

BURNOUTSYMPTOMS AND ASSESSMENT

More than 130 possible symptoms (Schaufeli & Enzmann) ranging from

a(anxiety) to z(lack of zeal)• Affective (e.g., depressed mood, emotional

exhaustion, …)• Cognitive (e.g., poor concentration,

forgetfulness, …)• Physical (e.g., headache, sleep

disturbances, …)• Behavioral (e.g., poor work performance,

absenteeism, …)• Motivational (e.g., loss of idealism,

disillusionment, …)

BURNOUTSYMPTOMS AND ASSESSMENT

Irritability, dehumanization, indifference

Job satisfaction, job turnover, low morale

BURNOUTBurnout, job stress and depressionJOB STRESS:temporary adaptation process at work

that is accompanied by mental and physical syndromes

DEPRESSION:lethargy and feeling guilty, lack of

reciprocity between investments and outcomes in private life.

BURNOUTBurnout, job stress and depressionBURNOUT: final stage in a breakdown

in adaptation that results from the long term imbalance of demands and resources. Prolonged job stress. Dysfunctional attitudes and behaviors toward the recipients of one’s care or services (depersonalization), one’s job, and the organization. Burnout is job related and related to lack of reciprocity between investments and outcomes at work

BURNOUT

Maslach Burnout Inventory (MBI)

• the most frequently used questionnaire, includes 22 items that measure all three burnout dimensions.

• MBI is considered the golden standard for identifying burnout in medical research literature.

BURNOUTPrevalence in health care:Denmark: 11% occupational physicians,

9% psychiatrists, 9% teachers, 8% general practitioners, 8% nurses, 7% midwives, 7% social workers

Britain: same results in inpatient services and outpatient services

Netherland: 1% police officers, 2% hospice workers, 2%ICU services, 2% oncology nurses, 2% staff working with mentally retarded, 3% jailors

Nurses versus physiciansExhaustion

BURNOUT

is more likely to occur with• trauma surgeons,• urologists,• otolaryngologists,• vascular and general surgeons,• and younger health-care professionals

having children • in addition to working more than 60

hours per week, • having more calls per week than the

regular (2 nights/week),

BURNOUTThe correlates, causes and consequences

BURNOUTPsychological explanations:

as emotional overload as lack of reciprocity

as emotional contagion

Intervention methods• To reduce stress at

work, one should consider interventions on two levels:

the individual the environment

Individual interventions:

Stress management courses:

1.Relaxation2.cognitive-behavioral

therapy3.patient-centered therapyBalint sessionsExercise

Stress management courses

cognitive-behavioral therapy:

• focusing on cognitive behavioral techniques,comes to preventing and treating burnout in

healthcare professionals.• Stress management strategies among

general medicine practitioners (GPs) reported that relaxation and cognitive-behavioral skills proved helpful

• Group methods are both more cost-effective and more beneficial than individual counseling

Mindful meditation:• Mindfulness :a self-directed

practice for relaxing the body and calming the mind through focusing on present-moment awareness.

• The emphasis of mindfulness is staying in the present moment, with a non-judging, non-striving attitude of acceptance

Mindful meditation • a complementary therapy that

has shown promise in the reduction of negative stress and the extraneous factors that lead to burnout.

• Many studies evaluated these ‘mindfulness-based’ intervention techniques and showed that they potentially play a role in decreasing stress and burnout.

Balint sessions• group sessions that train

doctors on how to apply a patient-centered approach with a special focus on doctor-patient relationships.

• a common therapeutic strategy that reduces stress and burnout symptoms.

Exercise• A 10-min stretching exercise in the

work place has proven to reduce anxiety levels and exhaustion symptoms while improving the mental and physical well-being of health-care workers.

• Aerobic exercise is negatively associated with depression reducing overwhelming stress and improves the biological markers that may intervene between burnout and cardiovascular disease.

Occupational interventions• Mentor program• Confidential support group• Physician health committee• Annual well-being retreat• Fitness center• Sabbatical program• Periodic medical education• Reducing paperwork• Job rotation

A recent review showed that individual-intervention programs are beneficial in reducing burnout in a short term (6 months or less), while a combination of both personal and organizational interventions have longer lasting positive effects (12 months and more)

EE: emotional exhaustionDP: Depersonalization PA: personal accomplishment

Conclusions• Burnout among physicians is a

common serious entity with devastating personal and professional consequences

• Multidisciplinary actions that include changes in the work environmental factors along with stress management programs that teach people how to cope better with stressful events showed promising solutions to manage burnout.

• However, up until now, there have been no rigorous studies that prove this

• More interventional research targeting medical students, residents and practicing physicians are needed in order to improve psychological well-being, professional career enjoyment as well as the quality of care provided to patients.