BURNOUT : Doctors are especially vulnerable to burnout

 Doctors are especially vulnerable to burnout

A syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment 
Work is a significant source of stress in all occupations

Surveys have shown that approximately one-third of working Americans experience chronic work stress

The term "burnout" originated in the 1940s as a word to describe the point at which a jet or rocket engine stops operating .
 The word was first applied to humans in the 1970s by the psychiatrist Herbert Freudenberger, who used the term to describe the status of overworked volunteers in free mental health clinics.

Burnout is a problem of the social environment in which people work and is a function of how people within that environment interact with one another and perform their jobs

"major mismatch between the nature of the job and the nature of the person who does the job"
Burnout can occur in any setting, and it has been studied most extensively in a wide range of occupations within the human services field, from healthcare professionals to teachers, police, and prison workers
healthcare is  the leading  branch for burnout
I can say  every one of these factors were ther  when I was working  at  Dallas VA medical center

• Work overload: Limitations in terms of staff, time, and other resources ( to some extent  40 %)
• Lack of control: Unable to perform job functions the way an individual believes is the "right" way( 100%)
• Insufficient reward: Absence of acknowledgment of an individual's contributions in the work environment and lack of opportunities to advance (100 %)
• Absence of community: Poor working relationships, absence of adequate supervisory or peer support, poor leadership style ( 100 %)
• Lack of fairness: Inequality in workload, salary, or other signs of professional respect
• (100%)
• Conflict in values: Disagreement between job requirements and an individual's personal principles (100%)
• from a personal standpoint   negative emotions and social inhibition were major factors./ personality traits are common among physicians

fatigue is usually associated with health-related causes, whereas burnout is caused by job-related factors

I had all of them

• Anger
  Depression
  Anxiety
  Frustration
  Guilt
  Cynicism
  Tension, irritability
  Mood swings, outbursts of temper
  Sadness
  Withdrawn, numb feeling
  Emotional detachment
  Decreased coping abilities
  Inability to concentrate
  Lack of drive or initiative
  Loss of idealism
  Dissatisfaction with personal accomplishments
  Addictive behavior
• Inability to communicate with family, friends, and colleagues
  Cynicism, suspiciousness toward co-workers and others in work environment
  Neglect of family and social obligations
  Marital dysfunction
  Questioning of spiritual beliefs

• 
  

1. The term "burnout" was first applied to humans 

A. by welfare workers in the 1930s. 

a. in the 1970s by psychiatrist Herbert Freudenberger. 

C by social psychologist Christina Maslach in the 1980s. 

D. by social scientists in the early 2000s. 

2. As described by Maslach, the term burnout is now usually limited to mean 

A. loss of idealism in the helping professions. 

a. a mild degree of unhappiness caused by distress. 

C a problem related to an individual, not the work environment. 

D. a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment. 

3 Isolation and apathy characterize which stage of burnout? 

A. Stage 1 

a. Stage2 

c r Stage3 

D. r Stage4 

4. Which of the following statements regarding personal risk factors for burnout is TRUE? 

A. Burnout is more prevalent among older individuals. 

a. Across most work settings, levels of burnout are greater in men than in women. 

C The rates of burnout are higher among married workers and those with children. 

D. There are higher levels of burnout among workers with higher levels of education. 

5. In measuring burnout, which of the following is the best approach to gain a better 

understanding of the sources of stress for an individual? 

A. The full Maslach aurnout Inventory alone 

a. Three items from the Maslach aurnout Inventory 

C The full Maslach aurnout Inventory with the General Health Questionnaire 

D. Two items from the Maslach aurnout Inventory and the aurnout Risk Survey 

6. The overall burnout rate among physicians is 

a. r t020% 

7. Which of the following statements regarding burnout according to physicians' career stage is 

TRUE? 

A. aurnout rates stay relatively stable through physicians' careers. 

a. The rate of depersonalization is greatest among physicians. 

C Burnout rates are higher among medical students and residents than among physicians. 

D. aurnout that develops early during medical training generally resolves during residency. 

8. The most commonly reported causes of stress, job dissatisfaction, and burnout, across career 

stages and specialties, are 

A. type D personality, depression, and inadequate social supports. 

a. work overload, inadequate work-life balance, and lack of control over one's work. 

C mandatory participation in work events, alcohol abuse, and low number of patients. 

D. strong working relationships, reliance on outdated documentation methods, and small practices. 

9. According to a survey of physicians, which of the following is the most satisfying factor in 

medical practice? 

A. Financial rewards 

3. Prestige of medicine 

C Interaction with colleagues 

D. Forming relationships with patients 

10. Which of the following mental health factors is more prevalent in physicians than the general 

population? 

A. Depression 

a. Suicidal ideation 

C Alcohol abuse/dependence 

D. All of the above 

11. Which of the following statements regarding burnout and clinical work is TRUE? 

A. aurnout is associated with decreased productivity. 

a. In one study, burnout scores correlated with increases in professional effort. 

C. Research indicates that physicians most likely to leave practice are those in 

D. Stress and lack of control over one's work are the strongest predictors of intent to reduce clinical 

work hours or leave the current position. 

12 A high score on which MB' domain is associated with suboptimal patient care in physicians 

and residents? 

Depersonalization 

Mental quality of life 

Emotional exhaustion 

Personal accomplishment 

13 Which of the following statements regarding prevention of stress and burnout in physicians is 

TRUE? 

A. Physicians have been shown to accurately define their own well-being. 

a. No guidelines exist for the incorporation of identifying and managing practitioner health issues. 

C Many physicians seek help for stress or burnout because of the belief that these conditions are 

abnormal for the profession. 

D. Self-care warrants particular emphasis for physicians, as they have been trained to put the care of 

others ahead of themselves. 

14. Which of the following is an effective organizational-level strategy for managing stress and 

preventing burnout? 

A. Discourage strong leadership styles. 

a. Create a healthy work environment. 

C Participate in outside interests and/or volunteer activities. 

D. Make documentation a personal priority (i.e„ do not delegate these tasks). 

15. Which of the following statements regarding the promotion of a healthy medical work 

environment is TRUE? 

A. Flexible scheduling is an important element of a healthy work environment. 

a. Physicians can become champions of a healthy work environment by developing or participating in a 

wellness committee. 

C Programs offering physicians an opportunity to meet with colleagues in a structured format 

substantially reduced the rate of burnout. 

D. All of the above 

There are 3 types of personalities that have been related to physical health and disease. What are they?

Type A (also known as the coronary-prone behavior pattern) are individuals who are hard-driving, competitive, and try to overachieve. The stereotype of the driven and overworked executive who one day keels over with a heart attack, has some basis in fact, as Type A individuals are more prone to coronary heart disease.

Type B individuals are laid-back, never rush, and tend to take things easy. While Type As are focused on competing and attaining measurable goals, Type Bs are more about living in the moment.

Type D (also known as “distressed” or “disease-prone”) persons tend to be worried, irritable, and express a great deal of negative emotions. Also linked to coronary heart disease, there is a tendency for Type Ds to experience illnesses (particularly stress-related illnesses) in clusters. The disease-prone personality is related to Type D and you can read more about it here.

What Type Are You?

Agreeing with these items suggest Type A personality, disagreement suggests Type B:

• Are you pressed for time at and after work?

• Do you always take work home with you?

• Do you eat rapidly?

• Do you have a strong need to excel?

• Do you have trouble finding time to get your hair cut/styled?

• Do you feel or act impatient when you have to wait in line?

*  Are you bossy and impatient. 

Affirmative answers to these questions suggest Type D personality:

I am often irritable.

I tend to keep to myself.

I tend to hide my feelings from others.

I often feel gloomy and down in the dumps.

What to Do? 

Type As may be more prone to stress (and potential heart-related issues),

 but research suggests that this can be helped by learning to appropriately manage and

 express emotions. On the positive side, Type As tend to be successful at work due their

 drive and dedication. 

Burnout usually occurs early in one's career (in the first one to five years), and

many young, burned-out individuals leave the profession; as a result, the remaining

 individuals in an occupation are the "survivors" 

higher levels of burnout among workers with higher levels of education [

The MBI addresses the three defining aspects of burnout syndrome with 22 statements in three subscales [6]:



Emotional exhaustion: Nine statements to measure feelings of being emotionally overextended and exhausted by one's work


Depersonalization: Five statements to measure an unfeeling and impersonal response to the recipients of one's services, care treatment, or instruction


Personal accomplishment: Eight statements to measure feelings of competence and successful achievement in one's work



Age is a factor in burnout among physicians, with the lowest rate (22%) among physicians 66 years of age and older 

 The highest rates of burnout are found for physicians who are middle-age:

 53% for physicians 46 to 55 years of age

51% for physicians 36 to 45 years of age 




Specialty has an effect on the prevalence according to age.

 For example, in the Medscape survey,

 the overall burnout rate was 44% for physicians 35 years or younger, 

but rates were much higher among physicians of this age-group in small specialties such as 

urology (63%),

HIV/infectious diseases (61%),

 and nephrology and obstetrics/gynecology (53% each)




 [31]. 




ONCOLOGY is the least stressful specility 

No wonder  James wilson the oncologist friend  of  Dr.House  is   least stressed !




The rate was also higher for physicians 35 years and younger in

 internal medicine (53%) and was similar for family medicine (43%).

 For the so-called high-stress specialties,

 the burnout rates for younger physicians were lower than the overall rates; the rates were 

42% for critical care, 

38% for emergency medicine, 

30% for oncology [31].