FAST FACT AND CONCEPT #168: Health Professional Burnout: Part II

Author: Linda Blust , MD

As described in Fast Fact #167, burnout is a “psychological syndrome in response to chronic interpersonal stressors on the job” (Maslach, 1982). This Fast Fact will explore symptoms of burnout and its personal and professional consequences. Additional Fast Facts will describe avoidance and assessment of burnout.

Symptoms of each sequential stage of burnout

• Stress Arousal: anxiety, irritability, hypertension, bruxism, insomnia, palpitations, forgetfulness, and headaches.
• Energy Conservation: Work tardiness, procrastination, resentment, morning fatigue, social withdrawal, increased alcohol or caffeine consumption, and apathy.
• Exhaustion: Chronic sadness, depression, chronic heartburn, diarrhea, constipation, chronic mental and physical fatigue, the desire to “drop out” of society.

Consequences

• Personal
• Depletion of emotional and physical resources
• Negative self-image: feelings of incompetence and lack of achievement
• Self-neglect: 35% of Johns Hopkins’ medical graduates had no a regular source of health care
• Questioning of previously held spiritual beliefs
• Neglect of family and social obligations
• Mental Illness: anxiety, depression, substance abuse, suicide
• Substance Abuse: MD lifetime risk is 10-14%
• MD suicide rates similar to general population for both genders
• Relative Risk of MD suicide versus other professionals
• Male MDs: 1.1-3.4
• Female MDs: 2.5-5.7
• Female MDs complete suicide as often as male MDs
• Professional
• Longer Work hours: If I work harder, it will get better.
• Withdrawal, absenteeism, and reduced productivity.
• Depersonalization: attempt to create distance between self and patients/trainees by ignoring the qualities that make them unique individuals.
• Loss of professional boundaries leading to inappropriate relationships with patients/trainees.
• Compromised patient care.
• 45% of University of Washington residents who self-report burnout also report providing “suboptimal care”.

References:

1. Booth JV, Grossman D, Moore J, et al. Substance Abuse Among Physicians: A Survey of Academic Anesthesiology Programs. Anesthesia Analg 2002; 95: 1024-1030.

2. Center C et al. Confronting Depression and Suicide in Physicians: A Consensus Statement. JAMA 2003;289: 3161-3166.

3. Gross CP, et al. Physician Heal Thyself? Regular Source of Care and Use of Preventive Health Services Among Physicians. Archives of Internal Medicine 2000;160: 3209-3214.

4. Linzer M, et al. Predicting and Preventing Physician Burnout: Results from the United States and the Netherlands. The American Journal of Medicine. 2001;111: 170-175.

5. Maslach C. Burnout: The Cost of Caring. Englewood Cliffs, NJ: Prentice-Hall, 1982.

6. Maslach c, Schaufeli WB, Leiter MP. Job Burnout. Annual Review of Psychology. 2001;52: 397-422.

7. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and Self-reported Patient Care in an Internal Medicine Residency Program. Annals of Internal Medicine. 2002; 136: 358-367.

Fast Facts were edited by David Weissman MD, Palliative Care Center, Medical College of Wisconsin until January 2007.  For comments/questions write to the current editor, Drew Rosielle MD: drosiell@mcw.edu. The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Blust L. Fast Fact and Concept #168. Health Professional Burnout Part II. November 2007. End-of-Life / Palliative Education Resource Center www.eperc.mcw.edu.

Disclaimer: Fast Facts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Purpose: Self-Study Guide, Teaching

Audience(s)

ACGME Competencies: Professionalism

Keyword(s): psychosocial and spiritual experience