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Burnout in Physicians: 

Burnout in Physicians Hakan YAMAN, MD, MS

Slide2: 

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.

Learning Objectives: 

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

Performance Objectives: 

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

İntroduction: 

İntroduction 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

İntroduction-2: 

İntroduction-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.

The Concept of Burnout: 

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).

The Concept of Burnout-2: 

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

The Concept of Burnout-3: 

The Concept of Burnout-3 Five stages of disillusionment: - enthusiasm -stagnation -frustration -apathy -intervention

The Concept of Burnout-4: 

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

Three stage transactional model of burnout:Stage 3-Burnout: 

Three stage transactional model of burnout:Stage 3-Burnout Maladaptive coping mechanisms Responses Physical Emotional Adaptive coping mechanisms balance restored responses resolved

Sources of Stress: 

Sources of Stress House officers syndrome: - long training hours - excessive work loads - sleep deprivation - changing work conditions - peer competition - self denial

Sources of Stress-2: 

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

Sources of Stress-3: 

Sources of Stress-3 - difficulties to keep up to date - challenge to explain and defend work - daily confrontation with sickness and death

Coping behavior: 

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

Coping behavior-2: 

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

Coping behavior-3: 

Coping behavior-3 Avoiding to be with family: - Physician Dawdler - Electronic Physician - Out-of-town Academician

İntervention: 

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

İntervention-2: 

İntervention-2 Learning of new adaptive coping mechanisms: - self-assesment and determination of stressors - specification of life priorities - sharing and expressing feelings

İntervention-3: 

İntervention-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

Conclusion: 

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.

References:: 

References: 1. Deckard GJ, Hicks LL, Hamory BH. The occurrence and distribution of burnout among infectious disease physicians. JİD1992;165:224-8. 2. Schneider J. Self-care: Challenges and rewards for hospice professionals. Hopice J 1987;3:121-146. 3. Fawzy Fİ, Fawzy NW, Pasnau RO. Burnout in health professions. İn: 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. 1979;12:2108-2111. 5. Maslach C. Burned-out. Hum Behav 1976;5:16-22. 6. Cherniss C. Staff burnout:Job stress in the human services. Beverly Hills: SagePubl.1980. 7. Simendinger EA, Moore TF. Organizational burnout in Health care facilites:Strategies for prevention and change. Rockville:Aspen Syst Co.1985. 8. Edelwich J,BrodskyA. Burned-out:Stages 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 1987;3:121-147.

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