Preventing Burnout

Mamta Gautam,

MD, MBA, FRCPC, CPDC, MOT

Disclosure of Conflict of Interest

Conflicts to Declare:

• No affiliation with a pharmaceutical, medical device or communications organization.

• President and CEO – PEAK MD

Learning Objectives

• Understand why we are vulnerable to stress in medicine

• Recognize the early warning signs of stress

• Define burnout

• Identify strategies to manage stress and prevent burnout

MYTH

Knowing what we should be doing means that we are doing it.

BIOLOGICAL FACTORS

BIOLOGICAL FACTORS

• Lack of Sleep

• Poor Eating Habits

• Poor Level of Fitness

BIOLOGICAL FACTORS -2

• Family history of psychiatric illness

• Overuse of alcohol or drugs

• Anxiety disorders

• Primary Affective Disorder

• Eating Disorders

PSYCHOLOGY OF THE PHYSICIAN

COMMON PERSONALITY TRAITS

• Overly conscientious

• People pleasing

• Sense of Responsibility and Guilt

• Unrelenting perfectionism

• Need to control others

• Chronic self doubts

• Uncomfortable with love, approval

• Ability to delay gratification

THIS IS SOCIALLY VALUABLEBUT

PERSONALLY VERY EXPENSIVE.

ISSUES ARISING FROM PAST EXPERIENCES

• Establish sense of self as children

• Believe three main assumptions

• Develop “Personal Historian”

• Perception: We are not good enough.

We do not measure up.

90:10 Rule

DEFENSES

• Highly intellectual types used.

• Major causes in delay of seeking help.

• Make therapy more difficult.

• ‘Brain-Heart’ Gap

COMMON DEFENSES EMPLOYED

• Reaction Formation

• Denial

• Minimization

• Rationalization

WORKAS A DEFENSE

SOCIAL DEMANDS ON PHYSICIANS

• Work and Career Demands

• Household Responsibilities

• People in Our Lives

• Personal Needs and Wants

“THE DREAM “ OF BECOMING A PHYSICIAN

OUR PATIENTS

OCCUPATIONAL HAZARDS

MEDICINE AS A BUSINESS

MAINTENANCE OF COMPETENCE

ORGANIZATIONAL CHANGES IN HEALTH CARE

ISSUES SPECIFIC TO WOMEN

• Minority status, discrimination still exist

• Isolation

• Life Stage considerations

HOUSEHOLD RESPONSIBILITIES

• Managing the household - shopping, cooking, cleaning

• Finances

• Anxieties about our future

CHILDCARE AND ELDERCARE

RELATIONSHIPS

• Singlehood

• Marital Issues

IN ALL OF THIS, THE PERSONAL NEEDS OF THE

PHYSICIAN ARE LAST, AND OFTEN LOST.

FIVE EARLY DANGER SIGNS

• Increase in physical problems and illnesses.

• More problems with relationships.

• Increase in negative thoughts and feelings.

• Significant increase in bad habits.

• Exhaustion.

BURNOUTA syndrome of emotional exhaustion, chronic overstress.

(Maslach)

-Distinct work-related syndrome – demands exceed individual resources

-Not a psychiatric diagnosis-Most likely to occur in jobs that require extensive care of

others-Common among practicing physicians

BURNOUT

Three Stages (Maslach Burnout Inventory):

• Emotional Exhaustion

• Depersonalization

• Reduced Personal Accomplishment

Review of Burnout Studies

• Emotional exhaustion = 46-80%

• Depersonalization = 22-93%

• Low Personal Satisfaction = 16-79%

Starts early in our training

• Burnout prevalent during medical school• Major US multi-institutional studies estimate at

least half of all medical students may be affected by burnout

• Persists beyond medical school – between 20-60% of practicing physicians

• Highest prevalence reported in residents (40-76%)

Work Related

• Demands of the workplace exceed individual resources – way of life for many physicians

• 2001 CMA PRQ:– 64% have workload too heavy– 58% felt family and personal life suffered– 57% felt patients’ expectations too high– 29% felt on call too often– 33% felt lack of locums and could not take holidays– 64% felt difficulty getting referrals for patients, – 46% felt limited in changing specialty/career path

Possible Risk Factors

• High Workload - demands exceed resources• Age - inverse relation between age and

burnout. ? Survivor bias.• Spousal support – inverse relation between

emotional exhaustion and support from partner

• Personality traits

SERIOUS CONSEQUENCES

1. Impaired job performance and Professional Problems

2. Changing jobs, reducing work hours3. Difficulty with Relationships – home

and work4. Physical Illnesses5. Addictions6. Psychiatric Illnesses – Anxiety,

Depression, Suicide

Even the healthiest and strongest of us can become unhealthy

in an unhealthy environment.

Preventing Burnout

• General Strategy

• Specific Strategies – Work related– Personal

General Strategy

• The number one cause of stress

leading to burnout:

THE PERCEPTION THAT WE HAVE

NO CHOICE, NO CONTROL.

• The number one skill in dealing with stress:

CHALLENGE YOUR PERCEPTION.

STEPS IN MANAGING STRESS

• Identify the stressor

• Recognize that you have more control than you think you do

• Identify what parts you do, and do not, control

• Focus on what you do control, and learn to cope with what you do not control

MAKING CHOICES

• Recognize that you have choices

• Focus on what you can control.

• Set priorities - self, family, work.

• Accept that you will not be perfect. “Good enough is good enough.”

• Phases – A Work in Progress

The Five Balls

• The Work Ball

• The Home and Family Ball

• The Relationships Ball

• The Friends Ball

• The Self Care Ball

Take care of yourself first

Take Away Messages

• The very traits that help us succeed can make us vulnerable to stress and burnout

• None of us are immune• We can look for warning signs of stress in

ourselves and our colleagues• Prevention is key. Take care of yourself first• There are things we can do to be resilient;

stay tuned!