Burnout is a commonly used term that in general refers to the negative impact of continued stress of job/training demands upon the person.
Maslach's model
includes three key components of burnout: emotional exhaustion; depersonalization; and, reduced personal accomplishment.
Emotional exhaustion is often viewed as a key element and may be a precursor to worsening of the other 2 features. Emotional exhaustion is the result of working/training at an extremely demanding level resulting in becoming emotionally over-extended, depleted and fatigued.
As Dr. Edward Krall, retired psychiatrist from the Marshfield Clinic and previous chair of the Clinic's Physician Health Committee, described "It comes from the need to be continually present. A person has nothing left to give."
Depersonalization is the experience of becoming more negative, cynical, impersonal or cold in one's interactions with family, patients, colleagues and staff. Dr. Krall noted, "Work has hardened the individual and he or she has lost their compassion. It may be a defense against further emotional exhaustion."
Patient dissatisfaction, complaints and medical errors emerge from this. Decreased
personal accomplishment is the reduced sense of competence and efficacy often associated with an increasing negative view of one's abilities. As Dr. Krall explained, "Not only has one lost his or her compassion, but one starts to doubt the worth of what he or she does. Does it really make any difference?" Questioning whether to drop out of training can emerge from this.
Thomas' (2004) review of the literature on burnout in residency concludes "burnout levels are high among residents and may be associated with depression and problematic patient care." A meta-analysis of burnout and quality and safety in healthcare (Salyers, et.al. 2016) found a consistent relationship between burnout (particularly emotional exhaustion) and patient safety/quality of care. A survey of over six thousand practicing physicians found a significantly higher rate of medical errors among physicians who reported burnout symptoms (Tawfik, et.al. 2018). The annual Division of Education Resident Health Survey conducted at the Resident Retreat in 2016 identified 20 percent of our residents as experiencing a high degree of emotional exhaustion.
Burnout, if not addressed, may render a resident more vulnerable for the emergence of depression. This results in patient care risks as literature (Fahrenkopf et al 2008) identifies a 6-fold increase in medication errors by depressed residents.
Wonder if you’re burning out? Here are some suggestions:
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Talk with someone you trust about your concerns. Don’t wait, don’t just think you need to quietly tough it out to prove “I’ve got what it takes to be a physician.”
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Review ways to manage and reduce burnout.
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Regain your balance. Burnout is often associated with a reduction in time spent in social activities, exercise, sleep, obtaining good nutrition. Make a deliberate effort to put more of these back into your life.
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Take this self-test: For a quick assessment for burnout and for detailed information on burnout and it’s management.
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Use Web-based
resources to build resilience.
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Self-Preservation: Practical Tools for Residency and Career
References:
The National Academy of Medicine (in the spring of 2018) constructed a Knowledge Hub on Clinician Wellbeing. It is comprehensive in scope and well organized to help you quickly find tools and resources related to wellbeing and burnout. ACGME identifies the NAM Knowledge Hub as the
go to national resource for medical education on this topic and we encourage you to explore it.
http://nam.edu/clinicianwellbeing/about/
The Relationship Between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis. Journal of Internal Medicine, 2016
Resident Burnout, JAMA. 2004
Rates of medication errors among depressed and burnt out residents: prospective cohort study, BMJ 2008
Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors. Tawfik et.al. Mayo Clinic Proceedings, 2018
Wisconsin Medical Society 2018 Report on burnout prevalence, factors and recommendations
