There is increasing public perception and commentary that there are systemic failures in Doctors, and that they will or are making mistakes. Regulatory bodies, medical boards, and government try to combat this by looking at systems to identify those who may pose a risk to public safety. The markers that they use are often based around burnout – substance abuse, mental or physical health, increased medical errors, and reduced patient satisfaction. There have been a number of studies correlating the link. So far the primary focus has been to identify and target those that pose a risk. As such, programs like revalidation, mandatory reporting, and increased pathways to check or make complaints, have become the accepted norm.
Recently however there is growing recognition that the above measures aren’t the only or even the best way forward, that they can indeed add to the growing worldwide incidences of physician burnout. So what is the alternative? One of the new age words that has been going around for a while is “Wellness”. This idea focuses on the concept of not just being absent of malady but reaching wellness through a balance of a number of parts of a person’s life. Wellness itself is a great tool for professionals going through burnout but not necessarily the only way to prevent burnout. There are systemic measures that need to be put into place.
Do you have Burnout? –
There are a number of ways to define burnout, but having a number of the following symptoms, suggests that if you don’t have it yet – you’re on your way to it:
- Physical – constant exhaustion leading to poor immunity and somatic complaints; no improvement after rest and
recovery; recurring aches and pains, colds and other ills; symptoms similar to those with depression such as poor sleep quality, lethargy, and a loss or increase in appetite
- Emotional – a negative outlook; detachment; loss of empathy, especially for patients and their situations; diminished motivation; sense of being defeated, trapped or helpless; possible persecutory ideas; angry inappropriate outbursts
- Behavioural – extreme negativity, callousness and cynicism; anger and cynicism towards patients, colleagues, hospital administration and family; substance abuse, such as an increased reliance on alcohol.
There is also often an inability or reluctance to engage with work, especially when it involves interacting with patients or colleagues.
A study in America found that 45% of physicians in 2011 showed significant signs of burnout, by 2014 that number had increased to 54%. In Australia Beyond blue’s link to beyond blue ref 2013 National Mental Health Survey of Doctors and Medical Students which surveyed 12,252 doctors and 1,811 medical students, found that those under 30 have the highest level of burnout, and young doctors have a much higher level of cynicism than students. Major stressors include lack of work/life balance, too much to do at work, increased responsibility, fear of making mistakes and long work hours. At any given day 1 in 3 doctors are going through issues of burnout.
How do doctors burnout?
There are a number of things that lead to burnout – there are a few reasons listed below in Table 1. I won’t go into too much detail about them, as a health professional I’m sure you know nearly all of these reasons very well.
|Stress||This can come in many forms|
|Fatigue||Lack of energy, tiredness, though it is often a sign of burnout, being fatigued constantly can lead to stress and burnout, and medical errors|
|Medical Errors||One thing all doctors worry about, and if gone through an incident can lead to significant symptoms of burnout.|
|Complaints||Whether justified or not, cleared or not, the actual complaints process, from the personal doubt, emotional hurt, to the professional questioning can often lead to burnout.|
|Personality||Where it’s the personality type that is attracted to medicine, or medicine fosters that type. A high achieving, driven personality who doesn’t deal well with failure.|
|Bullying||By supervisors, patients, colleagues, administrators – Figures suggest 21% of Australian doctors have been bullied in their workplace|
|Insufficient Resources||The constant struggle to provide healthcare for patients that you care for with insufficient resources.|
|Devaluation||This can come from patients, administrators, politicians, regulators, colleagues in other specialities , our peers, and even ourselves.|
|Poor Renumeration||Ongoing unpaid parts of our daily work – leading to feeling of devaluation, stress, financial pressures, and burnout.|
|Continuity of care||The actual role of a GP, with continuity of care, and care for whole family and community roles and positions perpetuates that idea of a 24/7 job/role.|
Specific groups at Risk –
Not the complete list but below are some groups of doctors and specifically GPs that are at higher risk of burnout:
GPs working with certain population groups including: –
- Vulnerable communities or groups of patients such as
- Aboriginal and Torres Strait Islander communities
- Refugees and asylum seekers
- Palliative care patients
- Victims of family violence
- Patients with complex post-traumatic stress disorders
- Addictions or severe mental health and/or social problems
What are the consequences of Burnout ?
Burnout can lead to a number of significant effects on a doctors health but also significant costs to a health system, and risks to patients.
- Mental Health consequences, direct and indirect (loss of working hours, costs in services needed etc..)
High risk of malpractice/negligence claims and adverse events
- Reduced effectiveness and efficiency in patient care
- Reduced patient satisfaction
- Reduced staff moral – the burnout sufferer but also staff around them
- Increased days off and the costs and consequences of that
- Hostile work environment, with other staff having to take up the slack, and general reduction in staff morale and cohesion.
- High turnover of staff, and the significant costs of that
It’s difficult to assess the costs of the above, but a costs of turnover study found 3.4-5.8% of a hospital’s annual operating budget goes to turnover of staff, much more if you factor in absenteeism or presenteeism
Presenteeism – the lost productivity that occurs when employees come to work but, as a consequence of illness or other conditions, are not fully functioning. In comparison, absenteeism occurs when employees do not come to work.
I think I might be Burnt out or heading there – What should I do?
If you’re identifying some of the symptoms of burnout, or know someone who has them, what can you do? A number of strategies are available to address this, but just recognising the burnout itself may be causing some of the symptoms is a great start. The RACGP has a list of suggestions that can be found on their clinical guidelines: “The doctor and importance of self-care”.
A lot of those suggestions are common sense, but still difficult to apply to your own life. One important thing is to consider “Wellness”. We’ve done a post on Wellness that explains this a bit more, and also ways to apply Wellness to your own life.
A couple of basic points:
- Seek help – don’t self manage or especially self medicate! There are number of avenues to do this. Start with family and friends, talk to them about how you are feeling. Colleagues/Mentors – can offer support and an objective viewpoint.
- Get your own GP – this is very important, so few of us have our own GP. If you’re not sure how follow this to
the Australian Doctors Health Network. You can call the number there for your state, and ask for a GP in your area.
- Self care – look after your physical health, take breaks, exercise, eat healthy, avoid alcohol/drugs, generally put your own health as a priority in your life.
- Wellness – look at wellness and a balance in your life, what aspects of your life have led to this burnout. Identify the issues, try to alter that, look at other aspects that can provide buffers and protection from the negativity of the causes.
- Make changes – don’t just say I should make changes. Sit down, work out what things you can change, and put some strategies in place and activate those steps.
Where to from here?-
If you’re active on social media on forums like GPDU (GP down under) or other medical forums or blogs, you would have noticed the increased discussion on burnout, self-care and mental health issues in medicine. Less positively you may have come across news of some doctors who have died tragically of suicide recently. This has increased awareness of the issue of burnout, and mental health in doctors. APHRA, RACGP/ACRRM and other colleges have already started taking steps to invest in self-care models for doctors, but there is a lot more that we can do systemically and at a personal level.
In the next series of posts I’ll talk about “Wellness” and how we can apply it to ourselves, in ways to help prevent burnout.
References and useful links:
“Changes in Burnout and Satisfaction With Work-Life Balance in ….” Accessed March 31, 2017. http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/abstract.
“Report – National Mental Health Survey of Doctors – Beyondblue.” Accessed March 31, 2017. https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1132-report—nmhdmss-full-report_web.
“Physician Burnout and Occupational Stress: An inconvenient truth with unintended consequences”. Michael R. Privitera, Alan H. Rosenstein, Franziska Plessow, Tara M. LoCastro. http://www.physiciandisruptivebehavior.com/admin/articles/38.pdf
The inevitability of physician burnout: Implications for interventions. By Anthony Montgomery [Link]