A Burnt Out Case1
Burnout among physicians is common and preventable. There are many examples in literature of protagonists who have lost idealism and passion for their jobs and experienced fatigue and alienation—the hallmarks of burnout. Greene recounts the story of a disillusioned architect named Quer-ry who escapes his job by fleeing to Africa. Querry becomes “reconstituted” by working in a leper colony with patients called “burnt out” because they have ceased physical suffering at the price of becoming mutilated beyond self-recognition by the disease.
In the medical realm, “burnout” is a psychological term that became popular in the 1970s to describe chronic exhaustion and decreased interest in work. Particularly common in human services professions, it has been described as “a progressive loss of idealism, energy, and purpose.”2 The most widely used definition is one developed and quantified by Maslach and associates,3 which describes burnout as emotional exhaustion, depersonalization, and lack of personal accomplishment.
• Emotional exhaustion: tiredness, emotional depletion, fatigue
• Depersonalization: negative cynical attitudes, impersonal feelings, disengagement, isolation, impatience, frustration with patients or staff
• Lack of personal accomplishment: incompetence, ineffectiveness, inadequacy, sense of failure, apathy to protect against frustration, lack of perceived control
All 3 dimensions have been strongly associated with measures re-flecting emotional and physical strain, stress coping, and self-efficacy.4
Physicians can be particularly vulnerable to job stress, with high work demands and responsibility for the well-being of others, particularly distressed individuals and families. Psychiatrists are a particularly susceptible group because of the nature of their work and the populations they serve. Therapeutic work with highly distressed patients who may be traumatized, suicidal, homicidal, hostile, or unappreciative can leave clinicians feeling helpless, powerless, and depleted. This interactional process can be particularly problematic for psychiatrists who become isolated from peer supervision and/or mentorship contacts that help them process their feelings and actions.
Adverse or negative behaviors of a patient’s relatives also contribute to psychiatric job stress. External stressors, such as the changing health care environment, malpractice concerns, and job obligations divided between diverse systems and different obligations, also contribute to feelings of lack of professional accomplishment or “ . . . a gradual process of disillusionment in a quest to derive a sense of existential significance from work.”5 Collectively, these factors increase the risk of burnout.
Burnout affects up to 40% of psychiatry residents and up to 30% of practicing psychiatrists.6,7 The rates are lower for psychiatrists who work in inpatient settings.8 In subgroup analyses by career stage, middle-career physicians are most likely to be exhausted, while depersonalization and home-work conflicts were more common among early-career physicians.9 Late-career psychiatrists frequently retire early because of or to avoid burnout. Middle age is a challenging developmental time for many professionals—lost opportunities, acceptance of one’s limitations, and a loss of idealism can lead to disillusionment.
The stages of burnout
The process of burnout occurs in 3 stages. Because prevention and treatment are possible, particularly in the earlier stages, it is important to recognize the stages.10
Stage 1 consists of milder signs and symptoms that are episodic, such as experiencing mental fatigue at the end of the workday; feeling unappreciated, frustrated, or tense; and having physical aches and pains. Often physicians feel that they are falling behind on goals and deadlines and are not meeting status quo requirements, and they experience growing dread at facing the next workday.
Dr Szigethy is Associate Professor of Psychiatry, Pediatrics, and Medicine and Director, Visceral Inflammation and Pain Center in the division of adult gastroenterology at the University of Pittsburgh; and Director at the Medical Coping Clinic at the Children’s Hospital of Pittsburgh. She reports no conflicts of interest concerning the subject matter of this article.
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