Burnout – When to Suspect, What to Do

What is burnout?

  • Burnout is not just simply stress!
  • “A state of vital exhaustion” (ICD-10)
  • “A deteriorating or unsuccessful response to repeated and prolonged occupational stress”
  • Three components:
    • Emotional exhaustion: loss of enthusiasm for work, compassion fatigue, “nothing more to give to others”
    • Depersonalization: being less engaged in day-to-day activities, “feeling like an automaton”,  cynicism, dehumanizing others/treating others as objects (both patients and coworkers)
    • Low sense of personal accomplishment: work is meaningless, “I don’t make any difference” / “what’s the point?”

 

What causes burnout?

  • Situational
    • Workload: large demands of time, with high responsibility
    • Sleep deprivation, shift work
    • Poor learning environment, harassment, intimidation
    • Repeated exposure to death, trauma, sadness
    • Poor nutrition, lack of self-care (exercise, relaxation)
  • Personal
    • Isolation
    • Family stresses, relationship stresses
    • Financial stress
  • Professional
    • High degree of responsibility
    • Medical errors
    • Reward/investment imbalance and work/values imbalance

 

Who gets burnt out?

  • Anyone!
  • Physicians are significantly more likely to experience burnout than their age and sex-matched employed counterparts
  • Front line physicians (Family Medicine, Emergency Medicine) are at highest risk
  • Burnout can start at any point during training or practice
    • Burnout prevalence in residency (for all specialties and years) is at least 50% (2) and in some studies as high as 70%

 

Diagnosing burnout

  • Maslach Burnout Inventory
  • Early signs: emotional exhaustion and depersonalization
    • Somatic symptoms: GI upset, palpitations, sleep pattern changes, panic attacks
  • Late sign: reduced sense of personal accomplishment
  • Left untreated, burnout can lead to: anxiety, depression, substance abuse, deteriorating personal relationships, and in some cases, suicide

It is important to note that burnout often presents similarly to depression, however, unlike depression which is pervasive all the time, the burnt out physician may still feel well when doing non work-related activities. That being said, left unchecked, the low self-esteem, exhaustion and cynicism may precipitate a depression.

 

When should I be concerned?

  • Burnout is serious, and despite being common, should not be taken lightly
  • Seek help if:
    • Symptoms are pervasive, affecting everyday life including non-work activities  (suggesting possible concomitant depression and/or anxiety)
    • Substance abuse, which may devolve to impact work and life obligations
    • Repeated lapses in professionalism
    • Deteriorating relationships
    • Suicidal ideation

 

What to do if I’m experiencing burnout?

  • Engage in self care:
    • Exercise, eat well, get much needed rest, get a massage, meditation
    • Take a mindfulness course
    • Take regular vacations, and spread them out through the year
    • Cultivate activities and relationships outside of medicine
  • Set limits:
    • Set email, notification-free, work-free, and study-free times of the day (e.g. after 18h no checking emails, turn off phone notifications, etc.)
    • Learn how to and when to say no, set boundaries where you can
  • Talk with someone you can trust:
    • Friends, family
    • Speak with your mentor, your preceptor, and/or your unit director
  • Speak with a professional:
    • See your family physician regularly (don’t be your own doctor!)
    • Consult the EAP (Employee Assistance Program) or other confidential help program offered through your employer
  • Contact crisis resources if you are in dire need of help

And remember…Prevention is key!

 

Burnout References;
1. M Fralick, K Flegel. Physician burnout: Who will protect us from ourselves? CMAJ. June 2014, 186 (10): 710.

2. R Blais, C Safianyk, A Magnan, A Lapierre. Physician, heal thyself: Survey of users of the Quebec Physicians Health Program. Can Fam Phys. Oct 2010, 56 (10): e383-e389

3. CMA. ICPH Report 2012. 2012 Annual International Conference on Physician Health, Montreal, Canada. Available from: https://www.cma.ca/Assets/assets-library/document/en/practice-management-and-wellness/report_icph_2012-e.pdf
Accessed July 7, 2016.

4. OMA Practice Management. Physician Burnout: Understanding causes, symptoms, treatment. Handout/Publication 2012. Available from: https://www.oma.org/Resources/Documents/PhysicianBurnout.pdf. Accessed July 7, 2016.