Burnout, Depression, Angst, & Ennui among Physicians

Transcription

1 Burnout, Depression, Angst, & Ennui among Physicians Benjamin R. Doolittle, MD, M Div Internal Medicine & Pediatrics Yale University School of Medicine Etiology of Burn-out A Burnt-Out Case Graham Greene ~ 1961 You heard what the doctor called me just now- one of the burnt-out cases. They are the lepers who lose everything that can be eaten away before they are cured....

2 Etiology: Burnout The Burnt-Out Case Graham Greene I ve come to an end. This place, you might say, is the end. Neither the road, nor the river go any further. You have been washed up here too, haven t you? ~ Querry I am the Intern on call. I am so burned out.

3 I am the Senior Resident. I am so burned out. I am the Attending Physician I am so burned out.

4 Burnout is serious. What burnout is. What it does. Who gets it. Who does NOT get it. What to do about it. What Burnout Is. Job-Related Syndrome Maslach Burnout Inventory Emotional Exhaustion The Winter of Your Intern Year Lack of Accomplishment Decay of Purpose Depersonalization Pneumothorax after line who cares? Emotional Distance & Cynicism

5 Burnout Influences. Increased Use of Drugs & Alcohol Marital and Family Problems Depression & Insomnia Job Turnover & Absenteeism Loss of Income Quality of Care Who gets burned out?

6 Burnout & Errors in Residency. 115 residents at U of Washington Affiliated Hospitals 76% Burned Out 50% Depressed More Likely to Give Sub-Optimal Care 53 % vs 21% (p=.004) Ann of Int. Med 2002; 136: Burnout & Sub-Optimal Care

7 Resident Burnout MAJOR STRESSORS Inadequate Leisure Time (42%) Inadequate Sleep (41%) Shifts >24 hours (40%) MAJOR AIDS 4 days off a month (97%) Ancillary Help (95%) Night Float (64%) But what about these new rules?

8 Residents Post ACGME Rules University-based Surgical Residency hrs/week 50% High Emotional Exhaustion 56% High Depersonalization 20% Low Personal Accomplishment AFTER DUTY HOUR POLICY NO SIGNIFICANT CHANGE Arch Surg 2004: 139: Residents Post ACGME Rules Wayne State Residents (Surg & Non-surg) 41% prevalence of Burnout Only the Interns Improved Burnout Scores 77% 42% Academic Psychiatry 2006;30:

9 Resident Burnout post-rules Orthopedic Washington U. Small survey ~ 21 residents trend towards significant but still nonsignificnant Those are the residents.. What about the attendings.

10 Burnout & Primary Care Physicians US Physician Work-life Study 2,326 Docs Burnout 22% Med Care 1999; 37: Burnout MAJOR STRESSORS Lack of control in work environment Not enough time to spend with patients Too many hassles, interruptions, paperwork Not enough input in decision-making Need for monitoring workload Work-Home Interface Need for better cross-coverage Need for flexible hours, child-care issues

11 Who else is burned out? Primary Care MD s 33 50% HIV Nurses & MD s 40% Oncology Nurses & MD s 44% Intensive Care MD s 50% Intensive Care Nurses 33% Burnout & ED Physicians Results of Maslach Burnout Inventory 268 of 395 ED Physicians Exhaustion Med-High 46% Depersonalization Med-High 78% Accomplishment Low-Med 79% J. of Emer Med 1994; 12(4):

12 ED Physicians Satisfaction with Life Survey Dissatisfied with Life 35% Mean score 20.5 Med-Peds Patients 22.2 Doctoral Students 24.3 Nurses 23.6 Victims of Abuse 20.7 Male Prison Inmates 12.3 Physician Resource Questionnaire Canadian Medical Assoc % Work-load too heavy 55% Family & Personal Life Suffer 27% On call too often CMAJ 1998;159:525-8

13 Physician Resource Questionnaire Canadian Medical Assoc I believe that most physicians unconsciously contracted with society to pursue their profession to the utmost of their ability and energy, to keep up their skills, and do whatever was needed to promote patient care. Physician Resource Questionnaire Canadian Medical Assoc In return we expected respect, the equipment to do the job, and freedom from financial anxieties. All 3 of these expectations have been abrogated, yet we continue to fulfill our side of the contract in confusion, disbelief, and a sense of betrayal.

14 I m So Burned Out What do I do now?? Burnout: Who doesn t get it? Older Age Married / Children Less Work Hours More Vacation Less Patient Contact Continuing Education Teaching & Publishing

15 But that is just demographics... What else is going on? Who isn t Fried? Wisconsin Research Network Open-Ended Survey of Coping Strategies 600 physicians asked: How do you solve dilemmas related to your physical, emotional, and spiritual well-being? WJM 2001:174:19-23

16 Who isn t fried? Wellness associated with Positive Relationships Work Choices (part-time) Self-Care (exercise, reading) Religion or Spirituality What about residents?

17 What About Residents? 108/163 (63%) YALE medicine & mp residents ~ February 2010 High Emotional Exhaustion ~ 86% High Depersonalization ~ 89% Low Personal Accomplishment ~ 8% Remember! It was February! The Survey. Demographics Behaviors Spirituality Emotional Coping Strategies

18 What made a difference? NOTHING! No single activity or behavior. Research, mentor, exercise, hobbies, time out with family or friends What about Spirituality? Spearman s rho p Personal Acc Depersonalization Emotional Exhaustion

19 Role of Humility & Personal Relations? Spearman s rho Personal Acc Depersonalization Emotional Exhaustion p What about emotional coping?

20 Emotional Coping Emotional Exhaustion Depersonaliz ation Personal Accomplish ment Denial (NS) Disengage ment Venting Emotional Coping Emotional Exhaustion Depersonaliza tion Personal Accomplishm ent Acceptance (NS) Active Coping Positive Reframing (NS)

21 Closing Thoughts. Is there a burnout personality? Is there a healthful personality? Can we change? Closing Thoughts Can we change the medical culture? Hidden agenda Can we change CULTURE? Consumerism, lack of sacred trust

22 Closing Thoughts. Burnout: Complicated & Multifactorial ~ ~ Less is More ~ ~ ~ ~ More is More ~ ~

23 So, what do you think?