Stress and burnout. Stress is a physiological response to an inappropriate level of pressure.

Stress and burnoutStress and burnout

Stress is a physiological Stress is a physiological response to an inappropriate response to an inappropriate

level of pressure level of pressure

Causes (in doctors)Causes (in doctors)

Escalating workloadEscalating workload Frequently imposed changeFrequently imposed change patients expectationspatients expectations fear of litigationfear of litigation ConflictConflict ?lack of career structure?lack of career structure

Definition of BurnoutDefinition of Burnout

Burnout is a state of mental and/or physical Burnout is a state of mental and/or physical exhaustion caused by excessive and exhaustion caused by excessive and prolonged stress.prolonged stress.

[Girdino, DA, Everly, GS, and Dusek, DE, Controlling Stress and Tension, Allyn & Bacon, [Girdino, DA, Everly, GS, and Dusek, DE, Controlling Stress and Tension, Allyn & Bacon, Needham Heights, MA, 1996]Needham Heights, MA, 1996]

Possible features of burnout include:Possible features of burnout include:

guilt at taking time off work guilt at taking time off work minimising contact with patients minimising contact with patients excessive discussions about past mistakesexcessive discussions about past mistakes excessive discussion about future workload excessive discussion about future workload becoming cross with a colleague or employee at becoming cross with a colleague or employee at

least once per day least once per day drinking alcohol before workingdrinking alcohol before working inability to concentrate on the matter in handinability to concentrate on the matter in hand emotional exhaustionemotional exhaustion

Predisposing factors to Burnout/ Predisposing factors to Burnout/ stress reactionstress reaction

Type A or obsessional personalityType A or obsessional personality ConscientiousnessConscientiousness Reluctance to decline workReluctance to decline work Reluctance to delegate Reluctance to delegate Single handed or dysfunctional partnershipSingle handed or dysfunctional partnership long hourslong hours lack of varietylack of variety

Signs to watch for (1)Signs to watch for (1)

Temper outburstsTemper outbursts Over drinking or smokingOver drinking or smoking Changes in eating habitsChanges in eating habits Withdrawing from usual activitiesWithdrawing from usual activities Becoming unreasonableBecoming unreasonable Rushing aroundRushing around Forgetfulness Forgetfulness

Signs to watch for (2)Signs to watch for (2)

poor timekeeping and decision makingpoor timekeeping and decision making sick leavesick leave increased frequency of mistakesincreased frequency of mistakes strained relationshipsstrained relationships

BMA Counselling ServiceBMA Counselling Service

150 calls per month to the counselling 150 calls per month to the counselling serviceservice

"Emotional" problems are by far the biggest "Emotional" problems are by far the biggest category category

35% of emotional problems are depression35% of emotional problems are depression This is 3 times the rate of all physical This is 3 times the rate of all physical

problems combined problems combined Doctors have a lifetime risk of 1in 15 for Doctors have a lifetime risk of 1in 15 for

alcohol and/or substance misuse alcohol and/or substance misuse

SuicideSuicide

Male doctors have a suicide rate lower than the Male doctors have a suicide rate lower than the general male population (SMR=66.8) general male population (SMR=66.8)

Female doctors have a much higher suicide rate Female doctors have a much higher suicide rate than the general female population (SMR = 201)than the general female population (SMR = 201)

4 times as many male suicides as females overall 4 times as many male suicides as females overall and absolute numbers are low and absolute numbers are low

Community health, Public health, Anaesthetics, Community health, Public health, Anaesthetics, General Practice have the highest rates. GP the General Practice have the highest rates. GP the highest absolute numbershighest absolute numbers

Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979-1995

K Hawton et alJ Epidemiol Community Health 2001;55:296-300 ( May

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