Physician burnout: a recipe for disaster

Burnout seems to affect health care staff more than other professions, and has been described as “a syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a low sense of personal accomplishment”.1

Novice (medical student) or masterchef (consultant), here is a possible recipe.

Ingredients

1. Brainwash

2. Practise medicine

3. Work for > 40 years

4. Struggle to have a life

 

Method

 

1. To make your brainwash:

   1. Definitely start with your patient; they always come first.

   2. Roll out your medical student with being thorough and committed, leaving no stone unturned and seeking continuous perfection and improvement.

   3. Add a good pinch of doubt, guilt and an exaggerated sense of personal responsibility.

   4. Pour in a glug of workahol. Who are we kidding? Add the whole bottle!

   5. Be sure to follow the recipe exactly; you’re not allowed to make any mistakes … ever.

   6. If you do happen to make a mistake, go back to (c).

    

   7. Once you are happy with your brainwash, add it to practising medicine.

      1. Knead in (equal measures of) dealing with the hurt, the sick, the scared and the dying.

      2. While you knead, be sure to feel frustrated by treatment failure, illness progression and your powerlessness against illness.

      3. Regularly reflect on your practice, and definitely revisit 1(c) and 1(d).

       

      4. Your clinical practice should be simmering nicely by now. Let it cook until retirement in your 60s.

         1. Discard any ideas you have of the “simple” patient; complex medical conditions are much spicier.

         2. Repeat 3(a) with your ethical decisions; this will help to turn up the difficulty.

         3. Mix in a good knob of bureaucracy; spice things up further with an electronic health record, clinic letters, results checking or any number of request forms.

         4. At this point, you can also ruminate using the ingredients for your brainwash.

         5. I find this step works best with long and irregular hours, frequent night shifts and a dash of uninterrupted vigilance.

         6. If you do happen to make a mistake, follow 1(c) and 1(e) again.

          

         7. With the free time you have left after completing steps 1–3, you can prepare a dressing I like to call “avoir une vie”.

            1. While completing steps 1–3, if you fall ill or have a life crisis, be sure to continue steps 1–3.

            2. Seriously, you’re a doctor. Unless you work in a restaurant or on a tropical island you only need to do steps 1–3.

             

             

            Discussion

            Wellbeing surveys of hospital staff show 40–50%2 of staff self-report high levels of emotional exhaustion and cynicism, key characteristics of burnout. Critical care and acute medicine are the worst specialties for staff burnout.3 Burnout is associated with medical error, fear of litigation, reduced career satisfaction and longevity, reduced patient satisfaction, and ultimately mental illness, substance misuse and physician suicide.4

            High rates of burnout can affect staff wellbeing and delivery of safe, effective health care, and we need cohesive, holistic and evidence-based strategies to tackle burnout. Based on my review of the current advice, there is no unified approach to addressing the prevention or recovery of physician burnout. Social connection seems to have an important protective role, and the following steps could be considered:

            • Individuals: identify what is important to you inside and outside work; ask how you are devoting and spending your time to align with those priorities.5 Are you able to see your friends and family? Do you have a hobby? Are you well read? Do you have a trusting relationship with your general practitioner?

            • Teams: seek to address isolation, be alert to signs of burnout in your colleagues and offer them your support.

            • Organisations: offer debriefing opportunities, resilience training,6 identify role models and mentors for all doctors, enact measures to provide safe rosters and approve leave quickly.

             

            If you are concerned that you or a colleague may be in difficulty, there are several places to turn to for support, safety and advice — friends, colleagues including your mentor, your GP, employee assistance programs (for hospital doctors), or similar systems through your College membership, your medical defence fund and the Doctors’ Health Advisory Service (available in all states and territories), to name a few.