Combatting Burnout

A Guide for Medical Students and Junior Doctors

Adam Staten

• Publisher: CRC Press
• Year: 2019
• eBook ISBN: 9780429824388
• Edition: 1
• Topic: Medicine
• Subtopic: Internal Medicine & Diagnosis

This timely aid, filled with 'down to earth' advice, provides invaluable guidance on avoiding burnout and on how to combat it should it occur. The book offers innovative ways to change working practices, shares advice on building protective mechanisms into daily working life and explores the diverse array of career options that are available to doctors.

Key features:

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• The first practical guide to help medical students and junior doctors identify, combat and avoid burnout

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• Recognises and describes the impact that burnout has on the ability of doctors to work safely and of students to study effectively, and the impact burnout has on the wider healthcare system

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• Discusses the factors that affect resilience and how this can be nurtured, and where help can be found for those who feel they are experiencing burnout

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• Enhanced by 'real life' examples throughout

Addressing the growing body of evidence that highlights burnout as an increasing problem among medical students and junior doctors worldwide, with a lasting impact on those directly affected, on the wider workforce and entire healthcare systems, this book will enable readers to identify and address problems quickly and see how they can build careers that are personally satisfying.

1

What is burnout?

Adam Staten

Clinical features of burnout

Impact on the individual

Effect on the NHS workforce

Effect on the NHS

Conclusion

References

The term burnout is used a lot and is often equated to feeling stressed by work, but burnout is more than simple stress. Burnout is a pervasive and debilitating state that results from an unsustainable period of overwhelming stress. Burnout among medical professionals is not a new phenomenon; in fact, the term was coined by the psychologist Herbert Freudenberger in 1974. Freudenberger was no stranger to stress. He was born a German Jew in Nazi Germany where his grandmother was beaten and his grandfather murdered. Still a child, he escaped on a false passport, travelling alone to New York, where he cared for himself and eventually studied for his psychology degree at night whilst working as a tool maker’s apprentice by day.

But it was not these experiences that shaped his thinking on burnout. In fact, he recognised the condition in himself and colleagues whilst working in drug addiction clinics in New York, where the unrelenting emotional stress of the work had a huge psychological impact on the staff.1

Burnout is not limited to those working in healthcare.2 It is a familiar concept in many areas of life, from the financial services sector to professional sports. Increasingly, burnout is recognised as a widespread issue in many walks of modern life, and this is reflected by the enormous amount of new research being conducted on the problem, not to mention the abundance of self-help literature that is published every year to help people cope with stress and burnout, whatever the cause. Burnout is, however, especially common in caring professions such as healthcare, social work, and teaching, with a prevalence of up to 25% in these professions suggested by some research.3

Burnout amongst doctors working within the NHS seems to be on the rise, and this is causing problems, not just for the individuals concerned, but for a healthcare system that is already desperately stretched and now at risk of losing huge numbers of staff because of it. For this reason, it is essential that we as individuals, and the system as a whole, understand what burnout is, what impact it has, and how it can be stopped or reversed.

Clinical features of burnout

Burnout is classically defined as an experience of physical, emotional, and mental exhaustion caused by long-term involvement with situations that are emotionally demanding.3 It comprises three major components: emotional exhaustion, depersonalisation, and an absent sense of personal accomplishment.4 These three major components were incorporated into a scoring system, the Maslach Burnout Inventory, which has been used to evaluate and study burnout in a variety of settings, and in a variety of guises, since its creation in 1981.5

When building their inventory, Maslach and colleagues defined each of these three components. They described emotional exhaustion as a feeling of being emotionally overextended by one’s work. Many writers and researchers see exhaustion as the key component of the burnout syndrome, and there are alternative scoring systems to reflect this line of thought.6,7 Exhaustion has a pervasive effect on the ability of a doctor to carry out his or her work safely and effectively or of a student to learn effectively. This feeling of exhaustion also carries over into the personal life of a burnout sufferer, affecting relationships and the ability to have a happy and fulfilling life outside of work. Thus, burnout can not only ruin careers, but it can damage all aspects of a sufferer’s life, resulting in a spiral of low mood and dissatisfaction.

The second major component of burnout, depersonalisation, is described as an unfeeling, unempathetic, and impersonal response to the interaction with patients. The burnout sufferer dehumanises the person with whom they are interacting (usually the patient, although this can also be junior colleagues), and this leads to cold, callous behaviour and cynicism. The result is interactions between patient and doctor, doctor and doctor, or doctor and student that are unsatisfying, unproductive, and potentially dangerous for the patient, as well as potentially damaging to the doctor’s career. This type of interaction also contributes to a diminished sense of personal accomplishment for the doctor, which is the third component of the burnout syndrome.

Personal accomplishment relates to a sense of competence or achievement in one’s work which results in job satisfaction or, if absent, dissatisfaction. A poor sense of personal accomplishment has been demonstrated by some studies to be the leading feature of burnout amongst certain groups of medical professionals such as physicians working in pain management in the US.8

The Maslach Burnout Inventory uses a questionnaire from which a score can be given to each of these three features to identify those who are suffering from burnout and those who are at risk of burnout. This sterile, statistical way of considering a human problem is particularly useful for research, but the real-life interaction between these three components varies considerably, resulting in different degrees of distress and debilitation for sufferers.

There are a number of factors that can contribute to occupational burnout, whatever the occupational environment. In general, people are at high risk of occupational burnout when they do not feel in control of their work. Workload can be an issue, but it is actually the ability to manage that workload by being able to make decisions and take control of the way it is managed that is key. In the literature, the ability to make these crucial decisions is known as decision latitude. If you lack decision latitude with regards to workload management, then this can lead to unsustainable workplace stress and burnout.9

It is easy to see how junior doctors and medical students can be robbed of decision latitude, being, as they are, at the whim of rota coordination, patient flow, and service demand. Related to a lack of decision latitude are dysfunctional workplace dynamics (i.e. management and senior colleagues preventing juniors making these decisions), which may also include workplace bullying and an unclear or ill-defined job role.

Burnout can be the result of work that is monotonous or work that is chaotic, or indeed work that combines elements of these two apparently conflicting features.4 Work within healthcare is often capable of combining these two elements, with mundane routine work frequently interspersed with complex, important, and emotionally demanding tasks. Perhaps this is why those working within healthcare find themselves at such high risk of burnout.

Low income can also be a factor, as demonstrated in a study of burnout among paediatric nurses.10 Like the paediatric nurses in the study, junior doctors working at the bottom end of the pay scale may feel themselves under-rewarded for the work they do and, of course, medical students have not yet even made ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Preface
• Editor
• Contributors
• Introduction
• 1. What is burnout?
• 2. Pressures of the job
• 3. External pressures
• 4. Burnout in medical school
• 5. Changing the way we work
• 6. Finding a voice
• 7. Finding the right career
• 8. Resilience
• 9. Finding help
• 10. Final thoughts
• Index