Stress and burnout Stress is a physiological response

Stress and burnout

Stress is a physiological response to an inappropriate level of pressure

Causes (in doctors) § § § Escalating workload Frequently imposed change patients expectations fear of litigation Conflict ? lack of career structure

Definition of Burnout § Burnout is a state of mental and/or physical exhaustion caused by excessive and prolonged stress. § [Girdino, DA, Everly, GS, and Dusek, DE, Controlling Stress and Tension, Allyn & Bacon, Needham Heights, MA, 1996]

Possible features of burnout include: § § § § guilt at taking time off work minimising contact with patients excessive discussions about past mistakes excessive discussion about future workload becoming cross with a colleague or employee at least once per day drinking alcohol before working inability to concentrate on the matter in hand emotional exhaustion

Predisposing factors to Burnout/ stress reaction § § § § Type A or obsessional personality Conscientiousness Reluctance to decline work Reluctance to delegate Single handed or dysfunctional partnership long hours lack of variety

Signs to watch for (1) § § § § Temper outbursts Over drinking or smoking Changes in eating habits Withdrawing from usual activities Becoming unreasonable Rushing around Forgetfulness

Signs to watch for (2) § § poor timekeeping and decision making sick leave increased frequency of mistakes strained relationships

BMA Counselling Service § 150 calls per month to the counselling service § "Emotional" problems are by far the biggest category § 35% of emotional problems are depression § This is 3 times the rate of all physical problems combined § Doctors have a lifetime risk of 1 in 15 for alcohol and/or substance misuse

Suicide § Male doctors have a suicide rate lower than the general male population (SMR=66. 8) § Female doctors have a much higher suicide rate than the general female population (SMR = 201) § 4 times as many male suicides as females overall and absolute numbers are low § Community health, Public health, Anaesthetics, General Practice have the highest rates. GP the highest absolute numbers Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England Wales, 1979 -1995 K Hawton et al J Epidemiol Community Health 2001; 55: 296 -300 ( May