Stress and Burnout

Causes of work-related stress

Doctor factors	Practice factors	Societal factors
Type A personality Obsessional, perfectionist High personal standards Conscientiousness Reluctance to decline work Reluctance to delegate Competitive nature Fear of failure to keep up with colleagues	Single-handed practice Professional isolation Repeated interruptions Unpredictable work Front-line Long hours Out-of-hours work Lack of variety/challenge Lack of peer recognition	Escalating patient expectations Rising complaints Increasing litigation Media reporting Frequent externally imposed changes Political interference

Burnout

Burnout is characterised by:

1. Emotional exhaustion – tiredness, irritability, depression, damage to interpersonal relationships, poor concentration leading to frequent mistakes, low self esteem, and sometimes alcohol/drug abuse

2. Depersonalisation – loss of human compassion, treating patients as objects

3. Falling levels of achievement – low productivity – sufferers typically get further and further behind with their work, leading to more stress

Four stages have been described:

• Overwork – poor timekeeping, increased sick leave, frequent mistakes
• Frustration – irritability shows
• Resentment – anger, apathy and cynicism take over
• Depression

Burnout avoidance

The issue of keeping doctors healthy and free from burnout seems to be much in the press currently, and the BMJ has been running a series of articles on this in the Career Focus section. There are four main areas to consider if you wish to manage your stress in a healthy way and avoid burnout:

1.      Acquiring the right skills

• Assertiveness in communication
• Time management
• Learn how to organise your workload efficiently and regulate your work pattern
• Leadership
• Negotiating skills

2.      Self awareness

• Knowing you limitations
• Coping with criticism
• Coping with difficult patients
• Understanding how you work in teams
• Understanding what motivates you

3.      Continuing Professional Development

• Finding the right job
• Planning your career
• Always maintaining the ability to change
• Knowing when to make a change
• Setting yourself challenging (but realistic) targets for each year
• Developing career and professional interests

4.      Keeping healthy

• Doctors as patients
• Exercise
• Maintain a sense of humour
• Get a life – maintaining a balance between home and work life
• Know where to find help if you need it

Optional further reading

• Jain A, Ogden J: General Practitioners’ experiences of patients’ complaints in BMJ 12 Jun 1999  http://www.bmj.com/cgi/content/full/318/7198/1596
• Positive Under Pressure by G Lindenfield and M Vandenburg, Thorsons 2000 ISBN  0-7225-3817-0 (you might find it in your practices patient's library).

 

Written by: Martyn Hewett

Last update: 29 August 2007