Battling Burnout |
By Louise Gagnon Medical Post November 20, 2001 Dr. Eric Grief made a conscious decision to
put his personal life before his care" in medicine because he saw he was
likely to be a victim of burnout if he maintained the status quo. A graduate of the "We were encouraged to handle our
concerns on our own," says Dr. Grief. "I was experiencing warning
symptoms of burnout. I felt I was working too hard. I felt I was asking
myself questions like: 'How much do I have to give of myself?' " A husband and father to one child, Dr. Grief
gave up his hospital privileges and now works independently at walk-in
clinics in the "The first thing they suffer from is
emotional exhaustion," she says. "They find that at the end of the
day they have no energy left." Patients tell Dr. Gautam that if they
come home and find the roof has leaked or the kids are asking to play street
hockey, they can't do it. They just have nothing else to give. Dr. Gautam
describes the phenomenon that physicians are facing as depersonalization and
withdrawal, which is characterized by individuals pulling away, isolating
them selves, feeling a diminished sense of accomplishment and considering a
departure from medicine altogether. Dr. Gautam says she wants to ensure that
medical students learn that it's alright to ask for help in their studies,
and that as physicians, reaching out is not a sign of weakness, but a sign of
strength. "The culture has to change from one of being tough to one
where it's OK to take care of yourself," said
Dr. Gautam. "There is more education taking place now at an earlier
stage. We are talking at grand rounds and at continuing medical education
events about this problem. The key is prevention." She says she observes that medical students
are striving to maintain a balance of work and life as students, which she
foresees will continue when they enter their professional careers. Her sentiments are echoed by Canadian
Medical Association President Dr. Henry Haddad, who says there has been a
sea change in the attitudes of medical students to ward coping with
difficulties. "I applaud today's students for wanting a more balanced
life between their professional responsibilities, family and leisure,"
says Dr. Haddad. "It's very healthy and they will probably cope better
with the everyday stresses of physicians. I think they are being instilled
with the notion that there is no shame in admitting they are having a hard
time." Indeed, the outlook of younger physicians
is in contrast to physicians of his own generation, notes Dr. Haddad.
"There has been a certain stigmatization to the fact that we are
sick," he explains. "We have believed ourselves to be supermen or
superwomen who cannot get sick. There have been concerns we may lose our licence, we would suffer a loss of income and a loss of
prestige if we seek help. Some physicians then and now medicate themselves." While the code of ethics of the CMA
explicitly calls for its members to seek help from their colleagues and
appropriate qualified professionals if they sense their work is adversely
affected because of physical or emotional strain, the CMA is actively encouraging
members to get help. It recently published a pamphlet on the subject which it
is distributing to physicians throughout Another survey of rural physicians in Dr. Haddad points to several probable causes
for the soaring numbers of physicians who feel overwhelmed by their jobs. For
one, with the proliferation of health information on the Internet, patients
are asking more questions of their physicians, requiring doctors to ensure
effective patient-physician communication. Not only is the population
increasing, but also
it is aging, making medical man power a critical issue that has to be
addressed. “Some
of our physicians are more vulnerable to stresses," says Dr. Haddad.
"If they are based in remote regions, they are indeed at risk of
experiencing depersonalization or are unable to feel accomplishment at
work." At present, the CMA now directs
any calls from physicians who are needing help to
the provincial chapters. Some provincial organizations, such as the Ontario
Medical Association, have a program for providing resources to physicians
needing assistance. Dr. Michael Kaufman, who directs
the physician health program at the OMA, says an increasing proportion of
calls are non-drug and non-alcohol related and that the number of calls
coming in is on the rise. He attributes this to greater awareness of the
existence of the service. “Doctors may call and say
they are burnt out, and we inquire as to what that means," says Dr.
Kaufman. "We ask for details of the presenting problem, looking for
things like anxiety, depression and stress. It's a preliminary assessment." The service receives about 150
calls per year, which Dr. Kaufman believes is an under-representation of the
extent of burnout among physicians. "It is likely nowhere near what the
problem actually is," he says. When physicians do seek
professional help they typically are involved in psychotherapy for about 12
to 18 months, says Dr. Gautam, who sees about 150 patients per month. They
may be taking antidepressants in addition to receiving psychotherapy. Dr. David Rainham,
a Kitchener-Waterloo, Ont., physician and author of stress management guides
for various audiences, says the medical profession may attract individuals
who are perfectionistic and have high expectations,
which may contribute to their stress. That being said, the profession needs
to be more proactive in providing re sources. “A more intense person has
a harder time with ups and downs," says Dr. Rainham,
who teaches at the |