Burnout is a work-associated stress response that leads to a persistent negative emotional state on a psychological and somatic level. Physicians are particularly at risk for burnout due to a variety of factors. To keep demands and coping resources in balance, it is important to identify stressors in time and apply effective coping strategies.
Conditions that favor the development of burnout are, in addition to a high workload, a lack of recognition and conflicts within the team. Perfectionists with high demands on their own performance and excessive expectations are particularly at risk of burnout. Dr. med. knows how important it is to have a good work-life balance in the medical profession. Anastasia Gudakovskaja, general practitioner in Vienna, from her own experience [1]. According to a survey, panel physicians work up to 60 hours per week, some even more, and often the general conditions are not ideal.
Recognize risk factors for burnout
If the requirements and resources for coping with them are disproportionate over a longer period of time, this can have psychosocial consequences. Burnout (box) is primarily characterized by exhaustion accompanied by chronic stress, reduced efficiency and motivation, and the development of dysfunctional behavior in the workplace [2,3]. On the somatic level, burnout is characterized by a disturbance of the neuroendocrine regulatory mechanism, which can manifest itself in vegetative symptoms [3]. This condition develops gradually and may go unnoticed by the affected individual for a long time. The most commonly used survey instrument is the Maslach Burnout Inventory (Overview 1) .
Keeping an eye on work-life balance
Numerous studies have shown that physicians are particularly at risk for burnout and depression, and it has been scientifically proven that there is a direct correlation between physicians’ health status and quality of care. “Physicians who feel both healthy and fit provide better and higher quality health care,” Dr. Gudakovskaya said [1]. Work-life balance could be paraphrased as “balance of energy expenditure for performance for society and energy gain by claiming performance from society and personal regeneration”. In a survey among physicians on what they understand by a good work-life balance, the spectrum of answers ranged from “Have never dealt with this before” to “balanced proportion of work and free time, feeling subjectively satisfied” or “being able to reconcile private needs with work with ease, depending on personal preferences” [1]. The speaker considers the latter to be a very good definition, although it should be taken into account that work-life balance also has different individual connotations depending on the life situation (e.g. family with children vs. singles) [1]. Tools and routines for enjoyable work are highly relevant. Approximately 20-50% of patients in primary care practices suffer from functional complaints and the prevalence of chronic conditions is generally increasing. According to a recent health survey in Germany and Austria, more than one third of the population is affected, reports the speaker [1]. The most common are back problems, followed by hypertension, chronic neck pain. Osteoarthritis and depression. The physicians surveyed fear that the workload will increase in the coming years due to rising patient numbers. Treating “difficult patients,” such as demanding, rude, or aggressive chronic pain patients or patients with psychiatric illnesses, requires an especially large amount of energy.
Use coping strategies
Physician-patient interactions and general coping strategies are highly relevant to everyday practice.
Emotion regulation: Emotional stress can have a negative effect on the energetic and motivational level and lead to an impaired ability to concentrate. As a physician, one should realize that emotion is an expression of a need or evaluation. Being able to interpret emotions appropriately is an important factor. For example, anger is an indicator that you perceive a need for change, something is bugging you, and you are overwhelmed, Dr. Gudakovskaya said, adding that communicating feelings can be very helpful [1]. With regard to doctor-patient interaction, it is very important to pick up patients on an emotional level, she said. Showing compassion and understanding is central, for example by saying “I would also like you to find relief, but to do so I need to get an overview of your complaints” or “I realize that you are at the end of your patience”, or “I feel your distress”. Only then does communication follow at the cognitive level, e.g. using “W” questions such as “What have you taken on so far”? In addition to active listening, patience, openness and empathy, important resources in dealing with difficult patients are the ability not to refer the other person’s problems and conflicts to oneself and the intuitive perception of what is not being said.
Expectation management: As a physician, you are confronted with multiple demands and constraints on a daily basis. Motivation and empathy can decline over time. The speaker would like to raise awareness that self-imposed and externally imposed expectations and related demands in the professional and private environment should not be in disproportion with one’s own energy balance and learned coping strategies over a longer period of time (i.e. months to years) [1]. “It’s very important to take an empathetic look at your own performance expectations, inflated expectations and beliefs, and your own perfectionism,” Dr. Gudakovskaya said. Doctors often endure symptoms for longer than average, which often has to do with fear of a loss of image. She emphasizes that it is important to be aware of one’s symptoms.
Demarcation: “For a good work-life balance and a good energy balance, we need to set personal boundaries,” explains the speaker [1]. You should feel where your limits are and be able to communicate them openly. Possible forms of demarcation include not being available to patients outside of practice hours, not reading professional emails at home, and avoiding distractions. Delegating administrative tasks and a strict separation of private obligations and working time is highly recommended, the speaker said. Of course, it is also important to ensure that basic physical and psychological needs are met and to counteract mood disorders. One should also respect the limits of one’s own knowledge. It’s an advantage as a doctor to be able to admit when you don’t know something, Dr. Gudakovskaya explains. In such cases, she advises exchange with colleagues and, if necessary, referral of the patient to a specialist. When dealing with demanding, dissatisfied, aggresive, and psychiatrically disturbed patients, demarcation is important as self-protection. Again, consideration should be given to referring patients to specialists.
Stress management: “Personal stress management is very important,” emphasizes the speaker. The personal stress and strain factors must be identified and specifically influenced [5]. The basic idea is that a state of burnout can be prevented. Accompanying coaching or communication training can be helpful for this, according to Dr. Gudakovskaja [1]. With the help of specific measures, strategies for coping with stress and an appropriate way of dealing with the stresses of everyday working life can be learned. Mindfulness is an important aspect of this. It is the opposite of multi-tasking by focusing on the clear and non-judgmental sensing of what is happening in the present moment [1]. Body sensations, thoughts and feelings, are merely considered and accepted as they are. This ability is often lost in the demanding daily routine [5].
Literature:
- “Enjoying the profession as a general practitioner to the fullest and with ease – Life balance for the general practitioner as the basis for optimal patient care”, Dr.med. Anastasia Gudakovskaya, 6 Highlights in 60 Minutes, WebUp, Sept. 30, 2022, Forum for Continuing Medical Education (D).
- ICD-11, https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/129180281, (last accessed Oct. 11, 2022).
- “Burnout – a guide from ifa,” Institute of Occupational Medicine, www.arbeitsmedizin.ch/fileadmin/data/downloads/Burnout__Leitfaden.pdf, (last accessed Oct. 11, 2022).
- Maslach C, Jackson SE, Leiter MP: Maslach Burnout Inventory Manual (3rd ed.). 1996, Palo Alto: Consulting Psychologists Press.
- “Depression,” Prof. Dr. Dr. Martin E. Keck, www.psych.mpg.de/2354388/depression_patienten_broschuere_keck.pdf, (last accessed Oct. 11, 2022).
InFo ONCOLOGY & HEMATOLOGY 2022; 10(5): 38-39.
HAUSARZT PRAXIS 2022; 17(10): 60-61
CARDIOVASC 2022; 21(4): 50-51