Physician's Weekly Article - When Physicians Become Patients: Coping With Stress and Burnout

       Physicians and surgeons who take steps to recognize the early warning signs for stress and burnout may be able to overcome their emotional exhaustion and increase physician well-being.

      Clinical investigations have demonstrated that burnout is present and widespread within the medical profession, and most American doctors are significantly overworked. “Stress and burnout are at epidemic proportions in the medical field, especially among surgeons,” says Wesley E. Sime, MPH, PhD. “Physicians are dealing with many professional demands and have widely diverse reactions to these strains. While some physicians become excessively ambitious—almost obsessive—in order to overcome workload problems, others develop a resigned, accepting attitude that leads to burnout.”

      Studies have examined surgeons’ attitudes on family life and work as well as how they deal with stress in light of emotional exhaustion, depersonalization, and being driven by personal accomplishments. The highest stressors have been excessive workload, increasing overhead, and night and weekend work. Seven out of 10 surgeons report being moderately or extremely emotionally exhausted, and 25% report frequent irritable behavior with their spouses, significant others, and family members when they are preoccupied with work matters. Sleep disturbances, withdrawal, overworking, procrastination, alcohol use, and overeating have also been negative outcomes associated with excessive workloads. “Physicians who don’t handle pressure well tend to slip into maladaptive practices such as denial, disengagement, substance abuse, and/or aggressive angry responses,” Dr. Sime adds.

      Acknowledge the Spillover Effect

      According to Dr. Sime, it is important to acknowledge the spillover effect of being exposed to trauma. “When caring for patients, stress is not limited to just the victims of a traumatic injury or medical crisis. Physicians also feel stressed when they lose a patient who seemingly could have been saved or when they must deal with the untimely death of a child. They may also feel helpless in dealing with nonfatal but devastating loss of function. Physicians and staff have empathy for their patients; they’re regularly dealing with the after effects of medical crises and the occasional failure. Unfortunately, the skill of being empathetic to patients and their families without getting caught up personally is not well addressed in medical training.”

      Recognize Early Warning Signs & Risks

      The prolonged exposure to critical decision making and patient complaints often leads to disillusionment, dissatisfaction, cynicism, irritability, and family problems (Table 1). “These are just some of the early warning signs of emotional exhaustion and burnout,” says Dr. Sime. “Our efforts in medicine can create risks by way of entrapment into stress and burnout syndromes.”

      Dr. Sime adds that no one is immune to the possible adverse health risks of distress, including physicians. “Some individuals are more resistant to stress than others. However, there’s an important link to be made regarding the mechanisms by which burnout may be related to disease. Amidst all of the exposure to major and minor trauma in medicine, physicians and staff might benefit from access to behavioral health specialists who have extensive stress-management training. These consultations appear to be compelling for those who regularly deal with the after effects of trauma and life-threatening crises. More attention is needed to address stress management among all healthcare providers. Established critical incident stress management procedures or similar initiatives provided through the leadership of physicians can have a significant impact.”

      Prevention is Possible

      Prevention is the preferred mode of intervention for burnout and should aim to alter the response to stress. Cognitive restructuring, biofeedback, relaxation, or exercise can all play a role in preventing burnout, according to Dr. Sime. “Physicians should capitalize on what they already do on a regular basis to cope with stress, such as participating in physical activity and exercise, eliciting family support, and engaging in leisure activities and hobbies. We must not underestimate the importance of family relationships, social support systems, and positive communication. These are powerful antidotes to burnout and emotional exhaustion.”

      Establish Well-Being Programs

      Many larger medical centers and hospitals are creating physician well-being programs to combat the emotional strain that impacts doctors and staff (Table 2). “These programs are designed to provide an in-house support system to monitor how physicians and staff are dealing with stress. They allow providers to discover healthy leisure and creative activities to get their mind off work. Organizing and systemizing these programs inside the hospital setting or clinical practice can be helpful to strengthen team building activities. These programs can also enable physicians and staff to better cope with stress and avoid burnout. Normalizing such programs may lead to better medical practices over the long run.”

      Wesley E. Sime, MPH, PhD has indicated to Physician’s Weekly that he has no financial interests to report.