© Borgis - New Medicine 4/2010, s. 169-170
*Ewa Ogłodek, Aleksander Araszkiewicz
Professional burnout among family physicians
Chair and Clinic of Psychiatry of the Nicolaus Copernicus University,
Collegium Medicum in Bydgoszcz, Poland
Head of Department: prof. Aleksander Araszkiewicz, MD, PhD
The ?burnout syndrome? (BOS) is used to describe a type of job stress specifically in those professionals who maintain a direct relationship with people who are the beneficiaries of their work, and means to be or feel burned out, exhausted, and overworked. The risk of professional burnout particularly concerns people who practise professions belonging to the so-called human services group. Professional burnout is a state of emotional and physical exhaustion caused by excessive and prolonged stress. As the stress continues, one begins to lose interest in or motivation for performing one?s job. Additionally, burnout reduces one?s productivity and energy. There are three phases of professional burnout: emotional exhaustion, depersonalization, and reduced sense of personal accomplishment. Professional burnout is often associated with incapacitation and high social, economic and individual cost, absenteeism, decrease in productivity, high turnover, increasing demand for health services, and abusive use of tranquilizers, alcohol and other drugs. Factors associated with burnout include age, marital status, how long the individual has been working as a health professional, work overload, interpersonal conflicts, conflicts between workers and their clientele, and lack of social support, of autonomy and of participation in decision-making processes. This paper discusses basic problems of professional burnout among family physicians.
Professional burnout syndrome is one of the more serious consequences of professional stress, in the literature often described as one of the possible reactions of an individual to chronic emotional stress related to working in professions where continuous contact with people is required. Professional burnout syndrome is, for a family doctor, one of the most serious results of stress (1, 2, 3).
Maslach dealt with the problem of professional burnout syndrome in the 1980s, and this concept was later supplemented by other researchers, such as Leitera, and Jackson. In the proposed model the symptoms of professional burnout syndrome have been grouped into three categories:
Emotional exhaustion ? it is the sense of emotional overload and depreciation of the possessed resources of emotions. The results of the lack of possibility to modify given stresses are pathological defensive reactions consisting in avoiding the stresses by withdrawal from contacts with patients, increasing the distance and even avoiding them;
1. The sense of alienation ? depersonalization. A person at this stage of burnout shortens contacts with patients to the necessary minimum, avoids eye contact and keeps a considerable distance in relations, with simultaneous appearance of his or her professional competences.
2. Reduced personal accomplishment is a reaction to failure in dealing with the experienced professional stress, which is associated with dissatisfaction with one?s accomplishments and leads to lowering of self-esteem and feelings of frustration (4, 5, 6).
According to the developed pattern, the course of professional burnout syndrome dynamics is as follows:
? first, as a result of a stressful job, emotional exhaustion intensifies, with psychosomatic symptoms dominant in its clinical picture: headaches, fatigue, insomnia;
? the next stage involves attempts to protect oneself against the consequences of exhaustion; the doctor applies mechanisms leading to the loss of care for those requiring help;
? the next, final stage is reduced personal accomplishment ? which reduces the quality of the performed work and extends the time of performing the undertaken tasks (7, 8, 9).
Prevention of the professional burnout syndrome in family doctors heavily burdened with a stressful job in everyday medical practice is an important element of consciously counteracting this phenomenon. Taking into account the fact that the discussed problem is of a complex nature, the actions undertaken for preventive purposes should apply to various areas of life (10, 11).
Prophylactic actions may be carried out in three dimensions, for the purpose of early detection and minimizing its presence:
1. The first level is the society; at this stage the most important actions are:
? education of the society about the professional burnout syndrome;
? improving professional education programmes for family doctors.
2. The second, directing level is based on preventive actions. These actions include:
? determination of work schedules, so that they do not exceed hourly standards provided for in the Act;
? if necessary, ensuring the possibility of rotation of personnel, based on a change of post or the type of work;
? creation of favourable working conditions, i.e. rest and refreshment rooms which will provide comfort and the possibility of rest;
? organization of employee meetings devoted to issues associated with the work performed;
? ensuring help and providing particular care for young employees who are beginning their professional lives (12, 13, 14).
3. The third level is the individual level. Actions undertaken individually for the purpose of defence against burnout are significant. We can distinguish here:
? awareness of the need to improve one's abilities and professional qualifications in order to ensure a sense of effectiveness and professional competence, which, in turn, allows one to avoid dissatisfaction;
? development of an attitude towards the suffering persons, which will prevent emotional engagement but also prevent objectified treatment of patients by them;
? changing unrealistic expectations and beliefs related to one's professional role, as well as their confrontation with reality for the purpose of verification,
? avoiding and preventing conflicts with team members,
? care for psychophysical regeneration of the body through regular and effective rest, development of interests, frequent meetings in a group of friends or learning various relaxation techniques (15, 16, 17).
The problem of professional burnout in family doctors discussed in the paper is one of the more serious effects of long-term stress resulting from the nature of the job they perform. Family doctors belong to the group of professions with a high probability of burnout syndrome development.
It is impossible to completely eliminate the effects of stress from the profession of a family doctor, but it is possible to minimize them by learning to shape and strengthen both personal and social resources. The work the essence of which is to help another person requires activation of one's own resources which are learned skills and professional competences as well as experiences in contacts with other people (18, 19, 20).
Contemporary medicine is becoming more and more challenging for family doctors since it assumes that a doctor, being the first contact for the patient, should be highly resistant to stress and should have well-developed mechanisms for dealing with difficult situations.
1. Anczewska M, Świtaj P, Roszczyńska J: Wypalenie zawodowe. Post Psychiatr Neurol 2005; 14(2): 67- 77. 2. Leenders MV, Henkens K: Burnout, work characteristics and retirement intentions. Tijdschr Gerontol Geriatr 2010; 41(3): 136-45. 3. Kjellberg A et al.: Stress, energy and psychosocial conditions in different types of call centres. Work 2010; 36(1): 9-25. 4. Ratanawongsa N et al.: Physician burnout and patient-physician communication during primary care encounters. J Gen Intern Med 2008; 23(10):1581-8. 5. Jensen PM et al.: Building physician resilience. Can Fam Physician 2008; 54(5): 722-29. 6. Santen SA et al.: Burnout in medical students: examining the prevalence and associated factors. South Med J 2010; 103(8): 758-63. 7. López-León E et al.: Professional burnout in family physicians and its association with social demographic and labor factors. Rev Med Inst Mex Seguro Soc 2007; 45(1):13-19.
8. Cetina-Tabares RE, Chan-Canul AG, Sandoval-Jurado L: Correlation between the level of work satisfaction and professional burnout in family physicians. Rev Med Inst Mex Seguro Soc 2006; 44(6): 535-40. 9. Trindade Lde L, Lautert L: Syndrome of burnout among the workers of the strategy of health of the family. Rev Esc Enferm USP 2010; 44(2): 274-9. 10. Soyka M: Many colleagues are overburdened. How is your mental health? MMW Fortschr Med 2010; 152(24): 26. 11. Prins JT, van der Heijden FM: Are you attached? Med Educ. 2010; 44(2): 120-1.
12. Potter P et al.: Compassion fatigue and burnout. Clin J Oncol Nurs 2010; 14(5): 56-62. 13. Hochstrasser B: Burnout ? ways to prevention and therapy MMW Fortschr Med 2010; 152(24): 30-3. 14. Golding M: Physician burnout and the revival of community activism. Md Med. 2010; 11(2): 5-6.
15. Miret C, Martínez-Larrea A: The professional in emergency care: aggressiveness and burnout An Sist Sanit Navar 2010; 33(Suppl 1): 193-201.
16. Arandelović M, Nikolić M, Stamenković S: Relationship between burnout, quality of life, and work ability index ? directions in prevention. Scientific World Journal 2010; 4, 10: 766-77. 17. Vićentić S et al.: Professional stress in general practitioners and psychiatrists ? the level of psycologic distress and burnout risk. Vojnosanit Pregl 2010; 67(9): 741-6. 18. Cafaro G, Sansoni J: Job satisfaction: a comparative study between public and private practice. Prof Inferm 2010; 63(2): 67-76. 19. Iglesias ME et al.: Reflections on the burnout syndrome and its impact on health care providers. Ann Afr Med 2010; 9(4): 197-8. 20. Huss E, Sarid O, Cwikel J: Using art as a self-regulating tool in a war situation: a model for social workers. Health Soc Work 2010; 35(3): 201-9.