How do you recognize when a physician is experiencing burnout? Given the high demands of contemporary medical practice and the extreme pressures physicians work under, you might think burnout would be most clearly signaled by a blowup—“I can’t take this anymore!”
However, according to experts, burnout is usually quieter.
As Kathi J. Kemper, MD, MPH of the Ohio State University Wexner Medical Center points out in learning tool “Burnout, Stress, and Resilience,” the blowup is a symptom of stress, not burnout.
Stress, she writes, shows up as “over-engagement; when emotions are over-reactive and the demeanor is one of anxiety or hyperactivity.”
Burnout, on the other hand, appears as “dis-engagement; when emotions are blunted, and the demeanor is one of depression, detachment, helplessness or hopelessness.”
In a recent paper Christina Maslach and Michael P. Leiter sum up research Maslach pioneered on burnout in the 1970s. They point out the current consensus on the three major elements of burnout:
Exhaustion: “Described [in the literature] as wearing out, loss of energy, depletion, debilitation, and fatigue,” the researchers write.
Cynicism: “Originally called depersonalization (given the nature of human services occupations), but…also described as negative or inappropriate attitudes towards clients, irritability, loss of idealism, and withdrawal.”
Inefficacy: A sense of not being as effective as one could be, was initially called “reduced personal accomplishment,” according to Maslach and Leiter. It’s come to be described as “reduced productivity or capability, low morale, and an inability to cope.”
Exhaustion and cynicism are the primary indicators and tend to reinforce each other. Together they frequently produce the sense of inefficacy.
On the other hand, if all three elements are reversed, the authors note, the result is engagement: “An energetic state of involvement with personally fulfilling activities that enhance one's sense of professional efficacy.”
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