by Elsabé Brits

A large-scale study in the British Medical Journal, revealed burnout levels are highest in hospital doctors working in emergency medicine and intensive care.

The scale of burnout amongst clinicians and the serious impact it can have on patient safety and staff turnover has been revealed in the largest and most comprehensive systematic review and analysis of studies on the subject to date.

Previous studies have highlighted concerns that burnout – defined as emotional exhaustion, cynicism and detachment from the job, and a feeling of reduced personal accomplishment – is reaching global epidemic levels among physicians.

In the UK, a third of trainee doctors report that they experience burnout to a high or very high degree, while in the US, four in 10 physicians report at least one symptom of burnout. And in a recent review of low- and middle-income countries the overall single-point prevalence of burnout ranged from 2.5% to 87.9% among 43 studies.

Doctors experiencing burnout are twice as likely to be involved in patient safety incidents and four times more likely to be dissatisfied with their job, suggests the research.

Their analysis showed that physicians with burnout were up to four times more likely to be dissatisfied with their job and more than three times as likely to have thoughts or intentions to leave their job (turnover) or to regret their career choice.

Equally worrying was the finding that physicians with burnout were twice as likely to be involved in patient safety incidents and show low professionalism, and over twice as likely to receive low satisfaction ratings from patients.

The analysis also found that burnout and poorer job satisfaction was greatest in hospital settings, physicians aged 31-50 years, and those working in emergency medicine and intensive care, while burnout was lowest in general practitioners.

The association between burnout and patient safety incidents was greatest in physicians aged 20-30 years, and people working in emergency medicine.

According to the study, burnout is defined as a syndrome related to work that involves three key dimensions.

Firstly, emotional exhaustion, which represents the basic individual stress dimension of burnout and refers to feelings of being overextended and depleted of emotional and physical resources.

Secondly, depersonalisation, which is the cynicism component and represents a motivational, interpersonal distancing dimension of burnout and refers to a negative, callous, or excessively detached response to various aspects of the job.

Finally, a sense of reduced personal accomplishment, which represents the self-evaluation dimension of burnout and refers to feelings of incompetence and inadequate achievement and productivity at work.

This is the largest study of its kind in which 4 732 peer review articles were identified, of which 170 observational studies of 239 246 physicians were included in the meta-analysis.

It would not be inaccurate to say doctors in South Africa are also experiencing high levels of burnout and that their experiences are similar.

In a study published last year in the SAMJ high rates of burnout, depression, and anxiety in rural doctors in northern KwaZulu/Natal was found. All of which were associated with the intention to leave the public sector in the next 2 years. Of particular concern was that community service medical officers had high burnout and anxiety rates, as well as females.

According to another study about burnout among registrars, which was published in 2019 in the SAMJ, the existence of burnout is often not acknowledged. Medical doctors have poor insight into their symptoms, and find it difficult to admit to weaknesses and play the patient role. Not recognising the existence of burnout leads to poor coping strategies and help-seeking behaviour.

Overall, a concerningly high burnout level of 84% was found. This is higher than rates in other studies. A 2012 survey of 1 701 registrars in the USA found a burnout level of 60.3%

The red flags

The symptoms are explained in a study and it follows stages.

  • It starts with the “Honeymoon phase”, when you are committed to work and is very productive.
  • Onset of stress: Irritability, anxiety, reduced quality of sleep, neglect of personal needs and reduced productivity.
  • Chronic stress: Procrastination, resentment, social withdrawal, denial, feeling pressured, alcohol/drug use, aggressive behaviour.
  • Burnout: Pessimism, physical symptoms, self-doubt, neglect of personal needs, escapism, headaches, behavioural changes.
  • Habitual burnout: Chronic mental fatigue, chronic sadness, depression, chronic physical fatigue.

Fear of stigma of mental illness and a culture of coping alone often prevents doctors from seeking help. Practices like mindfulness, therapy, stress management, and small-group discussions can help.

The views expressed here are the guest blogger’s own.

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