burnout; moral distress
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Etiology
- difficult to use electronic medical records linked to physician burnout[11]
Epidemiology
- physican burnout 55%, 10% increase in 3 years[4]
- physicians are more likely to have symptoms of burnout (38% vs 28%) & to be dissatisfied with work-life balance (40% vs 23%) than the general public[2]
- family practice, internal medicine, emergency medicine, & neurology at greatest risk[2]
- dermatology, general pediatrics, & pathology at lowest risk among physicians[2]
- physcian burnout increased during the Covid-19 pandemic[14]
- burnout symptoms increased to 63% of physicians & dissatisfaction with work-life balance increased to 70%[14]
- female physicians twice as likely as male physicians to experience burnout[14]
- emergency medicine, family medicine, & general pediatrics were speciaties at excess risk for burnout, compared other physicians[14]
Clinical manifestations
- frustation
- anger
- emotional detachment
- cynicism regarding work
- tense, sad feeling
- irritability
- withdrawal, numb feeling
- fatigue
- insomnia
- headache
- back pain
- changes in appetite
- GI distress
- fatigue, irritability, & negative expectations the strongest predictors of burnout during the Covid-19 pandemic[12]
Complications
- physician burnout adversely affects patient care
- 2-fold increase insafety incidents
- diminished professionalism
- low patient satisfaction[8]
- substandard patient care[13]
- application of nonmedical factors to standards of care is a source of stress for healthcare providers
- providing emergency-only hemodialysis to undocumented immigrants with end-stage renal disease (ESRD) through emergency department causes moral distress & burnout among physcians, incurs higher health care costs & higher short-term mortality[10]
Management
- lifestyle
- obtain adequate sleep
- ensure proper nutrition
- participation in regular physical activity
- schedule adequate vacation time
- participate in outside interests
- engage in spirituality
- meditate &/or pray
- use humor
- recognize limitations
- carry out positive inner dialogue
- social support systems
- foster open communication about professional stress with colleagues
- seek emotional support & practical assistance from family
- maintain network of friends
- organizational
- enhance cooperation among members of healthcare team
- carify roles & responsibilities of team members
- develop supportive work relationships
- improve policies to allow flexibility of staff to provide care
- reducing workloads[6]
- enhancing teamwork & communication skills[6]
- training in mindfulness, reflection, problem solving, work-life balance, & job satisfaction[3][6][7]
- improves measures of empowerment, engagement at work, & depersonalization
- does not improve psychosocial stress, symptoms of depression, quality of life, or job satisfaction
- self-compassion & vulnerability[7]
- organizational changes & individual training sessions are modestly effective[5]
More general terms
References
- ↑ Vachon MLS, Staff Stress and burnout: In: Berger AM, Portenoy RK, Weissman DE, eds, Principles & Practice of Palliative Care & Supportive Oncology, 2nd ed, Philadelphia, PA, Lipincott & Williams, 2003:831
- ↑ 2.0 2.1 2.2 2.3 Shanafelt TD et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012 Aug 20; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22911330 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1351351
- ↑ 3.0 3.1 West CP et al. Intervention to promote physician well-being, job satisfaction, and professionalism: A randomized clinical trial. JAMA Intern Med 2014 Apr 1; 174:527. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24515493
Goitein L. Physician well-being: Addressing downstream effects, but looking upstream. JAMA Intern Med 2014 Apr 1; 174:533 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24515255 - ↑ 4.0 4.1 Swift D Physician Burnout Climbs 10% in 3 Years, Hits 55% Medcscape. Dec 1, 2015 http://www.medscape.com/viewarticle/855233
- ↑ 5.0 5.1 West CP et al. Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. Lancet 2016 Sep 28; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27692469
Epstein RM, Privitera MR. Doing something about physician burnout. Lancet 2016 Sep 28 PMID: https://www.ncbi.nlm.nih.gov/pubmed/2769246 - ↑ 6.0 6.1 6.2 6.3 Panagioti M et al. Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. JAMA Intern Med 2016 Dec 5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27918798
- ↑ 7.0 7.1 7.2 Thomas LR, Ripp JA, West CP. Charter on Physician Well-being. JAMA. Published online March 29, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29596592 https://jamanetwork.com/journals/jama/fullarticle/2677478
Mount Sinai Hospital/Mount Sinai School of Medicine Medical group offers steps to address physician burnout. EurekAlert. March 29, 2018 https://www.eurekalert.org/pub_releases/2018-03/tmsh-mgo032818.php
Schwenk TL Physician Well-being and the Regenerative Power of Caring. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29596590 JAMA. Published online March 29, 2018 - ↑ 8.0 8.1 Panagioti M, Geraghty K, Johnson J et al Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction. A Systematic Review and Meta-analysis. JAMA Intern Med. Published online September 4, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30193239 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2698144
Linzer M Clinician Burnout and the Quality of Care. JAMA Intern Med. Published online September 4, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30193370 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2698140 - ↑ Rotenstein LS et al. Prevalence of burnout among physicians: A systematic review. JAMA 2018 Sep 18; 320:1131 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30326495
Dyrbye LN, Burke SE, Hardeman RR et al. Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians. JAMA 2018 Sep 18; 320:1114 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30422299 - ↑ 10.0 10.1 Cervantes L, Richardson S, Raghavan R et al. Clinicians' perspectives on providing emergency-only hemodialysis to undocumented immigrants: A qualitative study. Ann Intern Med 2018 Jul 17; 169:78 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29800062 <Internet> http://annals.org/aim/article-abstract/2682329/clinicians-perspectives-providing-emergency-only-hemodialysis-undocumented-immigrants-qualitative-study
- ↑ 11.0 11.1 Melnick ER et al The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians Mayo Clinic Proceedings Nov 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31735343 https://www.mayoclinicproceedings.org/article/S0025-6196(19)30836-5/fulltext
- ↑ 12.0 12.1 Kachadourian LK, Feder A, Murrough JW et al. Transdiagnostic psychiatric symptoms, burnout, and functioning in frontline health care workers responding to the COVID-19 pandemic: A symptomics analysis. J Clin Psychiatry 2021 Apr 27; 82:20m13766. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34004095 https://www.psychiatrist.com/jcp/covid-19/transdiagnostic-psychiatric-symptoms-burnout-functioning-frontline-health-care-workers-responding-to-covid-19/
- ↑ 13.0 13.1 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ 14.0 14.1 14.2 14.3 14.4 Shanafelt TD et al. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic. Mayo Clin Proc 2022 Sep 13; [e-pub]. https://www.mayoclinicproceedings.org/article/S0025-6196(22)00515-8/fulltext
Hodkinson A et al. Associations of physician burnout with career engagement and quality of patient care: Systematic review and meta-analysis. BMJ 2022 Sep 14; 378:e070442. https://www.bmj.com/content/378/bmj-2022-070442