Background     As described in Fast Fact #167, burnout is a “psychological syndrome in response to chronic interpersonal stressors on the job” (Maslach 1982).  This Fast Fact will explore symptoms of burnout and its personal and professional consequences.  Fast Facts #169 and 170 will describe avoidance and assessment of burnout.

Symptoms of each sequential stage of burnout

• Stress Arousal:  anxiety, irritability, hypertension, bruxism, insomnia, palpitations, forgetfulness, and headaches.
• Energy Conservation:  Work tardiness, procrastination, resentment, morning fatigue, social withdrawal, increased alcohol or caffeine consumption, and apathy.
• Exhaustion:  Chronic sadness, depression, chronic heartburn, diarrhea, constipation, chronic mental and physical fatigue, the desire to “drop out” of society.

Consequences

• Personal
  • Depletion of emotional and physical resources.
  • Negative self-image:  feelings of incompetence and lack of achievement.
  • Self-neglect:  35% of Johns Hopkins’ medical graduates had no a regular source of

       health care.

• Questioning of previously held spiritual beliefs.
• Neglect of family and social obligations.
• Mental Illness: anxiety, depression, substance abuse, suicide.
  • Substance Abuse:  MD lifetime risk is 10-14%.
  • MD suicide rates similar to general population for both genders
  • Relative Risk of MD suicide versus other professionals
    • Male MDs: 1.1-3.4
    • Female MDs:  2.5-5.7
    • Female MDs complete suicide as often as male MDs
    • Professional
• Longer Work hours:  If I work harder, it will get better.
• Withdrawal, absenteeism, and reduced productivity.
• Depersonalization:  attempt to create distance between self and patients/trainees by ignoring the qualities that make them unique individuals.
  • Loss of professional boundaries leading to inappropriate relationships with patients/trainees.
• Compromised patient care. Burnout has been linked to
  • More medical errors
  • Diminished sense of empathy for patients
  • Impaired decision-making
  • 45% of University of Washington residents who self-report burnout also report providing “suboptimal care.”

References:

1. Booth JV, Grossman D, Moore J, et al.  Substance abuse among physicians:  a survey of academic anesthesiology programs.  Anesthesia Analg. 2002; 95: 1024-1030.
2. Center C, et al.  Confronting depression and suicide in physicians:  a consensus statement.  JAMA. 2003; 289:3161-3166.
3. Gross CP, et al.  Physician heal thyself?  Regular source of care and use of preventive health services among physicians.  Arch Int Med.  2000; 160:3209-3214.
4. Linzer M, et al.  Predicting and preventing physician burnout:  results from the United States and the Netherlands.  Am J Med. 2001; 111:170-175.
5. Maslach C.  Burnout:  The Cost of Caring.  Englewood Cliffs, NJ:  Prentice-Hall; 1982.
6. Maslach C, Schaufeli WB, Leiter MP.  Job burnout.  Ann Rev Psychology. 2001; 52:397-422.
7. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Int Med. 2002; 136:358-367.
8. Pereira SM, Fonseca AM, et al.  Burnout in palliative care: a systematic review. Nurs Ethics 2011; 18:317-326.
9. Dunwoodie DA, Auret K. Psychological morbidity and burnout in palliative care doctors in Western Australia. Intern Med J 2007;37:693-698.

Version History:  This Fast Fact was originally edited by David E Weissman MD and published in November 2006.  Version copy-edited in April 2009; revised again July 2015 with references #8 & #9 added and incorporated into the text.