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.
- 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
- 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
- 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.”
- Booth JV, Grossman D, Moore J, et al. Substance abuse among physicians: a survey of academic anesthesiology programs. Anesthesia Analg. 2002; 95: 1024-1030.
- Center C, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA. 2003; 289:3161-3166.
- 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.
- Linzer M, et al. Predicting and preventing physician burnout: results from the United States and the Netherlands. Am J Med. 2001; 111:170-175.
- Maslach C. Burnout: The Cost of Caring. Englewood Cliffs, NJ: Prentice-Hall; 1982.
- Maslach C, Schaufeli WB, Leiter MP. Job burnout. Ann Rev Psychology. 2001; 52:397-422.
- 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.
- Pereira SM, Fonseca AM, et al. Burnout in palliative care: a systematic review. Nurs Ethics 2011; 18:317-326.
- 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.
Fast Facts and Concepts are edited by Sean Marks MD (Medical College of Wisconsin) and associate editor Drew A Rosielle MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact’s content. The full set of Fast Facts are available at Palliative Care Network of Wisconsin with contact information, and how to reference Fast Facts.
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