Doctors, stress and burnout
Doctors are exposed constantly to risks, including stress, alienation, over-involvement, automatic behaviour, and burnout… The medical profession has until now been in the paradoxical position of needing as much… [support] …as any other group of clinicians (if not more), but generally getting less (Launer, 2006, p. 24).
One of the greatest challenges is to create a culture where difficulties are accepted as part and parcel of professional life. The social implications of the pursuit of a medical career, as well as the major cognitive challenges, need to be considered. Firth-Cozens (2003) emphasises the significant levels of stress among junior doctors – with 28% showing above threshold levels of stress, compared to 18% in the general working population. Differences in perceptions of and responses to stressful circumstances may well be indicative of personality predispositions. For example, McManus et al. (2004) reported a large-scale longitudinal cohort study of UK medical students and determined that personality traits, identifiable at the time of application to medical school, are strong predictors of subsequent job satisfaction and of the perceived supportiveness of the working environment. These traits include neuroticism, which shows a strong predictive effect for stress, and surface learning style, which is associated with a later surface-disorganised approach to work, and tends to predict expressions of high perceived workload. In contrast, the trait of ‘agreeableness’ is associated with later perceptions of supportive work environments. They suggest therefore that:
stress is not a characteristic of jobs but of doctors, different doctors in the same job being no more similar in their stress and burnout than different doctors in different jobs (McManus et al., 2004, p. 9).
It is not difficult to understand that a welter of negative feelings in an overworked, isolated, possibly frightened doctor may lead to disinterest in learning, and to feelings of estrangement from the professional community, as suggested by the following description of burnout.
What started out as important, meaningful and challenging work, becomes unpleasant, unfulfilling and meaningless. Energy turns into exhaustion, involvement turns into cynicism, and efficacy turns into ineffectiveness (Maslach et al., 2001).
McKimm (2009) notes the importance of being sensitive to the support needs arising during periods of change and transition and draws on Hay’s model of the Competence Curve (see figure) to highlight the possible responses trainees may have to personal change and stressors, which may compromise their competence for a period of time. As a supervisor, it is important to be alert to signs of difficulty and ready to provide specific targeted input as the trainee moves into stages of acceptance and development. McKimm suggests routinely building in 10 minutes of ‘talk time’ at the beginning or end of a supervision session, where the trainee is invited to talk about any personal issues that may be causing concern. This approach provides the trainee with permission to raise issues with you and acknowledges the interplay between ‘work’ and ‘life’.
Think about trainees who seem to struggle in your specialty or workplace.
- What characteristics do they seem to have in common?
- What strategies might you be able to put in place to support their transition?
- What interventions or strategies could you put in place to increase a sense of supportive work environment?