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burnout; moral distress

Etiology: - difficult to use electronic medical records linked to physician burnout [11] Clinical manifestations: 1) frustation 2) anger 3) emotional detachment 4) cynicism regarding work 5) tense, sad feeling 6) irritability 7) withdrawal, numb feeling 8) fatigue 9) insomnia 10) headache 11) back pain 12) changes in appetite 13) GI distress 14) fatigue, irritability, & negative expectations the strongest predictors of burnout during the Covid-19 pandemic [12] 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] 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: 1) lifestyle a) obtain adequate sleep b) ensure proper nutrition c) participation in regular physical activity d) schedule adequate vacation time e) participate in outside interests f) engage in spirituality g) meditate &/or pray h) use humor i) recognize limitations j) carry out positive inner dialogue 2) social support systems a) foster open communication about professional stress with colleagues b) seek emotional support & practical assistance from family c) maintain network of friends 3) organizational a) enhance cooperation among members of healthcare team b) carify roles & responsibilities of team members c) develop supportive work relationships d) improve policies to allow flexibility of staff to provide care e) reducing workloads [6] f) enhancing teamwork & communication skills [6] 4) 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 5) self-compassion & vulnerability [7] 6) organizational changes & individual training sessions are modestly effective [5]

General

syndrome

References

  1. 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. 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; PMID: 22911330 http://archinte.jamanetwork.com/article.aspx?articleid=1351351
  3. 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: 24515493 - Goitein L. Physician well-being: Addressing downstream effects, but looking upstream. JAMA Intern Med 2014 Apr 1; 174:533 PMID: 24515255
  4. Swift D Physician Burnout Climbs 10% in 3 Years, Hits 55% Medcscape. Dec 1, 2015 http://www.medscape.com/viewarticle/855233
  5. West CP et al. Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. Lancet 2016 Sep 28; PMID: 27692469 - Epstein RM, Privitera MR. Doing something about physician burnout. Lancet 2016 Sep 28 PMID: 2769246
  6. Panagioti M et al. Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. JAMA Intern Med 2016 Dec 5. PMID: 27918798
  7. Thomas LR, Ripp JA, West CP. Charter on Physician Well-being. JAMA. Published online March 29, 2018 PMID: 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: 29596590 JAMA. Published online March 29, 2018
  8. 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: 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: 30193370 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2698140
  9. Rotenstein LS et al. Prevalence of burnout among physicians: A systematic review. JAMA 2018 Sep 18; 320:1131 PMID: 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: 30422299
  10. 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 PMID: 29800062 http://annals.org/aim/article-abstract/2682329/clinicians-perspectives-providing-emergency-only-hemodialysis-undocumented-immigrants-qualitative-study
  11. Melnick ER et al The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians Mayo Clinic Proceedings Nov 2019 PMID: 31735343 https://www.mayoclinicproceedings.org/article/S0025-6196(19)30836-5/fulltext
  12. 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: 34004095 https://www.psychiatrist.com/jcp/covid-19/transdiagnostic-psychiatric-symptoms-burnout-functioning-frontline-health-care-workers-responding-to-covid-19/
  13. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  14. 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