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Knowing The Stages In Physician Burnout

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In the demanding realm of healthcare, physicians often find themselves navigating through a myriad of challenges that can lead to burnout. Understanding the stages of physician burnout is crucial for both medical professionals and the healthcare system as a whole. In this article, we will delve into the various facets of burnout, exploring the stages and shedding light on this pervasive issue.

Burnout: A Syndrome Born from Chronic Workplace Stress

Burnout is a psychological syndrome that results from chronic workplace stress that has not been successfully managed. It is characterized by feelings of exhaustion, cynicism, and inefficacy. Burnout typically occurs in stages, and various models describe these stages with some variation. Two popular models that exist to describe physician burnout include theories by American Psychologist Herbert Freudenberg and the Maslach Burnout Inventory by Christina Maslach and Susan E. Jackson.

The WHO has provided clarification about burnout being characterized by a syndrome that stems from occupational stress. Burnout can typically affect both your mental and physical state. Burnout occurs when you are feeling overwhelmed with work and can no longer keep up with the rigors of work.

Herbert Freudenberger, a psychologist, introduced the concept of “burnout” in the 1970s. He conducted research on the experiences of individuals working in high-stress professions, particularly in the helping professions such as healthcare. The term “burnout” was coined by Freudenberger to describe a state of physical and emotional exhaustion resulting from chronic workplace stress experienced by medical professionals including physicians and nurses. Physicians and nurses experience burnout due to their tireless work.

Key features of burnout include:

  • Emotional Exhaustion: Feeling drained and depleted of emotional resources, leading to a sense of being overwhelmed and unable to cope with stress.
  • Depersonalization (Cynicism): Developing negative attitudes and feelings towards work, colleagues, and oneself. This can manifest as a cynical or detached outlook.
  • Reduced Personal Accomplishment: A decline in feelings of competence and successful achievement in one’s work with a tendency to evaluate oneself negatively.

Burnout is often associated with work-related stress, but it can also result from other sources of chronic stress, such as caregiving responsibilities, personal health issues, or major life changes. It is prevalent in professions that involve a high level of emotional labor, long working hours, or intense interpersonal interactions.

Of course, natural epidemics like COVID-19 have magnified burnout among medical professionals. According to Medscape, physician burnout has increased to 53% from 42% with over 23% of physicians reporting that they were experiencing depression.

Common causes of burnout include:

  • Workload: Excessive workload, unrealistic expectations, and constant pressure to perform can contribute to burnout.
  • Lack of Control: Feeling a lack of control over one’s work or decisions can lead to a sense of helplessness and contribute to burnout.
  • Lack of Recognition: Not receiving acknowledgement or appreciation for one’s efforts and achievements can contribute to feelings of frustration and burnout.
  • Poor Work-Life Balance: When work takes up a significant portion of an individual’s time and energy, leaving little room for personal life and self-care, burnout can occur.

Difference between Burnout, Stress and Depression

Workplace stress occurs when you have too much work to handle, too many responsibilities and too many hours working. When you are experiencing burnout, you are experiencing not enough motivation, or energy and not enough care.

You can also distinguish burnout from depression. In burnout, you feel exhaustion and difficulty in performing tasks. In depression, you experience persistent feelings of hopelessness, worthlessness, and helplessness.

Different work situations which cause burnout include situations when you experience poor self-esteem, have unrealistic expectations, have a heavy workload, are understaffed, have workplace conflicts, or are not rewarded well at work. These situations create stressors which result in burnout.

What Are The Different Stages Of Burnout?

Burnout is not an instant phenomenon. It develops through stages. These stages develop to create an end stage where you are not able to carry out your occupational duties.

1. Honeymoon Phase

During this phase, also known as the enthusiastic phase, you are filled with high levels of energy and enthusiasm. You are filled with optimism and carry out multiple tasks and take on additional responsibilities which enable you to tap into your creative side.

2. Stress Phase

During this phase, you feel stressed and stress becomes an everyday part of your life. You begin to lose focus and your productivity starts to dwindle. Physically, you may experience less sleep or even take part in activities outside of work.

3. Chronic or Persistent Stress Phase

Stress becomes a chronic or persistent phenomenon. Stress becomes continuous, ultimately affecting the work you do. Also known as the stagnation phase, individuals start to feel overwhelmed and fatigued. They neglect their own needs and feel frustrated and disillusioned.

As the work pressure starts to mount, your work will become affected. Your apathy increases, making you unable to complete work on time. You begin to procrastinate in the completion of tasks and withdraw from normal social conversations. You even become angry and lash out at co-workers.

Some of these feelings even follow you to your home. Your relationships with family and friends suffer. Known as the apathy phase, Individuals may become detached from their work and colleagues. They may develop a cynical attitude, experience a decline in performance, and exhibit signs of emotional exhaustion.

4. Burnout Phase

This is the phase when you lose all your normal operations. Problems at work continually consume you. You experience self-doubt and may also feel numb. The mental symptoms aggravate the physical symptoms where you experience symptoms like chronic stomach aches, headaches, and gastrointestinal problems. Friends and family also notice behavioral changes.

5. Habitual Burnout Phase

During this phase, burnout becomes an everyday life phenomenon. This eventually leads to anxiety and depression. There is chronic mental and physical fatigue which prevents you from working. Your very job may be in jeopardy because of this.

Symptoms and Feelings of Each Stage

Burnout is typically characterized by three main components: emotional exhaustion, depersonalization (cynicism), and reduced personal accomplishment. Here are the symptoms and feelings associated with each stage:

1. Emotional Exhaustion

Symptoms

  • Feeling drained of emotional resources.
  • Frequently feeling tired, fatigued, or physically and emotionally depleted.
  • Difficulty in getting motivated or finding the energy to face work tasks.

Feelings

  • Overwhelmed.
  • Emotionally drained.
  • Easily irritated or frustrated.

2. Depersonalization (Cynicism)

Symptoms

  • Developing negative and cynical attitudes toward work and the people one is working with or for.
  • Treating clients, colleagues, or tasks as if they are impersonal or meaningless.
  • Withdrawing emotionally from work-related activities.

Feelings

  • Detached.
  • A sense of cynicism.
  • Developing a negative outlook.

3. Reduced Personal Accomplishments

Symptoms

  • Feeling a lack of achievement or accomplishment at work despite hard work and effort.
  • Evaluating oneself negatively in terms of competence and successful achievement in one’s work with people.
  • A decline in feelings of competence and successful achievement in one’s work with people.

Feelings

  • Ineffectiveness.
  • Low self-esteem.
  • Doubt about the value of one’s work.

It’s important to note that burnout is a gradual process and may not always follow a linear progression through these stages. Additionally, individuals may experience these symptoms to varying degrees.

It’s crucial to recognize the signs of burnout early and take steps to address and prevent it. This may involve seeking support, setting boundaries, and prioritizing self-care to promote overall well-being. If you or someone you know is experiencing symptoms of burnout, seeking professional help from a healthcare provider or counselor is recommended.

Recovering From The Different Stages Of Burnout

Recovering from burnout is a gradual process that involves addressing physical, emotional, and mental aspects of your well-being. The stages of burnout can vary, but here are some general strategies that may help at different stages:

Stage 1: Recognizing Burnout

  • Self-Awareness: Acknowledge and accept that you are experiencing burnout. Be honest with yourself about the signs and symptoms.
  • Seek Support: Talk to friends, family, or colleagues about your feelings. Sometimes, simply expressing what you’re going through can provide relief.
  • Set Boundaries: Assess and establish clear boundaries between work and personal life. Avoid overcommitting and learn to say no when necessary.

Stage 2: Addressing Physical Symptoms

  • Prioritize Sleep: Ensure you are getting enough restorative sleep each night. Establish a consistent sleep routine and create a comfortable sleep environment.
  • Healthy Diet and Exercise: Eat nutritious meals and engage in regular physical activity. Exercise has been shown to improve mood and reduce stress.
  • Medical Check-Up: If physical symptoms persist, consult with a healthcare professional to rule out any underlying health issues.

Stage 3: Emotional Well-Being

  • Practice Self-Compassion: Be kind to yourself. Understand that it’s okay to take a break and prioritize your mental health.
  • Mindfulness and Relaxation Techniques: Incorporate mindfulness or relaxation practices into your routine, such as meditation, deep breathing, or yoga.
  • Engage in Activities you Enjoy: Rediscover hobbies or activities that bring you joy and relaxation. Taking time for yourself is crucial in combating burnout.

Stage 4: Reevaluating and Adjusting

  • Reflect on Priorities: Reevaluate your goals and priorities. Make adjustments to your workload or lifestyle that align with your values and well-being.
  • Seek Professional Help: If burnout is significantly impacting your life, consider talking to a mental health professional for guidance and support.
  • Skill Development: Identify areas where you can improve your skills or delegate tasks. This can help prevent future burnout by creating a more manageable workload.

Stage 5: Prevention

  • Maintain Balance: Continuously strive for a healthy work-life balance. Regularly reassess and adjust your priorities to prevent burnout from recurring.
  • Build a Support System: Cultivate relationships with friends, family, and colleagues who can provide emotional support and understanding.
  • Learn Stress Management Techniques: Develop and practice stress management techniques, such as time management, problem-solving, and assertiveness.

Remember that recovering from burnout is a process that requires patience and commitment. If your symptoms persist or worsen, seeking professional help is crucial for tailored guidance and support.

FAQs

What are the symptoms of the final stage of burnout?

This is a stage of complete physical shutdown and uncontrollable anxiety attacks.

Does burnout contribute to medical errors?

Yes, Burnout does contribute to medical errors which in turn accentuates burnout.

Does burnout happen immediately?

No burnout does not happen immediately. Burnout gradually evolves in phases. The longer the burnout is not addressed, it can lead to a breakdown.

When should you seek medical help for burnout?

When you are experiencing burnout and having difficulty in concentrating or are constantly worried, you must immediately consult a doctor.

How long does clinical burnout last?

Clinical burnout can last anywhere between 3 months to one year.

References

https://www.everydayhealth.com/burnout/

https://www.medscape.com/slideshow/2023-lifestyle-burnout-6016058#2/

https://integrisok.com/resources/on-your-health/2021/november/what-are-the-5-stages-of-burnout/

https://www.forbes.com/sites/melodywilding/2023/02/21/am-i-burned-out-how-to-recognize-the-12-stages-of-burnout/

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