“Physician burnout”的意思、由来-开放百科全书

Physician burnout has been classified as a psychological syndrome that can be expressed as a prolonged response to due chronic occupational stressors.^[1] In the practice of medicine, it has been known to affect a wide variety of individuals from medical students through practicing physicians although its impact reaches far beyond that. Because of the toll taken on the healthcare industry, various treatment and prevention strategies have been developed at individual, team, and organizational levels in hopes to seek the best method of addressing this epidemic.

Characteristics

Prevalence

While occupational burnout has existed all throughout time, current literature suggests the prevalence of physician burnout now exceeds 50%.^[2] This refers to not only physicians currently practicing medicine, but also those in training. Signs of burnout have even been traced back to medical students who have experienced disconnect between taught professional behaviors and those witnessed in practice.

Signs

Burnout has been referred to as a compilation of cynicism, depersonalization, and a low sense of accomplishment.^[3] Other symptoms included feelings of emotional exhaustion, inadequacy, and detachment. This is thought to be due to imbalances whether that be in regards to workload, personal values, incentive, justice, and a sense of community. Factors such as time pressure, chaotic work environments and a lack of alignment between physicians and executives have been known to exacerbate this burden.^[2] These elements can cause clinicians to become frustrated and overwhelmed. Moreover, the correlation between lack of control and burnout has been explored and shows that an increased sense of lack of control has been linked to a greater risk of being affected by burnout.

[https://blog.curemd.com/physician-burnout/ Physician Burnout] of medical practitioners isn’t an individual problem. It has consequences for the whole healthcare industry. Healthcare in the US is expensive; but it is even more costly to replace a physician (approximately $250,000 to $1000000).

The practitioner also takes more leaves to reduce their burnout; which affects their overall productivity and reduces earnings significantly. Also, patients might switch to other clinicians and medical practitioners if they are absent for too long.

Furthermore, the impact of burnout has shown to negatively impact overall care delivery, more error rates are found, and patient care is gravely affected. An AMIA study has shown that physician burnout has the following indicators:

Models^[1]

Likewise, burnout has been analyzed utilizing differing conceptual models. One strategy examined burnout as a product of three stages. Stage one consists of exhaustion at work that progresses into detachment and negative feelings at work that later starts to affect patients and coworkers in stage two. Lastly, stage three is composed of feelings of inadequacy and failure. However, a more recent approach sought to choose three stages that served as a bridge between said stages and imbalances. The first groups together all job stressors such as imbalances caused by work demands while the second solely addressed individual strain in the form of anxiety and exhaustion. Lastly, the third described changes in mood and behavior as defensive coping that could be closely linked to cynicism.

Impacted populations

Physicians

The progression of physician burnout takes a toll on the individual whether it be a medical student or practicing clinician mainly through adverse psychological affects that have lasting consequences. A concept known as asymmetrical rewards speaks of how physicians are rarely recognized for what they do well, yet there is much attention surrounding medical malpractice suits ready to capitalize on a physician’s errors. In addition, clinicians become desensitized to patients and medicine resulting a perspective shift towards viewing patient care as a chore more than a desire to heal. However, the affects of burnout extend past the physicians themselves to ultimately affect anyone in contact with them.

Colleagues

Friends and family often feel the burden when interacting with burned-out clinicians since most of these individuals will be disengaged and can exhibit symptoms of major depressive disorder. Coworkers are also likely to be impacted. For example, burnout initiated by a chaotic, unsupportive work environment results in higher rates of miscommunication and unresolved conflicts. It has also been shown that a workforce afflicted by burnout contributes to an overall greater hostile atmosphere.

Health Industry

Other impacted populations include the patients and healthcare industry seeing as burnout results in decreased quality of care.^[4] Research has generated evidence supporting an inverse correlation between burnout and productivity. Thus the shift in decreased productivity sometimes ends in decreased physician retention due to low job satisfaction and decreased mental health. Since successful medical interactions are based on trust between providers and patients, this constant staff turnover can go on to reflect poorly upon the institution.

Treatment & prevention

Individual-approach

Treatment strategies first focused on addressing the individual. Physician-oriented approaches ranged from cognitive behavioral techniques (CBT) such as mediation and coping strategies to professional coaching which aimed at reinforcing individual resilience. Professional coaching involves the implementation of mentors that would aid in guiding physicians using their previous experiences with patients. Gazelle, Liebschutz, and Riess discussed the benefits of professional coaching as being able to cater to each provider using his or her own previous experiences therefore personalizing the intervention as opposed to CBT which delivers treatment in a standardized manner. On the other hand, Dr. Kelly speaks of how altering perception of patients from chores and potential litigation sources to opportunities to heal is key to the reversal of burnout.

Organizational-approach

However, some research suggests that a combination of individual, team, and organization approaches is the only way to address all levels of burnout and successfully put an end to this epidemic.^[5] Generally, organizational approaches have shown much promise as successful treatment options by reducing workloads and distributing more flexible schedules among employees. A shift to realign goals between physicians and executive administrators could also contribute to reducing the risk of burnout. A systematic review analyzing individual and organizational strategies found that organization-oriented approaches were more effective.^[6] Other examples of team approaches are the implementation of honest discussions between caregivers to emphasize compassion as well as organization-wide events to enhance workforce well-being. While Gazelle and Panagioti concluded that organizational approaches were superior to individualized interventions, the final verdict has not yet been reached as Wuest’s combined intervention addressing burnout at the individual, team, and organizational levels might be the key.

References

1. ^¹Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry, 15(2), 103-111. doi:10.1002/wps.20311
2. ^¹Rothenberger, D. A. (2017). Physician Burnout and Well-Being: A Systematic Review and Framework for Action. Diseases of the Colon & Rectum, 60(6), 567-576. doi:10.1097/DCR.0000000000000844
3. ^Gazelle, G., Liebschutz, J. M., & Riess, H. (2014). Physician Burnout: Coaching a Way Out. Journal of General Internal Medicine, 30(4), 508-513. doi:10.1007/s11606-014-3144-y
4. ^Dewa, C. S., Loong, D., Bonato, S., Xuan Thanh, N., & Jacobs, P. (2015). How does burnout affect physician productivity? A systematic literature review. BMC Health Services Research, 325(14). doi:10.1186/1472-6963-14-325
5. ^Wuest, T. K., MD, MMM, Goldberg, M. J., MD, & Kelly, J. D., IV, MD. (2017). Cinical Faceoff: Physician Burnout - Fact, Fantasy, or the Fourth Component of Triple Aim? Clinical Orthopaedics and Related Research, 475(5), 1309-1314. doi:10.1007/s11999-016-5193-5
6. ^Panagioti, M., Panagopoulou, E., Bower, P., Lewith, G., Kontopantelis, E., Chew-Graham, C., . . . Esmail, A. (2017). Controlled Interventions to Reduce Burnout in Physicians A Systematic Review and Meta-analysis. JAMA Internal Medicine, 177(2), 195-205. doi:10.1001/jamainternmed.2016.7674