Healthcare professionals need to acknowledge that the
stresses they work under and the toxic environment they work in predispose them
to burnout and depression. It is therefore imperative that they recognise the
drivers and the symptoms of the condition and seek help before it becomes a
self-perpetuating cycle of hopelessness that makes treatment and the learning
of coping mechanisms and resilience skills extremely difficult.

“When we deal with burnout in doctors, we find that the
burnout itself limits the ability to treat it because by the time they seek
help, their feelings of hopelessness make it very difficult for them to believe
that change is possible,” says well-known psychiatrist, Dr Franco Colin. He was
speaking to paediatricians at the recent UPdate conference at the University of
Pretoria, specifically about the reasons for burnout in paediatricians and how
it can be prevented and treated.

Presenting statistics showing that around 35% of
paediatricians, or one in three, experience burnout at some point in their
careers, he cited issues such as dealing with the emotional trauma of a child
dying, managing stressed and sometimes aggressive parents of sick children and
the difficulty of diagnosing and treating a child who is unable to give an
accurate account of his/her medical history or symptoms as some of the unique
stressors contributing to depression and burnout in this specialty. Further
contributing factors that also apply to other disciplines are personal issues
such as negative life events, feelings of sadness and depression and work-related
issues such as a hectic or chaotic work setting, working more than 50 hours a
week and having worked in the same position for more than four years.  In addition, there is the phenomenon of healthcare
providers being the “second victims” where they are traumatised by an
unanticipated adverse patient event or a medical error which make them feel
personally responsible for the patient outcome and having failed the patient.

Physicians who are less likely to succumb to burnout are
those who are in good physical health, who are getting personal support from
their colleagues, who have adequate resources to provide optimal patient care
and who have the autonomy to decide on the best care for their patients. However,
these are mostly lacking in the South African health environment due to issues
such as medical schemes interference in treatment choices, cost considerations,
having to adhere to the rules of the institutions doctors work in and rising
malpractice litigation.

According to Dr Colin, research has shown that in
paediatrics, the absence of positive job features such as autonomy and the recognition
for a doctor’s work and the utilisation of his or her skills contribute more to
burnout than the presence of negative job characteristics such as work overload
and having to deal with distressed parents. Doctors who experience a positive
work environment are much more likely to see the work they are doing as
meaningful and to tolerate stressful aspects, which in turn give them the strength
and ability to be motivated and engaged in the work they are doing.

“Burnout is a sign that something is wrong in the environment
which is aggravated by personal characteristics that diminish the person’s resilience
and ability to bounce back and adapt,” Dr Colin stressed. “Physicians who have
mastered the individual skills, behaviours and attitudes of resiliency are far
better equipped for the challenges in medical training and patient care and are
less likely to experience burnout.”

Recognising burnout

The term burnout describes conditions developing in the
context of the workplace characterised by emotional exhaustion, a feeling of depersonalisation
and a low sense of accomplishment. But while it is mostly triggered by psychological
stress, it can also be aggravated by psychiatric disorders such as anxiety,
major depressive disorder and bipolar disorder.

It is therefore imperative that physicians who seek help
first go to a psychiatrist to determine if there are underlying psychiatric
disorders that are making them more susceptible to develop burnout, “says Dr

Burnout impacts on doctors’ competency, their
professionalism, career satisfaction and the quality of care they give to their
patients, often leading to substance abuse through self-prescription of drugs
that they have access to. They have more self-reported clinical and medication
errors, have decreased adherence to best practices, their clinical reasoning is
impacted, they hate their work and are often absent from work. Burnout also
affects their physical health, personal relationships and their ability and
motivation to learn. They tend to withdraw from their colleagues, friends and
families and isolate themselves. They overvalue negative feedback and tend to
be irritable, cynical and tend to lose perspective, explained Dr Colin.

Barriers to seeking

But even if they acknowledge that something is wrong, physicians
find it very difficult to seek help because they work within a culture that frowns
on what they deem to be “weakness”, fear of “what others may think”  and reluctance to acknowledge personal
struggles. Physicians also tend to have very strong egocentric personalities
that make it difficult for them to accept outside advice or support and to consider
taking time away from practice “as they feel they have to take care of everything
themselves”, Dr Colin explained.

Managing burnout

Dr Colin stressed that acknowledging that you need help is
the first step in treating the condition. Doctors also have to recognise that
they need to prioritise themselves and believe that they have the ability to
make the changes they require to improve their mental and physical well-being.
These could include more flexible working hours, making more time for recreation
and family and friends, changing schedules to allow for more hours of sleep and
exercise, and to ensure that they make time to enjoy a proper meal.

Most importantly, you must believe you can change the
situation by learning and implementing coping mechanisms, Dr Colin said. These
could include eliminating or modifying the sources of stress, identifying and analysing
stressful situations, acquiring and learning problem solving and communication
skills, and learning to control stress by acquiring stress management skills
such as deep breathing and muscle relaxing techniques.

But hospitals and practices also need to change and implement
wellness programmes that contribute to the wellbeing of physicians. Ideally,
these should include:

  • A wellness scale that helps physicians to assess their risks
    for burnout.
  • Honest discussions between doctors, management and other
    hospital and practice staff.
  • Encouraging physicians to talk about adverse events and medical
  • Developing flexible schedules and controlling working hours.
  • Encouraging non-over time work days.

Prevention begins in
medical school

But says Dr Colin, learning to cope with the stressors that
lead to burnout starts in medical school where the introduction of training aimed
at increasing awareness of stress, the promotion of a supportive culture, the destigmatisation
 of depression in medical students and the
creation of a safe space to identify and treat students who are at risk can go
a long way in preparing and helping junior doctors to cope in and adapt to  a  stressful
working environment.