BURN OUT – THE SILENT EPIDEMIC Presented at the CCIH Annual Conference May 29, 2006 by Ron Mataya, MD, Chair, Department of Global Health Loma Linda University School of Public Health

The Syndrome Emotional Exhaustion Depersonalization Reduced personal accomplishment –occurs among individuals who do “people work” of some kind (Burnout: The Cost of Caring by Christina Maslach) A type of job stress –arising from the social interaction between helper and recipient

Emotional overload Subsequent emotional exhaustion –people feel drained and used up –emotional resources are depleted and there is no source of replenishment –people no longer able to give of themselves to others

Depersonalization –detached, callous and even dehumanized response signals –developing a poor opinion of people –expecting the worst from them –even actively disliking them

“I began to despise everyone and could not conceal my contempt. I find myself caring less and possessing an extremely negative attitude.” Provider may: –derogate other people and put them down –refuse to be civil and courteous to them –ignore their pleas and demands –fail to provide the appropriate care or help

Reduced personal accomplishment –results from being down on others and eventually on oneself –feelings of guilt about the way they have treated others –gnawing sense of inadequacy about their ability to relate to recipients –resulting in a self-imposed verdict of “failure”

“It’s painful to say it, but maybe I ‘m just not cut out for this kind of work. I thought of myself as a sensitive and caring person, but often I’m not sensitive and caring when I’m with clients – so I’m really deluding myself about the real me.”

Crumbling of self esteem results in –depression in some people –seeking for counseling or therapy –change jobs By abandoning any kind of work that brings them into stressful contact with people

Real Life Situations Teacher of a class of 30 students –must deal with their personal and social needs –discipline, influence, shape, manage and direct their behavior –face possible friction and hostility from parents –uncertainty of layoffs from administrators –ever-present budget cutoffs

A Mother: must care for several young children at home without help or support from others with no opportunity for a work break A Minister: A source of refuge and support for anyone seeking help any time Has no one to turn to when personal problems arise

A Police Officer deals continuously with seamy side of life with lawbreakers and victims of crime with violence and potential danger lurking in every encounter with a stranger

A Physician Wades in an unending stream of patients who are sick, upset, angry and frightened by their illness or its implications

Reactions The “Who?” question results in: –Blaming people provider of care recipient of care or both including self

The “What?” question Points us to the situation that is causing the burn out –What kind of tasks are they expected to do and why? –What settings do these activities take place? –What limitations or constraints exist for them because of protocol, rules, standard operating procedures?

“Although personality does play some part in burnout, the bulk of evidence I have examined is consistent with the view that burnout is best understood (and modified) in terms of situational sources of job-related, interpersonal stress.” Burnout – The Cost of Caring – by Christina Maslach, p. 14

How to handle burnout - personal approaches Working smarter instead of harder –setting realistic goals –doing the same thing differently –breaking away –taking things less personally Caring for Oneself as well as for Others –accentuating the positive –know thyself –rest and relaxation –making the transition –a life of one’s own

Social & Organizational Approaches Social support –the companionship of colleagues –help –comfort –insight –comparison –rewards –humor –escape

Improvements in the Work Place Getting more resources Doing it better –dividing up the work –changing the contact with clients –limiting job spillovers –taking time off –getting help

The Serenity Prayer “God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference”.