1. Stress and burnout

2. Stress is a physiological response to an inappropriate level of pressure

3. Causes (in doctors) Escalating workload Frequently imposed change
patients expectations
fear of litigation
Conflict
?lack of career structure

4. Definition of Burnout
Burnout is a state of mental and/or physical exhaustion caused by excessive and prolonged stress.
[Girdino, DA, Everly, GS, and Dusek, DE, Controlling Stress and Tension, Allyn & Bacon, Needham Heights, MA, 1996]

5. Possible features of burnout include:
guilt at taking time off work
minimising contact with patients
excessive discussions about past mistakes
excessive discussion about future workload
becoming cross with a colleague or employee at least once per day
drinking alcohol before working
inability to concentrate on the matter in hand
emotional exhaustion

6. Predisposing factors to Burnout/ stress reaction
Type A or obsessional personality
Conscientiousness
Reluctance to decline work
Reluctance to delegate
Single handed or dysfunctional partnership
long hours
lack of variety

7. Signs to watch for (1) Temper outbursts Over drinking or smoking
Changes in eating habits
Withdrawing from usual activities
Becoming unreasonable
Rushing around
Forgetfulness

8. Signs to watch for (2) poor timekeeping and decision making sick leave
increased frequency of mistakes
strained relationships

9. BMA Counselling Service
150 calls per month to the counselling service
"Emotional" problems are by far the biggest category
35% of emotional problems are depression
This is 3 times the rate of all physical problems combined
Doctors have a lifetime risk of 1in 15 for alcohol and/or substance misuse

10. J Epidemiol Community Health 2001;55:296-300 ( May
Suicide
Male doctors have a suicide rate lower than the general male population (SMR=66.8)
Female doctors have a much higher suicide rate than the general female population (SMR = 201)
4 times as many male suicides as females overall and absolute numbers are low
Community health, Public health, Anaesthetics, General Practice have the highest rates. GP the highest absolute numbers
Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales,
K Hawton et al
J Epidemiol Community Health 2001;55: ( May