1. Stress and burnout

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

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

4. Definition of Burnout Burnout is a state of mental and/or physical exhaustion caused by excessive and prolonged stress. 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] [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 guilt at taking time off work minimising contact with patients minimising contact with patients excessive discussions about past mistakes excessive discussions about past mistakes excessive discussion about future workload excessive discussion about future workload becoming cross with a colleague or employee at least once per day becoming cross with a colleague or employee at least once per day drinking alcohol before working drinking alcohol before working inability to concentrate on the matter in hand inability to concentrate on the matter in hand emotional exhaustion emotional exhaustion

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

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

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

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

10. Suicide Male doctors have a suicide rate lower than the general male population (SMR=66.8) 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) 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 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 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, 1979-1995 K Hawton et al J Epidemiol Community Health 2001;55:296-300 ( May

11. Watch for This

12. To avoid this

13. And Get back to This