IMAGINE you are a doctor and are just about to start your day at work. Despite having adequate sleep and eating well, your body feels weak, your mind is already tired, and you find yourself feeling inadequate in terms of your work performance.
All of these add on to your already pessimistic disposition and you find yourself yearning for the time when you can go home and rest. You might even be alarmed with yourself when you realise that you have been callous with your patients or were unable to empathise with them.
At the end of the work day, you feel as if you did not give your best and get frustrated. This is the gist of doctor or physician burnout.
It would be foolish to assume that burnout is “just a phase”. A 2018 study done in a Brazilian medical school suggests that burnout is already prevalent among medical students, with 48% to 70% of the participants saying they experienced at least one of the symptoms, and 44% of students fulfilling the criteria of burnout.
Even before their imminent entry into the workplace, medical students are not spared from the grasp of burnout. Findings of another recent study presented at the American Psychiatric Association (APA) 2018 annual meeting noted that an average of one doctor would commit suicide in the United States per day, with the number of doctor suicides ranging from 28 to 40 per 100,000 – twice the rate for the general population, in which the ratio is 12.3 per 100,000.
In our own country, we have heard or read news of doctors attempting suicide, the most recent case being a young doctor in Kuching who was found by his family to have overdosed on prescription medication in May this year. Another doctor was found dead in his hotel room where he seemingly injected himself. Since then, the Health Ministry has been conducting a nationwide mental health awareness campaign with a little more emphasis on depressive disorders.
Despite the well-meaning efforts of the Health Ministry, doctors are finding it difficult to confide in another professional about their own emotional issues. After years of toil in their studies, doctors find themselves lacking interest in their chosen career. Burnout causes doctors to lose their concentration, reduces their ability to think and eventually affects their professionalism. This is bound to affect the people around them and could possible set off a vicious cycle that would affect the quality of healthcare delivery.
Due to chronic lack of sleep, continuous working hours and with hardly any time or energy left for recreational activities, doctors tend to fall into burnout. In fact, the World Health Organisation (WHO) has acknowledged burnout as an occupational hazard in May 2019. It is defined in the 11th edition of the International Classification of Diseases as “a syndrome conceptualised resulting from chronic workplace stress that has not been successfully managed”.
It is characterised by three dimensions, namely feelings of energy depletion or exhaustion, increased mental distance from one’s job or feelings of negativism and cynicism related to one’s job, and reduced professional efficacy.
It is crucial to identify doctors suffering from burnout before we can address the problem. In fact, a questionnaire has been formulated for this very purpose. Called the Maslach Burnout Inventory (MBI), this scale has been in use since the 1970s. It can identify burnout with three cardinal symptom clusters which are in accordance with the WHO classification of this disorder.
Secondly, temporary workplace stress needs to be eliminated by analysing if the three cardinal symptoms affect an individual temporarily or for a prolonged period at a time.
Many methods have been proposed to reduce stresses that contribute to burnout. Some are even very imaginative, such as the “squeegee breath”. However, all doctors need to realise that he or she is not alone in feeling the emotional signs and symptoms of burnout or in thinking that these are a sign of slacking professionalism or failure. It’s only when the emotions they are experiencing are affirmed and acknowledged that the issues of doctor burnout can be resolved.
There needs to be an understanding between medical colleagues about the emotions they are feeling because of work. The medical profession is dynamic and ever changing, and so are the emotions that are generated in the course of the day.
There needs to be a strong support framework for doctors so that they can cope with burnout and enhance their will to persevere in their career. Without a solid structure or mutual understanding to manage burnout among doctors, reduction in the physicians’ work output would ultimately affect the quality of our healthcare delivery.