The Burnout Paradox: Why Are We Still Surprised?

by SkepticalScalpel | Jan 18, 2018

If you go to medical school, you will be stressed—bigly. It should not come as a surprise. Two posts on the Kevin MD website highlight the problems facing many medical students today. The first was by an anonymous rising fourth year student who has come to the conclusion that going to medical school was “a terrible, terrible decision.” It ended with a comment that medical school “is not fun. It’s jarring, scary, disappointing and absolutely depressing.” The second was by another anonymous student who described how miserable he (or she) has been since he started medical school. He said “’burnout’ is the word I would use to best describe my medical school experience.” On the day he wrote his post, he was about to text the surgery residents to tell them he would not be there for the last day of his rotation because he was too anxious. He mentioned a strong family history of anxiety disorders and being diagnosed with depression and anxiety as he was applying to medical school. He did not disclose this during the application process. Burnout is not limited to a few students. A literature review in 2013 found “at least half of all medical students may be affected by burnout during their medical education.” Nor is the problem confined to medical students. A national survey published in Academic Medicine in 2014 found that 58.2% of medical students, 50.8% of residents/fellows, and 40% of early career physicians screened positive for depression. Last week, Medscape’s 2017 Lifestyle Report, a survey of practicing physicians, found that 51% were burned out—an increase from 40% in 2013. The...

Is Burnout Talk Causing More Burnout?

by SkepticalScalpel | Jan 18, 2016

Almost every day for the last few years, someone is writing about physician burnout or depression. The problems begin in medical school. A recent paper featured drawings that medical students had done depicting faculty as monsters. One student felt so intimidated during a teaching session that she drew a picture of her urinating herself. The paper equated faculty and residents supervising students to “zombies, vampires, ghosts, and other supernatural figures.” In dealing with the state of the world today, the authors cited a comment by the novelist Stephen King saying that to cope with adversity, people make up horror stories. That sounds pretty serious. Could the problem be declining student resilience? An article about college students in Psychology Today pointed out that they are less able to deal with seemingly minor affronts. And teachers are reluctant to “give low grades for poor performance, because of the subsequent emotional crises they would have to deal with in their offices.” “If emotional contagion has such an impact on Facebook users, maybe all these stories about burnout and depression have an impact on students and doctors too.” This has forced faculty “do more handholding, lower their academic standards, and not challenge students too much.” The article pointed out that college students exhibit more anxiety and depression and take more prescription drugs for these problems than ever before. It’s not just students. A systematic review of 54 studies found that 29% of resident physicians were depressed or had depressive symptoms. The number ranged from 20.9% to 43.2%, depending on the method studies used to assess depression. Investigators from the Mayo Clinic and...

Living for Yourself, Prioritizing Your Needs

by TimH | Jan 23, 2015

Research indicates that physicians tend to put the needs of their patients before their own. “We’re never taught that we’re allowed to put any of our own needs first, or even that it’s sometimes healthy to do so,” says Robb Hicks, MD. “Unfortunately, this perception often continues when physicians are developing and maintaining a practice because it requires being as available to patients as possible.” Understanding Priorities Dr. Hicks says that physicians must ensure that their own needs are being met in order to be the best providers for their patients. “That means that physicians must prioritize their time and energy,” he says. “This requires us to put some of our own needs before those of our patients.” Providers who are unable to find a work–life balance are likely to burn out and make mistakes. “While we shouldn’t put all our needs first, we must make daily efforts to maintain our own physical, mental, spiritual, and emotional health,” Dr. Hicks says. “The key is to figure out what things are truly needs, and which are simply desires.” Once there is an understanding of priorities in their life, physicians must notice when their thoughts or behaviors are not consistent with their priorities. “It’s important for physicians to recognize when they sacrifice time with their spouse or their children, or when they give up their routine activities because of work obligations,” says Dr. Hicks. “This is when their priorities have become confused or are out of sync.” Making Positive Changes Recognizing that changes are needed and making these changes are two different things, according to Dr. Hicks. “The inability to create...

How Nurse Burnout Affects Hospital-Acquired Infections

by admin | Feb 20, 2014

Previous research has linked invasive devices and clinical practice to hospital-acquired infections (HAIs). There is now evidence suggesting that elements of nursing care are also linked to the prevalence of HAIs. Few studies have rigorously examined the possible underlying mechanisms of the relationship between nurse staffing and HAIs. In the American Journal of Infection Control, my colleagues and I had a study published that assessed job-related burnout among registered nurses to determine its accountability for the relationship between nurse staffing and infections acquired during hospital stays. Burnout Affects Infection Rate Our findings show that job-related burnout among nurses appears to be a plausible explanation for some HAIs. Nurses had an average total of 17 years experience, caring for an average of about six patients. Almost 37% reported high levels of burnout. At the hospitals involved in the study, 16 of 1,000 patients acquired some type of infection, particularly urinary tract infections (UTIs), surgical site infections (SSIs), and gastrointestinal infections, as well as pneumonia. For modeling and further analysis, we limited the types of infection to UTIs and SSIs. As patient loads escalated, the number of UTIs and SSIs increased significantly. In additional modeling, nurse burnout was highly associated with these infections, a finding that hasn’t been reported in previous research. A 10% increase in a hospital’s composition of high-burnout nurses was linked to an increase of nearly one UTI and two SSIs per 1,000 patients. Perhaps the most important finding from our model was that reducing nurse burnout by 30% could prevent more than 4,000 UTIs and more than 2,200 SSIs each year and save up to $69 million...

Duty Hour Regulations: Perceptions of Surgical Residents

by admin | Feb 6, 2014

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) released its first regulations on work hours and supervision for residents. However, with these first regulations came much debate on how effectively duty hour limitations were at achieving the intended goals of improved patient safety as well as enhanced resident education. In 2011, the ACGME increased these regulations, a change that dramatically shifted traditional 24-hour in-house call schedules for many programs across the United States. The newest regulations require that interns have direct supervision from more senior residents or attending physicians at all times. The 2011 standards also limit first-year resident duty periods to a maximum of 16 hours and have a stricter 24-hour limitation for senior residents. “With the most recent ACGME duty hour regulations, the professional development of residents and the quality of their education has come into question,” explains Brian C. Drolet, MD. “The regulations inevitably lead to more frequent patient handoffs and less continuity of care.” Although fatigue can be an issue for patient safety, there is also evidence that frequent transfers of care and miscommunication can lead to errors. Surveying Views of Surgery Residents Previous studies have suggested that surgical residents believe some level of duty hour restriction is warranted, but they do not support significant regulation of duty hours. More recently, Dr. Drolet and colleagues had a study published in JAMA Surgery that examined surgical residents’ views of the ACGME requirements after they were implemented in 2011. The study assessed the perceived effects of the regulations on patient care, resident education, and quality of life. It also evaluated self-reported compliance and duty hour...

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