|Burnout: A growing problem|
|Thursday, 01 July 2010|
A recent survey has shown that ‘burnout’ amongst surgeons is on the rise and can lead to surgical errors. This feature section looks at the nature of the problem and the support available to those who need help
Surgeons by and large aren’t good at the feely touchy stuff. We are good at working hard, dealing with taxing clinical situations and we have all made personal scarifies to achieve our original goal of being surgeons. We spend the extra time, we put in the extra effort which makes a difference for our patients and we deal with the setbacks which inevitably come with high stakes endeavour.
We also ensure that as far as possible we keep our emotions and personal problems from interfering with our work. These are professional attributes which should be highly regarded, but there is a boundary between that hard work and resolve and a situation where a proportion of the profession are struggling with personal and professional distress.
We are usually pretty clear that it is other people who are affected by psychological issues not ourselves. Recent studies have shown that not only are surgeons not immune from these problems, but in fact we are as susceptible as anyone else. What is more, this type of problem is associated with error, so it may be bad for our patients as well as ourselves.
"It is likely that this significant proportion of the profession could have their quality of life and performance significantly improved if these symptoms could be dealt with"
The American College of Surgeons have commissioned work into psychological problems amongst their Fellows. The results are sobering. Nearly 40% of those responding to the study met validated criteria for burnout. Burnout is a syndrome of emotional exhaustion and depersonalisation leading to poor performance. The literature suggests that there is a strong association between burnout and poor quality of care. Nine percent of the American surgeons reported a recent major medical error and 70% of them attributed that error to individual rather than to system failure. Reporting of a major error was very significantly associated with a poor quality of life score but this may have been due to the error rather than the cause of it. Reporting an error was also significantly associated with depersonalisation and emotional exhaustion. A cross sectional study such as this cannot show cause and effect but the longitudinal studies which have been done tend to suggest that the burnout symptoms come before the error.
Is this a problem which only affects American surgeons? The international literature is again consistent, with European, Australasian and North American doctors showing remarkably consistent results. UK surgeons have been studied, again showing similar rates to the recent American results. Whether these numbers are a true reflection of the psychological wellbeing of the profession is debateable, but what seems clear is this is an issue we need to learn more about and take seriously.
While these symptoms may be distressing and perhaps lead to poor productivity, do they affect patient care? We know that 10% of hospitalised patients have their care associated with error as distinct from complications. The impact of these errors is significant and there need to be systems in place which reduce the impact of them on individual patients. We appear to have an association between a common problem amongst surgeons which is itself associated with error.
This clearly needs more examination in order to understand the factors associated with it and how it might best be improved. Even if the error is not caused by the burnout it is likely that this significant proportion of the profession could have their quality of life and performance significantly improved if these symptoms could be dealt with.
In order to understand these issues better we have commissioned two articles, one about the nature of the problem and the second about some ways in which we can rehabilitate back into the workplace, those with the severe end of this spectrum.
This is a common problem which is here and now in a hospital near you.
John Duncan, Editor