
Physician work-related stress is a significant problem.1–3 U.S. physicians report higher than normal burnout rates7 and increased health problems, including alcohol use problems,5,6 excess weight,7,8 poor sleep,9 less exercise,8, and low career satisfaction.10 Physicians experience the burnout triad of:
- Emotional exhaustion (and depression) – discussed in Part 1 of this series
- Interpersonal disengagement (Depersonalization) – Part 2
- Low sense of personal accomplishment11 – discussed in Part 3 of this series
Interpersonal Disengagement (Depersonalization)
Interpersonal disengagement involves distancing from other people. Healthcare providers may express it as decreased empathy or compassion with patients, which is a problem because the bond with patients impacts the accuracy of diagnosis and treatment choices, as well as the overall success of clinical interventions from the intangible benefit of human connection.30–32 It may involve isolating from peers, which is problematic because medicine is a uniquely interactional profession that depends on discussions with peers for clinical guidance and support. We thus identify interpersonal disengagement as the most critical element to assess and impact.
Decreased contact with peers and distancing from patients leads to increased feelings of isolation33–35 and unrewarding interactions with patients. As seen in COVID-19 and the rest of medicine, the desire to heal is strong, and that desire ebbs as patient interactions become less effective and rewarding.
It is essential to catch interpersonal disengagement at an early stage. However, the busy nature of medical practice hinders detection by peers. Separation from peers, too, hinders the ability of peers to recognize this downward spiral. Patients are unlikely to call out a physician who appears aloof or distracted and may assume that the doctor is merely having a tough day.
The pandemic has worsened preexisting problems with patient interaction due to safety precautions and treatments.36 Healthcare providers who use detachment to cope with overwhelming emotions about patient suffering, frustration over limited treatments, and high mortality experience an increased impact on patient rapport.37 Alienation from family caused by bringing homework (such as documentation) impinged on shared time together before the pandemic. The pandemic magnified this alienation due to precautions taken to protect loved ones from catching the COVID-19 virus.38
In Part 3 of this series, we will discuss a changing sense of personal accomplishment and regret.
How can Lift help?
While interpersonal disengagement, or depersonalization, is part of the burnout triad, we reject the view that these terms are crushing weights that you cannot handle or that you must build up a barrier in defense. This element of burnout is not out of your control. At Clinical Tools, we propose solutions that lift health care providers up, empower them, and build upon their existing strengths, talents, and experience. Start with who you are, lift yourself, your colleagues, and the healthcare profession up.
References
Bibliography
- Patel RS, Bachu R, Adikey A, Malik M, Shah M Factors Related to Physician Burnout and Its Consequences: A Review. Behav Sci (Basel). October 25, 2018;8(11). doi:10.3390/bs8110098. PMCID: PMC6262585. PMID: 30366419.
- Brigham T, Barden C, Dopp AL, et al. A Journey to Construct an All-Encompassing Conceptual Model of Factors Affecting Clinician Well-Being and Resilience. NAM Perspectives. January 29, 2018. doi:10.31478/201801b.
- Tawfik DS, Phibbs CS, Sexton JB, et al. Factors Associated With Provider Burnout in the NICU. Pediatrics. May 2017;139(5). doi:10.1542/peds.2016-4134. PMCID: PMC5404731. PMID: 28557756.
- Shanafelt TD, Boone S, Tan L, et al Burnout and satisfaction with work-life balance among us physicians relative to the general us population. Arch Intern Med. October 8, 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199.
- Jackson ER, Shanafelt TD, Hasan O, Satele DV, Dyrbye LN Burnout and Alcohol Abuse/Dependence Among U.S. Medical Students. Acad Med. March 1, 2016. doi:10.1097/ACM.0000000000001138. PMID: 26934693.
- Oreskovich MR, Shanafelt T, Dyrbye LN, et al. The prevalence of substance use disorders in American physicians. Am J Addict. January 2015;24(1):30-38. doi:10.1111/ajad.12173. PMID: 25823633.
- Mota MC, De-Souza DA, Rossato LT, et al. Dietary Patterns, Metabolic Markers and Subjective Sleep Measures in Resident Physicians. Chronobiology International. October 1, 2013;30(8):1032-1041. doi:10.3109/07420528.2013.796966.
- Peckham C Physician Burnout and Exercise. Medscape Physician Lifestyle Report. 2015.
- Vela-Bueno A, Moreno-Jiménez B, Rodríguez-Muñoz A, et al. Insomnia and Sleep Quality among Primary Care Physicians with Low and High Burnout Levels. J Psychosom Res. April 2008;64(4):435-442. doi:10.1016/j.jpsychores.2007.10.014. PMID: 18374744.
- Keeton K, Fenner DE, Johnson TRB, Hayward RA Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol. April 2007;109(4):949-955. doi:10.1097/01.AOG.0000258299.45979.37. PMID: 17400859.
- Bohman B, Dyrbye, L, Sinsky, CA, et al. Physician Well-Being: The Reciprocity of Efficiency, Resilience, Wellness Culture. NEJM Catalyst. August 7, 2017.
- Wurm W, Vogel K, Holl A, et al. Depression-Burnout Overlap in Physicians. PLoS One. March 1, 2016;11(3). doi:10.1371/journal.pone.0149913. PMCID: PMC4773131. PMID: 26930395.
- Koutsimani P, Montgomery A, Georganta K The Relationship Between Burnout, Depression, and Anxiety: A Systematic Review and Meta-Analysis. Front Psychol. March 13, 2019;10. doi:10.3389/fpsyg.2019.00284. PMCID: PMC6424886. PMID: 30918490.
- Kraft U Burned Out. Scientific American. June 2006. doi:10.1038/scientificamericanmind0606-28.
- Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. December 6, 2016;316(21):2214-2236. doi:10.1001/jama.2016.17324.
- Mata DA, Ramos MA, Bansal N, et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. December 8, 2015;314(22):2373. doi:10.1001/jama.2015.15845.
- Kane, Leslie Medscape National Physician Burnout, Depression & Suicide Report 2019. Medscape; January 16, 2019.
- Loas G, Lefebvre G, Rotsaert M, Englert Y Relationships between anhedonia, suicidal ideation and suicide attempts in a large sample of physicians. PLoS One. March 27, 2018;13(3). doi:10.1371/journal.pone.0193619. PMCID: PMC5870971. PMID: 29584785.
- NIMH Depression. Mental Health Information. July 21, 2020.
- Maurer DM Screening for Depression. AFP. January 15, 2012;85(2):139-144.
- Hobson K New Medical School Programs Help Students Battle Burnout. US News & World Report. 2015.
- Tucker T, Bouvette M, Daly S, Grassau P Finding the sweet spot: Developing, implementing and evaluating a burn out and compassion fatigue intervention for third year medical trainees. Eval Program Plann. December 2017;65:106-112. doi:10.1016/j.evalprogplan.2017.07.006. PMID: 28763733.
- Dyrbye LN, Shanafelt TD, Werner L, Sood A, Satele D, Wolanskyj AP The Impact of a Required Longitudinal Stress Management and Resilience Training Course for First-Year Medical Students. J Gen Intern Med. December 2017;32(12):1309-1314. doi:10.1007/s11606-017-4171-2. PMCID: PMC5698225. PMID: 28861707.
- Ng R, Chahine S, Lanting B, Howard J Unpacking the Literature on Stress and Resiliency: A Narrative Review Focused on Learners in the Operating Room. J Surg Educ. August 24, 2018. doi:10.1016/j.jsurg.2018.07.025. PMID: 30146461.
- Farouk A Stopping burnout a top priority for physicians in training. AMA Wire. November 16, 2015.
- AMA Wire Student SOS: 6 ways to avoid “distress” in medical school. AMA Wire. May 15, 2015.
- Hu Y-Y, Ellis RJ, Hewitt DB, et al. Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. N Engl J Med. 31 2019;381(18):1741-1752. doi:10.1056/NEJMsa1903759. PMID: 31657887.
- Nanda A, Wasan A, Sussman J Provider Health and Wellness. J Allergy Clin Immunol Pract. December 2017;5(6):1543-1548. doi:10.1016/j.jaip.2017.05.025. PMID: 28734859.
- Dyrbye LN, West CP, Sinsky CA, Goeders LE, Satele DV, Shanafelt TD Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions. Mayo Clin Proc. 2017;92(10):1486-1493. doi:10.1016/j.mayocp.2017.06.020. PMID: 28982484.
- Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. June 2010;251(6):995-1000. doi:10.1097/SLA.0b013e3181bfdab3. PMID: 19934755.
- Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. June 2010;251(6):995-1000. doi:10.1097/SLA.0b013e3181bfdab3. PMID: 19934755.
- Klein J, Grosse Frie K, Blum K, von dem Knesebeck O Burnout and perceived quality of care among German clinicians in surgery. Int J Qual Health Care. December 2010;22(6):525-530. doi:10.1093/intqhc/mzq056. PMID: 20935011.
- Williams ES, Manwell LB, Konrad TR, Linzer M The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study. Health Care Manage Rev. September 2007;32(3):203-212. doi:10.1097/01.HMR.0000281626.28363.59. PMID: 17666991.
- Choi H, Irwin MR, Cho HJ Impact of social isolation on behavioral health in elderly: Systematic review. World J Psychiatry. December 22, 2015;5(4):432-438. doi:10.5498/wjp.v5.i4.432. PMCID: PMC4694557. PMID: 26740935.
- Cacioppo JT, Hawkley LC, Norman GJ, Berntson GG Social isolation. Ann N Y Acad Sci. August 2011;1231(1):17-22. doi:10.1111/j.1749-6632.2011.06028.x. PMCID: PMC3166409. PMID: 21651565.
- Tanskanen J, Anttila T A Prospective Study of Social Isolation, Loneliness, and Mortality in Finland. Am J Public Health. November 2016;106(11):2042-2048. doi:10.2105/AJPH.2016.303431. PMCID: PMC5055788. PMID: 27631736.
- McMahon SA, Ho LS, Brown H, Miller L, Ansumana R, Kennedy CE Healthcare providers on the frontlines: a qualitative investigation of the social and emotional impact of delivering health services during Sierra Leone’s Ebola epidemic. Health Policy Plan. November 2016;31(9):1232-1239. doi:10.1093/heapol/czw055. PMCID: PMC5035780. PMID: 27277598.
- Khullar D The Emotional Evolution of Coronavirus Doctors and Patients. The New Yorker. July 7, 2020.
- Hartzband P, Groopman J Physician Burnout, Interrupted. N Engl J Med. June 25, 2020;382(26):2485-2487. doi:10.1056/NEJMp2003149. PMID: 32356624.
~~
For Further Information
Company: Clinical Tools andHealth Impact Studio
Email: feedback@clinicaltools.com
Website: Lift.ClinicalEncounters
Founder, President, and Vision Leader: Bradley Tanner, MD, ME