THE BURNT-OUT DOCTOR. Dr Maria Phalime 18 th August 2018

Transcription

1 THE BURNT-OUT DOCTOR Dr Maria Phalime 18 th August 2018

2 INTENTION Common understanding Reflection

3 Not everything that is faced can be changed, but nothing can be changed until it is faced James Baldwin

4 WHAT IS BURNOUT? A psychological syndrome that arises in response to chronic interpersonal stressors on the job Christina Maslach, Wilmar B. Schaufeli, Michael P. Leiter. Annual Review of Psychology :1,

5 DIMENSIONS OF BURNOUT Emotional Exhaustion I ve got nothing left to give

6 DOCTORS ARE GIVERS Selfless Givers: High concern for others Low concern for themselves Set few or no boundaries Give to the point of exhaustion

7 DIMENSIONS OF BURNOUT Cynicism Negative attitude towards patients Irritability Callousness Detachment Depersonalisation Emotional Exhaustion

8 DIMENSIONS OF BURNOUT Depersonalisation Emotional Exhaustion What s the point? Imposter Syndrome Low sense of accomplishment

9 DIMENSIONS OF BURNOUT Depersonalisation Emotional Exhaustion Low sense of accomplishment

10 CONTEXT OF BURNOUT

11 CONTEXT OF BURNOUT WORKLOAD High patient volumes Long working hours Burden of disease Life & death decisions

12 CONTEXT OF BURNOUT WORKLOAD CONTROL Call roster Placement Resource constraints

13 CONTEXT OF BURNOUT WORKLOAD CONTROL REWARD Recognition Intrinsic reward meaning Financial

14 CONTEXT OF BURNOUT WORKLOAD CONTROL Low levels of support Toxic work relationships Working away from loved ones COMMUNITY REWARD

15 CONTEXT OF BURNOUT WORKLOAD Transparent policies and decision making FAIRNESS CONTROL COMMUNITY REWARD

16 CONTEXT OF BURNOUT Mismatch between personal & professional values Leaders who don t walk the talk Work/home conflict VALUES WORKLOAD FAIRNESS CONTROL COMMUNITY REWARD

17 CONTEXT OF BURNOUT Mismatch between personal & professional values Leaders who don t walk the talk Work/home conflict VALUES WORKLOAD High patient volumes Long working hours Burden of disease Life & death decisions Transparent policies and decision making FAIRNESS CONTROL Call roster Placement Resource constraints Low levels of support Toxic work relationships Working away from loved ones COMMUNITY REWARD Recognition Intrinsic reward meaning Financial

18 CONTEXT OF BURNOUT Human Rights Commission slams lack of VALUES WORKLOAD progress in KZN oncology crisis Alleged corruption behind Gauteng health crisis revealed FAIRNESS Med stockout crisis cripples North West Internship placement delay causing COMMUNITY headache for medical graduates REWARD CONTROL Life Esidimeni hearings: 'Not my fault they died'

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20 DOES IT MATTER?

21 1 Increased medical errors WHY IT MATTERS: 2 Breakdown in doctor-patient relationship 3 Low staff morale & dysfunctional work relationships 4 Absenteeism & high turnover 5 Physical and mental health issues

22 When doctors burn out

23 When doctors burn out Patients receive burnt-out care

24 WHAT DO WE DO ABOUT IT?

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31 RESILIENCE TRAINING TREATMENT Focuses on individual; ignores the context Contributes to stigma of burnout as personal failing/weakness Sends the wrong message - It s not your environment, it s you Futile if people continue to work in same contexts Doctors don t need more toughening up

32 BURNOUT IS AN OCCUPATIONAL HAZARD OF THE PRACTICE OF MEDICINE

33 APPROACH Address the drivers of burnout in the workplace Promote well-being and performance

34 NOTE: 1 There are no quick-fixes 2 No blame game. Doctor well-being is a shared responsibility 3 4 Design well-being strategies that encompass BOTH individual and organizational interventions Leadership is key

35 APPROACHES TO ADDRESS BURNOUT DRIVERS OF BURNOUT INDIVIDUAL Transform mindset of selfless giving Build self-awareness to recognise signs of burnout Nurture primary relationships Focus on what s working Meaning and engagement ORGANISATIONAL Acknowledgement & assessment of burnout in the workplace. Creative workload management Culture of no-tolerance to bullying Safe working hours Advocacy DoH, HPCSA PERFORMANCE & WELL-BEING Build skillset in personal performance & well-being: sleep, nutrition, energy management, self-compassion Training leadership; communication; teamwork Coaching & mentoring Peer support programmes Social activities Culture of caring for one another Ongoing feedback & refinement

36 WHERE TO FROM HERE? Keep the conversation alive to raise awareness and reduce stigma Implement interventions in your work units Targeted research Better understanding of the problem Assess effectiveness of interventions

37 HOW ARE YOU DOING?

38 THANK