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• Re:Avoiding Burnout
  Elisabeth Paice
  Published on: 1 November 2013
• Avoiding Burnout
  David Levine
  Published on: 25 August 2013

• Published on: 1 November 2013

  Re:Avoiding Burnout

  • Elisabeth Paice
  • Other Contributors:
    • Diana Hamilton-Fairley

  Dear Editor Our editorial was triggered by a PMJ paper showing that in a study carried out in the US, 76% of first year doctors exhibited burnout. We quoted other evidence that burnout may occur surprisingly early in careers and is not necessarily related to seniority. We know that jobs which require daily face to face interaction with people who are distressed or challenging lead to high levels of burnout. Sadly it is th...

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  Dear Editor Our editorial was triggered by a PMJ paper showing that in a study carried out in the US, 76% of first year doctors exhibited burnout. We quoted other evidence that burnout may occur surprisingly early in careers and is not necessarily related to seniority. We know that jobs which require daily face to face interaction with people who are distressed or challenging lead to high levels of burnout. Sadly it is those who are most empathetic who become emotionally exhausted most quickly. We also know that isolation, overwork, lack of sleep and lack of expertise all add to the risk of burnout. New doctors should not have to cope with all of those at once. There is evidence from the GMC's annual National Trainee Survey (and before that the London-wide Point of View Survey) that over the past 16 years the proportion of new doctors who feel stressed, bullied or sleep-deprived has steadily reduced. We are not aware of any evidence suggesting it has got worse, though stresses may well have been transferred to those higher up the career ladder. Big problem is dependence on doctors in training to deliver service. Not a problem as such, but it is when service demands mean working under stress and without colleagues and supervision. Unsupervised work provides experience but cannot be considered as training. Working in teams, even if the membership of the teams changes, mitigates against isolation and provides supervision for the junior members. Diana Hamilton-Fairley. Elisabeth Paice

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 25 August 2013

  Avoiding Burnout

  • David Levine, Academic tutor. Retired Physician

  Avoiding burnout in new doctors: sleep, supervision and teams Elisabeth Paice, Diana Hamilton-Fairley 2013;89:493-494 doi:10.1136/postgradmedj-2013-132214

  I applaud Paice and Hamilton-Fairley's call for better work schedules and supervision, but burnout seems to increase with seniority and probably reflects more fundamental problems. Achieving even the aims mentioned may be more difficult than the authors suggest...

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  Avoiding burnout in new doctors: sleep, supervision and teams Elisabeth Paice, Diana Hamilton-Fairley 2013;89:493-494 doi:10.1136/postgradmedj-2013-132214

  I applaud Paice and Hamilton-Fairley's call for better work schedules and supervision, but burnout seems to increase with seniority and probably reflects more fundamental problems. Achieving even the aims mentioned may be more difficult than the authors suggest.

  They note that instant teams function well in the airline industry but link this statement to a paper which referenced stability as one defining factor for well-structured teams1. The questionnaire to identify team membership in that study across all types of hospital employees didn't ask about (or exclude) stability in the 'well-structured' teams correlated with weaker stressor-strain relationships. One criterion defining membership of a well-structured team was 'regular team meetings', which surely implies at least moderate stability. 'Ensuring that there is a leader, shared goals, well-defined roles, and mutual respect' are indeed important but stability is also necessary for most medical teams. Instant teams might function on airline flights but such teams in Medicine present serious problems for care of patients as well as for clinical supervision and appraisal of new doctors.

  If it 'really isn't that hard' to avoid damaging work schedules, we might ask why they are still so common and why Deaneries and other bodies haven't been able to stop them. One answer is, presumably, that the profession has progressively lost influence in many Trusts. The experience of 'hospital-at-night' in many Trusts is very different from the original concept. Too often, a few doctors (without the other help provided in exemplar sites) are responsible for large numbers of patients. There is evidence of unacceptable demands on many medical registrars for whom effective supervision of newer doctors is not possible2

  It's interesting that stress and dissatisfaction appear to be increasing despite overall reduction in working hours. Preparing new doctors to cope with clinical reorganisations, NHS instability and employers' attitudes to medical staff is a significant problem. In truth, fewer doctors in both hospital and general practice seem to want to work at night and the NHS doesn't yet know how to cope with that. I wonder if current levels of burnout and dissatisfaction reflect a deeper malaise for which we might need a different type of conversation?

  References

  1. Buttigieg SC, West MA, Dawson JF. Well-structured teams and the buffering of hospital employees from stress. Health Serv Manage Res 2011;24:203-12. 2. Royal College of Physicians. The medical registrar: Empowering the unsung heroes of patient care. London: RCP, 2013

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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