The Science of Burnout Define compassion fatigue, secondary - - PDF document

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The Science of Burnout

What Is It, What Causes It, and What Makes It Go Away

Diana Coffa, MD Residency Program Director, Family and Community Medicine University of California, San Francisco

Roadmap

• Define burnout and discuss its impact
• Describe risk factors and protective factors
• Define compassion fatigue, secondary

traumatic stress, and compassion satisfaction

• Discuss strategies for preventing burnout and

promoting compassion satisfaction

Herbert Freudenberger’s original conception of burnout

• 1. Compulsion to prove oneself
• 2. Working harder
• 3. Neglecting needs
• 4. Displacement of conflicts
• 5. Revision of values
• 6. Denial of emerging problems

Herbert Freudenberger’s original conception of burnout

• 7. Withdrawal
• 8. Obvious behavioral changes
• 9. Depersonalization

10.Inner emptiness 11.Depression 12.Burnout syndrome—physical and emotional collapse

The concept was refined by Christina Maslach, developer of the Maslach Burnout Inventory

• Emotional exhaustion
• Cynicism and depersonalization
• Loss of sense of efficacy

Impact of Burnout

• 25-75% of practicing physicians have burnout

at any given time.

• Over a career, periodic episodes of burnout

are virtually inevitable

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Impact of Burnout

Increased rates of

• Depression
• Anxiety
• Suicidality
• Increased inflammatory markers
• Possible association with cardiovascular

disease

• Increased sick calls
• Attrition from medicine

Adverse impacts spread

Increased

• Errors, both medical and surgical
• Patient dissatisfaction
• Postoperative recovery times
• Wound infections
• Patient nonadherance

Other Models

Secondary Traumatic Stress Compassion Fatigue Compassion Satisfaction

What is Compassion Satisfaction?

The satisfaction derived from being able to help

• thers.

“Incentivizing with money is a self-fulfilling prophecy

• f cynicism. We must promote compassion, courage,

and wisdom among our physicians before we make a sordid business of this high and sacred calling.”

The Impact of Compassion Satisfaction

• Studies on the impact of emotional

attunement and engagement

– Higher adherence to medications and recommendations – Increased patient satisfaction – Increased placebo response

Describe a time when you felt compassion satisfaction at work

• What were the conditions that promoted it?

– Personal conditions – Environmental/professional conditions

• How can you build more of those conditions

into your work?

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Risk Factors and Protective Factors

Work Personal Risk Protection

Work Related Risk Factors

• Lack of control
• Heavy workload
• Exposure to trauma

Risk Factors and Protective Factors

Work Personal Risk Lack of control Heavy workload Exposure to trauma Protection

Work Related Protective Factors

• Shared mission
• Flexible schedule
• Teamwork
• Work friends
• Supportive culture
• Teaching and administrative roles

– Opportunity for sense of effectiveness in the short to mid term

Risk Factors and Protective Factors

Work Personal Risk

Lack of control Heavy workload Exposure to trauma

Protection

Shared mission Flexible schedule Teamwork Work friends Supportive culture Teaching and administrative roles

Personal Risk Factors

• Temperament and personality features

– Alexithymia

• Life stress
• Personal history of trauma
• Approach to work

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Approach to work

• Surface organized

– Must be “just so”

• Surface disorganized

– Overwhelmed

• Deep approach

– Interested and engaged by complexity, problem solving

McMannus IC et al. Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates. BMC Medicine 2004. 2:29

Personal Protective Factors

• Cultivating relationships with patients
• Cultivating relationships with colleagues
• Social support
• Empathetic concern coupled with emotional

flexibility

• Openness to new experience
• Deep approach to work
• Self care practices

Risk Factors and Protective Factors

Work Personal Risk

Lack of control Heavy workload Exposure to trauma Temperament and personality features Alexithymia Life stress Personal history of trauma Approach to work

Protection

Shared mission Flexible schedule Teamwork Work friends Supportive culture Teaching and administrative roles Relationships with patients Relationships with colleagues Social support Empathetic concern Emotional flexibility Openness to new experience Deep approach to work Self care practices

Self-care practices

• Meditation
• Exercise
• Outside interests
• Psychological practices
• Therapy
• Micro-breaks
• Vacations

Meditation

• Increased attentional control
• Increased ability to notice and accurately label

emotions

• Decreased impulsive reaction to negative emotion
• Shift from “brooding” or perseverative style to

“compassionate noting” style of awareness

• Increased positive affective states

– Happiness, joy, love, gratitude, contentment, hope, interest, amusement, awe

• Increased internal resources:

– greater purpose in life, improved resilience, enhanced

• ptimism, greater mindfulness, more self-acceptance,

more hope

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Far Enemy Near Enemy Compassion Cruelty Devastating Grief/Pity Loving-kindness Hate Desire Resonant Joy Jealousy Giddiness Equanimity Agitation Apathy

Psychological Practices

• Gratitude list
• Taking in the good
• Perspective taking
• Deep breath
• Visualization

Micro-breaks

• Short, dispersed throughout day
• Work-related

– Conversations with colleagues

• Physical

– Walk down the hall – Stretch

• Relaxing

– Deep breath – Visualization – Words

Vacations

• Reduced work related stress and burnout for

1-2 months

• Shorter if high workload upon return
• Consider shorter, more frequent vacations

Your assignment

• Notice the moments when you experience

compassion satisfaction.

• Take the time to soak it in when it happens.
• Look for ways to build more in.