Doctors' rapid burnout; need for counseling

Extracts from the encyclopedia compiled

By

DR. MRS. Meenal Kumar, M.D. senior gynecologist and menopause consultant, sector 20 civil dispensary, Chandigarh
DR.R.KUMAR M.S., OPHTHALMOLOGIST AND HEALTH COLUMNIST, 232, SECTOR 16, CHANDIGARH

The overwork and poor working conditions expose the doctors to early and rapid burnout. This has to be prevented by various ways including improvement of the working conditions of the doctors and their counseling. A study carried out on Norwegian doctors seemed to indicate the need and the benefits of such counseling to the doctors.

.”A short-term counseling intervention was effective in reducing burnout and stress in a cohort of Norwegian clinicians, according to the results of a study published online November 12 in the British Medical Journal.

"Research on the mental health of doctors has led to a call for preventive interventions to lower the risk of burnout and mental distress," write Karin E. Isaksson Rø, MDr, from the Research Institute, Modum Bad, in Vikersund, Norway, and colleagues. "Early intervention programs could ensure that practicing doctors in trouble get help in time, before their problems interfere with care of patients and give rise to medical errors, but such programs have been poorly investigated."

At a Norwegian resource center, 227 physicians participated in a counseling intervention during 2003 to 2005 and completed a self-reported assessment at 1 year. The intervention consisted of individual counseling lasting 1 day or group-based counseling lasting 1 week, aimed at motivating reflection on and acknowledgement of the physicians' situation and personal needs. Primary endpoints were levels of burnout, measured with the Maslach burnout inventory, and predictors of reduced emotional exhaustion, based on linear regression.

Of 185 physicians (81%) who completed 1-year follow-up, 88 were men and 97 were women. On a scale of 1 to 5, the mean level of emotional exhaustion significantly decreased from 3.00 ± 0.94 to 2.53 ± 0.76 (t = 6.76; P < .001), which was similar to the level found in a representative sample of 390 Norwegian physicians. In addition, participants had decreased their working hours by 1.6 ± 11.4 hours/week.

The proportion of physicians on full-time sick leave decreased from 35% (63 of 182 physicians) at baseline to 6% (10 of 182 physicians) at follow-up, and the proportion that had undergone psychotherapy increased from 20% (36 of 182 physicians) to 53% (97 of 182 physicians). After adjustment for sex, age, and personality dimensions, reduction in emotional exhaustion in the overall cohort was independently associated with reduced number of work hours per week (β = 0.17; P = .03). Among men, "satisfaction with the intervention" was an independent predictor of reduced emotional exhaustion (β = 0.25; P = .04).

"A short term counseling intervention could contribute to reduction in emotional exhaustion in doctors," the study authors write. "This was associated with reduced working hours for the whole cohort and, in men, was predicted by satisfaction with the intervention."

Study limitations include an inability to determine causality, lack of further analyses of subgroups possibly causing a false negative finding (type 2 error), regression analyses for each sex also subject to possible type 2 errors, and possible recall bias.

"Considering doctors' reluctance to seek help, despite high levels of distress, it is important to offer interventions that facilitate access and that can enhance motivation to reconsider personal and professional priorities when necessary," the study authors write. "The indications of factors possibly contributing to reduction in emotional exhaustion need to be further investigated with a more controlled design."

The Norwegian Women's Public Health Association and Modum Bad psychiatric hospital supported this study. Dr. Rø has been employed at the resource center, Villa Sana, and was reimbursed for a presentation of preliminary results at an internal meeting of the Norwegian Medical Association.(BMJ. Published online November 12, 2008.)

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