Professional burnout
Anyone who works, leads or manages health services knows how subtle the problem of burnout of colleagues is and, why not?, their own.
Yet burnout remains unnoticed,
a problem we prefer to avoid. Just as our patients and their families often do with eating disorders: they tend not to recognize it, to push it away, to remove it. Until it gets too serious and you struggle to manage.
Burnout undermines the passion for care and weakens, if not worse, the opportunities for care offered to patients. All those who move around the treatments, professionals, patients, their families and all stakeholders are indirectly affected.
For some years now, scientific authorities have been drawing attention to the issue of burnout. Now, having opened a season marked by syndemics, the problem has become more serious and urgent.
Burn-out concretely is a collection of many insidious less known symptoms which can deeply affect the lives of professionals working in close contact with patients and their relatives and can be contagious spreading in the work environment and affecting the therapeutic settings. Obviously it does not apply only to professionals who deal with ED; it is present in every service and in every discipline. For example Lacy and Chan (1) refer that“burnout may affect more than 60% of family practice providers and at least one third of gastroenterologists”.
The validity of data is always a delicate thing and their transfer from one place to another or from one defined group to another is always difficult and thoughtful.
Burn-out is defined in various ways but the most prefer a multifaceted definition with three dimensions: emotional exhaustion, depersonalization, and decreased personal fulfillment.
WHO ICD 11 defines and considers burnout between factors influencing health status.
Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
1) feelings of energy depletion or exhaustion;
2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and
3) a sense of ineffectiveness and lack of accomplishment = reduced professional efficacy.
Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.
To have a better clinical definition, the outcome of the study conducted by Bianchi and Collaborators is interesting (2). He finds the overlap of burn-out and depression. In fact it is not clear how the end stage of the burn-out process can be differentiated from depression. So burnout can be a very severe mental illness.
Some studies have shown that younger physicians, physicians performing high-risk procedures, and physicians experiencing work-life conflicts are at greatest risk.
Some professions appear to have a higher risk of burnout than others. for example nurses. For them it seems that burnout is an almost inevitable outcome (3). too much stress, too much factors: low/inadequate nurse staffing levels, more than 12-h shifts, low schedule flexibility, time pressure, high job and psychological demands, low task variety, role conflict, low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship.
Numerous studies conducted in various countries and on different groups of professionals agree that occupational burnout is widespread. For these reasons already in 2019 the European Agency for Safety & Health at work insert burnout between the main psychosocial risks, while in 2019 again AHRQ, states “A Crisis in Health Care: A Call to Action on Physician Burnout” (4).
So Canu and Coll wrote a paper to introduce an harmonized approach to face professional burnout (5)
A long list of negative factors transform the world into an open air hospital.
All together produce syndemic, as Horton said (6). Pandemic – War – Enormous Public Debt – Poverty and Inequality - Lack of funding - Shortage of specialized professionals – Globalization - Internet hyper-connection - Diversity - Climate change – Polarization - Mental health crisis - Burnout
And syndemic increases in burnout.
In the Remarks Oct 2022 (7), the WHO General Director remarks said: At least a quarter of health and care workers surveyed reported anxiety, depression, and burnout symptoms,
This topic became so important that citations in Pubmed go from 13977 (2019) to 24710 (dec 2022). Between them more than six thousand (6504) explore nurse burnout when almost six thousand deal with physician burnout.
It is interesting to note that with the syndemic attention to the professionals well-being explodes. Previously it was an ignored topic; at the end of 2022 in Pubmed there were 1561 articles on health care professional wellbeing.
There is very little about the professionals dealing with ED. But should there be a different condition from that of other professionals who deal with care and mental illness? There is no reason to imagine that the ED professionals are very different than described. Especially since the research has crossed the different countries and the different professions.
However, some aspects capture the specifics of EDs.
Working in a multidisciplinary team as indicated for EDs is both a source of tension (8) and an opportunity for support (9). It therefore depends on the quality of the relationships within the team and on the ability of the leader.
Good teams and good leaders protect professionals against burnout. Teams with difficult internal relationships or poorly trained leaders produce burnout.
It follows that much attention must be paid to team management both in terms of team building and team management.
Team leadership training should have much more space in academic training.
Higher levels of burnout were associated with being younger, female, and overweight; working longer hours; having less experience; and experiencing a patient's death.
Conversely, working in a private practice setting, having children, and having a personal history of an eating disorder were associated with lower burnout levels (10).
Emotional exhaustion is the most common aspect of burnout experienced by eating disorder treatment providers
Warren & Ot. identify the experience of patient death as a predictor of "emotional exhaustion," among clinicians specializing in the treatment of ED.
Clinicians who concentrate their work on anorectic patient population may experience patient death during the course of their careers; this a risk of increasing burnout (11).
So coping with burn-out is a healthcare priority.
There are some factors that protect from burnout.
They are: Feelings of appreciation, Team cohesion, Open communication inside the team, Authoritative leadership, Proactive strategies to manage chronic stress, regular clinical supervision, regular organizational supervision, Effective relationship with supervisors, Training, Research, Creativity. And every professional has to be trained to take care of their burnout and better to take care of themselves.
We need to help professionals and their units to work better and to protect from burnout. It’s a European AED priority.
Referencies
1, Brian E Lacy , Johanna L Chan , Physician Burnout: The Hidden Health Care Crisis, Clin Gastroenterol Hepatol, 2018 Mar;16(3):311-317
2, Bianchi R,Schonfeld IS,Laurent E. Burnout-depression overlap: a review.
Clin Psychol Rev ,2015 Mar;36:28-41.
3 Chiara Dall'Ora, Jane Ball ,Maria Reinius Peter Griffiths, Burnout in nursing: a theoretical review, Hum Resour Health, 2020 Jun 5;18(1):41.
4, Jha AK, Iliff AR, Chaoui AA, et al. A Crisis in Health Care: A Call to Action on Physician Burnout , Waltham, MA: Massachusetts Medical Society, Massachusetts Health and Hospital Association, Harvard T.H. Chan School of Public Health, and Harvard Global Health Institute; 2019. January 30, 2019
5, Irina Guseva CANU, Olivia MESOT, Christina GYÖRKÖS, Zakia MEDIOUNI, Ingrid Sivesind MEHLUM, and Merete Drevvatne BUGGE, Burnout syndrome in Europe: towards a harmonized approach in occupational health practice and research, Ind Health 2019 Nov; 57(6): 745–752.
6, Horton R, Covid-19 is not a pandemic, Comment, The Lancet vol 396 issue 10255 p 874 20 sept 2020,
8, Garcia A.M. Interdisciplinary team for the treatment of eating disorders, Eating& Weight Disorders, 2000 Dec 5(4) , 223-7
9, Kaisa Gretl & Ot, Methodology for a mental health plan for health care workers, NEJM Catalyst- Innovations in care delivery. 2022, 11
10, Warren Cortney & Ot, Demographic and work-related correlates of job burnout in professional eating disorder treatment providers, Psychotherapy (Chic), 2013 Dec;50(4):553-64.
11, Kamryn T. Eddy Patient mortality as a predictor of burnout among clinicians specializing in eating disorders Psychotherapy (Chic), 2013 Dec;50(4):568-9.