Helping professions are by nature, asymmetrical where the clinical team does the giving, ideally without expectation of any particular response from the patient and family. Christina Maslach , one of the original researchers on burnout observed key symptoms; overwhelming emotional exhaustion, cynicism and detachment from the job, and a sense of ineffectiveness and failure. Another dynamic has been described as depersonalization, where patients are reduced to objects and in the view of the burnt-out clinician, therefore robbed of their full humanity. There are physical manifestations as well, muscular tension which can lead to headaches, belly pain or other typical signs of stress like changes in appetite, sleep and energy. Compassion fatigue is closely linked and is described as being specifically related to exposure to suffering in others.
Burnout is an ethical issue because of the risk to the patient, and it also has a strong adverse effect in the burnt-out professional. Burnout can result in professionals leaving the field of palliative care. The intervention for burnout can be helped by a change, and that change can be in how the practice is viewed, or an internal change or external changes to circumstances. Short of leaving the field, professionals may change work hours, setting, or clinical team membership.
There are other hazards from burnout, including forgetfulness, isolation, irritability and poor performance. The results can be low professionalism, lateness, giving up on advanced training, feeling more judgmental and bitter feelings towards patients. Team members may notice signs of burnout in a colleague but are unlikely to bring up the topic.
In a recent training on communication in complex care, Tammy Bhang, DNP, ARNP, ACHPN and Juan Iregui, MA, MD, FAAHPM of Core HCG, discussed how any attachment to a particular outcome can place team members at risk. If we hold expectations that a patient will make a particular choice, that we consider sensible, we are at risk. This risk may show up regularly until the clinician gains more mastery of attending to process without expectation.
Sometimes a patient, family or colleague can turn their anger or intense emotion directly on the clinician. This can be both unpleasant and very stressful. Big emotions may evoke our own early family culture. We are often coached not to take things personally but rarely does anyone tell us how to do that. One way to work on this skill can be to say, “I have no idea what led up to this moment for this person.” This helps us diffuse, realizing that the emotion in front of us likely had a long trajectory that is not about us at all. This one statement is truly the key to prevent taking the emotions of others personally.
Burnout can be more of a risk for some than others. We all bring internal risk factors, as we face exposure to risk factors in our working environment.
Burnout Part 2 in a series: Understanding the Risk Factor
- Pat Justis, Washington State Department of Health