Bourn out syndrome

Ernesto Gil Deza

Henry Moore Oncological Institute

Humanization of the Medical Figure

Epistemological Fragility of knowledge vs. Omniscience

Ethical Conflict of Interests vs. Medical Sanctity

Practical Burnout syndrome vs. Omnipotence

Burnout Syndrome

Freudenberger (1974) Maslach (1977)

“It is a syndrome that causes emotional duress, detachment and reduced efficiency, which can occur in people whose work is to assist others”

It can affect

DoctorsNursesPharmacistsPsychologistsSocial WorkersAdministrative workers

Burnout syndrome characteristics

Final stage of professional stress Emotionally exhausted Personal Detachment Low self esteem and insatisfaction

66% of clinical oncologists

Maximum stress

Incorrect course of action /inability to act

Implausible expectations

Incidency

10 – 70 %

Severity

25 studies show40% more suicides in male doctors130% more suicides in female doctors

Cause of professional stress

“Becoming a physician has meaning far beyond completing medical school and residency. It is the entry to a way of life, the one characteristic common to every true profession. It may sound old-fashioned, but the learned professions are really "callings" from which the members cannot separate their lives. There are no part-time professionals; having accepted such a calling, one is bound to live it or to leave it. This does not mean that a physician cannot be a good spouse, a good parent, or a good citizen of his/her community; it just means that the spouse, parent, and citizen is always a physician as well”.

Challenges of professional life

Truth Illness Family Death

Handling the truth

The most important organ for handling the truth is our ear, not our tongue.

Illness

Preventable Curable Paliable Feared Terminal

Caring for the family

Human group that looks after a dying pacient

Family Illness Previous mournings Family structure Roles Children

The dilemma of death

Existential Instantaneous Irreversible Inevitable Uncertain Incomprehensible Shocking Inexplicable

Current medical paradigm

Challenges of modern times

Is there a person in every case?

Diagnosis

Evluation of Burnout Syndrome

Tiredness Unable to concentrate Depression Insomnia Changes in Appetite

Evaluation of Burnout Syndrome Tiredness

Insatisfaction Indifference Cynisism Short temper Lack of input

Evaluation of burnout syndrome Cansancio Insatisfaccion

A feeling of professional failure A feeling of personal failure

Noxious Habits Job abandonment

Evaluacion del burnout

Tiredness Insatisfaction A feeling of professional failure A feeling of personal failure

Noxious habits Job abandonment

Social relationship problems

–Marital – familiar Permanent death

Professional abandonmentSuicide

Evaluation instruments

Prevention and teatment

The care for ourselves should be an essential part of our professional activity

First Step

First Step

Understanding our limitations Discovering our limits Respecting them

Magical

Prehistoric evidence “Savage” and “Urban” tribes. Imposed diagnosis. Conjural therapy Esoteric knowledge Clonal transmission

Clinical

Empirical Relational Experimental Exposed diagnosis Universal knowledge Scholar transmission

Pathological

Two diagnosis moments:

Clinical + Certification. Knowledge specialization is

born. The body-soul dicotomy is

fundamented

Assisted

Three diagnosis moments:

Clinical + Complementary

studies + Certification. Images Laboratory

Predictable

Genetic Diseases Old Age Alzheimer Cancer Cardiopathies Endocrinopathies

Genómica

Transcriptómica

Proteómica

Complejidad

Desire Derived

Cosmetics Transexuality Ortodonciy Plastic Surgery Obesity

Co-Active

Irritable colon Alopecy Menopause Osteoporosis High Cholesterol levels Femenine Sexual

Deficiency

The magical mentality persists…even if we don’t know it

Horus

Latin interpretation

Transformation into Recipe

Doctor-Doctor relationship

Influence on the doctor-patient relationship

Care for second opinions Respecting the missing

colleague Explain personal point of

view in case of a disagreement

Written note to the treating doctor.

Second step

Second step

Understanding conflicts Discovering barriers Trying to overcome them

Third step.Fighting Burnout

Advice for fighting Burnout Syndrome

Teamwork Work training and rules (watch out for

“elitism” ) Personal Vocations

Advice for fighting Burnout

Teamwork– Work training and rules (Watch out for

“elitism” )– Personal Vocations– Periodic Vacations– Critical Replacements– Weekly meetings– Group diversions– Communication training

Task Redesign Containment of Pacient and Family Paliative Care Clinical research Teaching Public Education Recreational workshops

Advice for fighting Burnout

Generating an integrating medicine Patient Family Society

They are, or should be, part of the team…

Advice for fighting Burnout

Thank you very much.