How would you handle this case?
Discussion
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Over the past 15 years, physician burnout has become an increasingly recognized entity in the profession, with a growing literature base to reflect its importance. In a survey of surgeons, the American College of Surgeons identified, among the 7,905 respondents, a 40% burnout rate, a 30% positive screen for symptoms of depression, and a mental quality of life score one-half standard deviation below the population norm (Ann Surg. 2009;250:463–471). Numerous studies have confirmed this range of burnout over many specialties, both medical and surgical. Burnout occurs in both community practitioners and academic faculty alike, and it occurs in military physicians working in a high tempo combat deployment environment. Concerns about the effects of this level of physician burnout on patient care are clearly appropriate.
Burnout in physicians and surgeons is a response to multiple factors that can negatively impact their professional and personal lives, leading to emotional exhaustion/depletion, depersonalization, reduction in career satisfaction, and negative patient and non-patient personal interactions. Burnout may be a progressive process that waxes and wanes over the years, depending on the work and personal environments, but it may eventually lead physicians and surgeons to consider early retirement or a career change away from direct patient care. Quality-of-life issues with respect to work-personal balance can be caused by burnout as well as affected by this condition. In sum, burnout has come to the forefront as a major professional issue that needs to be recognized, understood, and mitigated.
Younger physicians and surgeons may be more susceptible to developing burnout, perhaps in part because they have not yet developed appropriate experience and coping mechanisms. Indeed, it is estimated that up to 50% of medical students exhibit signs or symptoms of burnout at some point in their undergraduate medical career (Bull Am Coll Surg. 2011;96:17–22). This may well carry into residency training, and might even be exacerbated by increased educational and clinical pressures and decreased personal recovery time. Residency training is a time of highly accelerated acquisition of knowledge and skills and includes challenges in time management and wide-ranging experiences. Particularly in the surgical specialties, each resident physician brings to the training experience an abundance of intellectual and technical skills, cultural and family experiences, biases and perspectives, and personality traits. For surgeons, a healthy dose of obsessive/compulsive behavior is felt to be necessary, with perfectionism often a goal, even when these behaviors can occasionally reap negative results.
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