David Brill
Short counseling sessions can reduce burnout among doctors and encourage them to make positive changes to their working lives, a new study suggests.
Doctors who volunteered for an intervention program in Norway reported lower levels of emotional exhaustion, worked fewer hours per week and were less likely to be on full-time sick leave a year later.
They were also more likely to seek further professional help, with 53 percent having undergone psychotherapy at 1-year follow-up compared to just 20 percent at the time of enrollment.
Many had already reached high levels of distress and had considered attending the program for quite some time before actually doing so, according to Dr. Karin Rø of the University of Oslo, who led the study.
“The program legitimizes the need for doctors to take a step back for a while and think about their situation,” she said.
“A lot have come back to me and said that it was really important at that time in their life to have somebody to talk to, to get a different perspective on their own situation. Giving a little help, in time, is much better than having to give a lot of help when the situation is much worse.”
Volunteers at Villa Sana – the only center of its kind in Norway – chose between a single one-on-one counseling session of around 6 hours, or a week-long course involving daily lectures followed by group discussions. All sessions were confidential and no medical records were kept. A total of 227 doctors were included in the study, 185 of whom completed 1-year follow-up questionnaires. [BMJ 2008 Nov 11;337:a2004]
Dr. Sim Kang, a consultant psychiatrist at the Institute of Mental Health, Singapore, hailed the research as an important reminder of a timely issue.
“The healthcare profession is certainly susceptible to the onset of burnout if one is not careful about it. The demands of the job are changing and the expectations are quite high from the public nowadays,” he said.
“The symptoms of burnout encroach not just upon the sense of physical tiredness but also the sense that one is mentally wearied and emotionally drained. The message is that if prevention isn’t working and things are getting out of hand then they should seek help.”
Another BMJ study published this year reported that depressed pediatric residents made six times as many medication errors per month as non-depressed residents. [2008 Mar 1;336(7642):488-91]
Rø pointed to this finding as evidence that doctors need to take care of their own wellbeing in order to take care of others.
“When you fly on a plane and the oxygen masks come down you’re supposed to put your own one on before you help anyone who needs it. I think that’s a very good picture of doctors,” she said, adding that she hopes the study will prompt the creation of other similar centers in future.
A year on from the intervention the participants had reduced their mean working hours by an average of 1.6 hours per week. Just 6 percent were on full time sick leave, compared to 35 percent at baseline.
High rates of depression and suicide have been well documented among doctors. A recent study of Brazilian medical students found that as many as 38.1 percent had depressive symptoms, with females particularly susceptible. [BMC Medical Education, in press]
Rø noted that the Norwegian counseling intervention helped the doctors to normalize their situation, having previously felt that they were the only ones experiencing such feelings of distress. They often fail to seek help because they are used to focusing solely on the needs of their patients and do not realize when they are in need of help themselves, she said.
The exact prevalence of depression among the medical community in Asia is largely unknown.
However, Sim encouraged doctors to discuss their feelings of stress and anxiety in informal support groups with their peers whenever possible, adding that he would like to see longer-term data on the sustainability and generalizability of the Norwegian model before advocating the adoption of more formal, structured programs.
Seven tips for avoiding burnout
Dr. Sim Kang, a consultant psychiatrist at the Institute of Mental Health, Singapore, offers his advice on how to de-stress before it gets too late.
1 – Acknowledge and accept that we are all equally vulnerable and can feel trapped and overwhelmed like anyone else. Medical professionals are not superheroes.
2 – Be willing to communicate with others, particularly through informal networks of colleagues, family and friends.
3 – Clarify your responsibilities within the job and resolve any ambiguities that may be causing additional stress.
4 – Determine your own strengths and weaknesses and play to them.
5 – Educate yourself about the symptoms of burnout.
6 – Find time off to unwind and relax.
7 – Group together with your peers to discuss the difficult issues and identify any problems you may be experiencing.
No comments:
Post a Comment