Trainee burnout

Question 1

Relevant history for trainee appearing irritable, frustrated

Answer 1

1. Recent work experiences
2. Assess for depression/mania, psychosis, substance use
3. Assess workplace burnout
   - > emotional exhaustion, depersonalisation and a sense of reduced personal accomplishment.
4. Family/personal life and support
5. Risk assessment

Question 2

Emotional exhaustion

Answer 2

feeling ‘used up’ at the end of the workday, and having nothing left to offer patients from an emotional standpoint.

Question 3

Depersonalisation

Answer 3

feelings of treating patients as objects rather than human beings, and becoming more callous towards patients.

Question 4

Reduced personal accomplishment

Answer 4

feeling of ineffectiveness in helping patients with their problems, and a lack of value of the results of work-related activities, such as patient care or professional achieves.

Question 5

Symptoms of burnout

Answer 5

1. Emotional exhaustion: feeling ‘used up’ at the end of the workday, and having nothing left to offer patients from an emotional standpoint.
2. Depersonalisation: feelings of treating patients as objects rather than human beings, and becoming more callous towards patients.
3. Reduced personal accomplishment: feeling of ineffectiveness in helping patients with their problems, and a lack of value of the results of work-related activities, such as patient care or professional achieves.

Other symptoms can include:
- Reduced efficiency and energy
- Lowered levels of motivation
- Fatigue
- Headaches
- Irritability
- Frustration
- Suspiciousness
- More time working with less being accomplished.
Some factors that make psychiatry stressful include:
- Patient violence and suicide
- Limited resources
- Crowded inpatient wards
- Changing culture in mental health
- High work demands
- Poorly defined roles of consultants
- Inability to effect system change
- Isolation.

Question 6

Some factors that make psychiatry stressful include:

Answer 6

Patient violence and suicide
Limited resources
Crowded inpatient wards
Changing culture in mental health
High work demands
Poorly defined roles of consultants
Inability to effect system change
Isolation.

Question 7

Risks for doctor suicide

Answer 7

Doctors are as exposed as anyone else to risks associated with genetic predisposition, early traumatic life events, later bereavements, illnesses or relationship breakdowns

Also:
Perfectionism
Obsessiveness
Elements of martyrdom

From an early age they are driven, competitive, compulsive, individualistic and ambitious – features that can go into overdrive when stressed.

As doctors work harder, they blame themselves for not being able to deliver the care required by their patients, and feel guilty for events beyond their control.

Consequently, doctors can suffer from a triad of guilt, low self-esteem and a persistent sense of failure.

To survive a lifetime in medicine, doctors also have to develop psychological defences that include depersonalisation and dissociation. This can make it harder to create attachments to others or to recognise when the emotional burden of their work becomes too much, and thus contributes to the spiralling of discontent and increased risk of suicide.

Question 8

Psychiatrist rates of suicide

Answer 8

Physicians’ relative suicide risk is at 1.1–3.4 for men and 2.5–5.7 for women compared with those for the general population, and at 1.5–3.8 for men and 3.7–4.5 for women compared with those for other professionals.

Psychiatrists appear to be associated with higher risk.

In an Australian survey, approximately a quarter of doctors reported having had thoughts of suicide prior to the past 12 months (24.8%), and 10.4% reported having had thoughts of suicide in the previous 12 months.

Thoughts of suicide are significantly higher in doctors compared with the general population and other professionals (24.8 vs. 13.3 vs. 12.8).

Question 9

Accreditation workload for trainees

Answer 9

1. The recommended inpatient numbers is consistent with projections produced by the National Mental Health Service Planning Framework.
2. A maximum number of inpatients approaching 15 patients for full-time trainee or 8 for half-time trainee flags to the trainee and services when workload is excessive, and should be flagged to Service Managers, Clinical Directors, Training Committees and Directors of Training to urgently review the training post’s workload.
3. Workloads above the recommended inpatient numbers should be monitored closely by the supervisor, and discussed with the Service Manager / Clinical Director. If workload concerns cannot be addressed satisfactory, the post should be referred to the Director of Training and / or training committee.
4. Whilst noting there may be short periods when inpatient numbers may temporarily increase beyond the recommended numbers, the relevant Training Committee should be notified if the maximum number is reached for more than 14 days.

Question 10

Reporting to regulatory bodies-> self notification and notifiable conduct

Answer 10

1. Self-notification
   Doctors are able to self-notify to AHPRA if they believe that they have a mental health concern that could impact on their clinical work.
2. Notifiable conduct
   Section 140 of the National Law defines ‘notifiable conduct’ as when a practitioner has:
   a) practised the practitioner’s profession while intoxicated by alcohol or drugs; or

b) engaged in sexual misconduct in connection with the practice of the practitioner’s profession; or
c) placed the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has an impairment; or
d) placed the public at risk of harm because the practitioner has practised the profession in a way that constitutes a significant departure from accepted professional standards

Question 11

Who is required by law to notify AHPRA if believe unwell, unable to practise safely

Answer 11

QLD complaints made to Office of the Health Ombudsman

1. a doctor - self notification
2. the doctor’s employer
3. any registered health practitioner
4. anyone in charge of an organisation that provides health services
5. a person in charge of an educational programme or course who believes a student may be unable to practise medicine safely.

Question 12

Actions/strategies to manage burnout

Answer 12

Immediate:

1. Speak to seniors for support e.g. reducing case load, fatigue leave, temporarily coming off on-call roster, extra supervision.
2. Take urgent recreational or sick leave.
3. Welfare officer or welfare programme at place of work.
4. Contact person in charge of RANZCP training e.g. Chief Training Supervisor / Director of training.

Short – medium term:

1. Mindfulness or meditation including the use of apps.
2. Lifestyle choices: reducing or eliminating alcohol intake, reducing caffeine; sleep, diet, exercise.
3. Taking regular holidays.
4. Making time for friends and family.
5. Starting new hobbies.
6. Getting a mentor.
7. Regular therapy / counselling.

Question 13

Do trainees with burnout need to self report

Answer 13

no