The professional activity of medical workers involved in the treatment and rehabilitation of patients assumes an emotional intensity and a high percentage of factors that cause stress. According to the classification of professions according to the “criterion of difficulty and unhealthiness”. The medical profession is of the highest type, based on the need for constant extracurricular work on the subject and oneself. In the 1960s, the term “occupational deformation” was first introduced in the U.S. in “human-to-human” professions, in which the effectiveness of work is significantly affected by the social environment. Conclusions were made about the existence of professional deformation and the necessity of a special professional selection in professions of the “man – man” system.
The emotional burnout syndrome (EBS) was first described in 1974 by the American psychologist Freidenberger to describe demoralization, frustration, and extreme fatigue, which he observed in workers of psychiatric institutions. The model developed by him turned out to be convenient for assessing this condition in medical workers, the profession with the highest propensity for “burnout”. After all, their working day is constant close communication with people, moreover, with patients, who require indefatigable care and attention, restraint.
The main symptoms of EBS are:
- Fatigue, fatigue, exhaustion after active professional activities;
- psychosomatic problems (fluctuations in blood pressure, headaches, diseases of the digestive and cardiovascular systems, neurological disorders, insomnia)
- negative attitudes towards patients (instead of the positive relationships they had previously had)
- negative attitudes toward the work performed
- aggressive tendencies (anger and irritability towards colleagues and patients);
- a functional, negative attitude toward oneself;
- anxiety states, pessimistic mood, depression, feeling of meaninglessness of occurring events, feeling of guilt.
This syndrome includes three main components: emotional exhaustion, depersonalization (cynicism), and a reduction in professional (personal) achievement (Maslach and Jackson, 1993, 1996):
Emotional exhaustion — feelings of emotional emptiness and fatigue caused by one’s own work;
Depersonalization — a cynical, indifferent attitude toward work and the objects of one’s work;
reduction of professional achievements – occurrence of the feeling of incompetence in the professional sphere, awareness of the failure in this sphere.
Individuals who place exorbitant demands on tools, colleagues, and themselves are most at risk of occurrence. If tools can be chosen at https://tz-trade.com/dental-laboratory, and colleagues can be selected that meet all parameters, then you cannot remake yourself. Individuals in this category associate their work with a mission, a mission, so they blur the line between work and personal life.
In the course of research, three more types of people were distinguished who are threatened by EBS:
The first type — “pedantic”, is characterized by conscientiousness, elevated to the absolute; excessive, painful accuracy, striving to achieve in any case the exemplary order (even if to the detriment of himself).
The second type — “demonstrative” is characterized by a desire to be on top in everything, always to be in full view. At the same time, they are characterized by a high degree of exhaustion during unremarkable, routine work, and overexertion is manifested by excessive irritability and anger.
The third type — “emotive”, is characterized by an unnatural sensitivity and impressionability. Their responsiveness, propensity to perceive another’s pain as their own borders on pathology, with self-destruction, and all this with a clear lack of strength to resist any adverse circumstances.
EBS includes 3 stages, each of which consists of 4 symptoms:
Stage 1 – “Tension” – with the following symptoms:
- dissatisfaction with self,
- “caged up”,
- experiencing psychologically traumatic situations,
- anxiety and depression.
Stage 2 – “Resistance” – with the following symptoms:
- Inadequate, selective emotional responses,
- emotional and moral disorientation,
- expansion of the sphere of economy of emotions,
- reduction of professional responsibilities.
Stage 3 – “Depletion” – with the following symptoms:
- emotional deficit,
- emotional detachment,
- personal detachment,
- psychosomatic and psycho-vegetative disorders.
Many factors influence the appearance and degree of burnout. The closest connection with burnout is age and length of work in a profession. It was shown that middle medical personnel of psychiatric clinics “burn out” in 1,5 years after the beginning of work, and social workers start to experience this symptom in 2-4 years. The tendency of younger workers to burnout can be explained by the emotional shock they experience when confronted with the reality that often does not correspond to their expectations.
Men were found to have higher depersonalization scores, and women were more susceptible to emotional exhaustion. This is due to the fact that men are dominated by instrumental values, while women are more emotionally responsive and have less sense of alienation from their clients. Working women experience higher work overload (compared to men) due to additional household and family responsibilities, but women are more productive than men in using strategies to avoid stressful situations
There are studies that testify to the connection between marital status and burnout. They show a higher degree of predisposition to burnout among unmarried people (especially males). Moreover, bachelors are more susceptible to burnout even in comparison with divorced men.
According to British researchers, in almost half of the medical workers, burnout is related to stress. Among the general practitioners surveyed in this country, high levels of anxiety were found in 41% of cases and clinically pronounced depression in 26% of cases. One-third of doctors took medications to correct emotional tension, the amount of alcohol consumed exceeded the average level. It was found out that one of the factors of a “burnout” syndrome is the duration of a stressful situation and its chronic character.
The development of chronic stress in representatives of communicative professions is influenced by:
- limitation of freedom of action and use of available potential;
- work monotony;
- a high degree of uncertainty in the assessment of the work performed;
- dissatisfaction with social status.
There are certain groups of physicians who are exposed to additional stressors, in particular female physicians, physicians practicing in remote and inaccessible areas. Not surprisingly, only 26% of female physicians are satisfied with their jobs, compared to 44% of their male colleagues.
Many physicians have no one but a spouse with whom to talk about anything personal. In doing so, they risk ruining personal relationships by bringing professional issues into the home and being unable to perform other duties. According to periodicals, divorce rates in physician families are 10-20% higher than in the general population. Marriages in which the husband and wife are medical professionals are more likely to be unhappy.
There are now many studies documenting widespread dissatisfaction with the profession and feelings of regret about choosing a medical career. Increased activity demands, long work hours, and overtime stimulate the development of burnout. Breaks in work have a positive effect and reduce the level of burnout, but this effect is temporary: the level of burnout partially increases in three days after returning to work and completely recovers in three weeks.
Doctors and nurses experience a higher level of burnout compared to hospital attendants, and a higher level is observed in medical personnel of oncology departments. A comparative analysis of staff working outside hospitals (for example doctors in private practice) with mentally ill people and in hospitals shows that the first group of workers is the most susceptible to burnout. Pines and Maslach (1978) found that the longer staff worked in psychiatric institutions, the less they liked working with the sick, the less they felt they were successful, and the less humane their attitudes toward the mentally ill were.
In a study of emotional distress in physicians, psychologist King (1992) drew a startling conclusion: “Physicians working in a medical setting are subject to significant personal distress, finding it difficult to open up to anyone outside their immediate family and circle of friends. The prevailing characteristic of the medical profession is to be in denial about personal health issues.”
Burnout is not just a result of stress, but a consequence of unmanaged stress. According to Grainger (1994), “Doctors are taught much about the theory and practice of medicine, but little about how to take care of themselves and cope with the inevitable stresses.
Naturally, doctors somehow try to find a way out of this situation on their own. There is the so-called escape from the current situation, in particular, the use of psychotropic substances (alcohol, drugs) and, as an extreme option, suicide. According to statistics, the number of suicides among doctors ranges from 28 to 40 per 100 thousand. The number of doctors who commit suicide in one year in the United States is comparable to one or two graduates of an average medical school. This is a fact. Female physicians are especially vulnerable. Among them, suicide rates are four times higher than among women in general. Among male doctors, it is twice as high. Naturally, such a doctor’s position has an unsatisfactory effect on himself, on the patient he treats, and on society as a whole. Behind this is all the tragic depth of his current position in society.