Personality Antecedents of Burnout among Middle-Aged Physicians

Abstract

Utilizing a prospective design, this study addressed the question of whether vulnerability to burnout among physicians is associated with certain longstanding, maladaptive personality tendencies that predate entrance into medical training and subsequent exposure to the intrinsic stresses of medical practice. Subjects were 440 practicing physicians whose personality traits and psychological adjustment had been assessed with the Minnesota Multiphasic Personality Inventory (MMPI) shortly before entering medical school who were followed up by mail questionnaire an average of 25 years later to evaluate current symptoms of burnout with the Tedium scale. Results revealed that higher burnout scores were significantly correlated with a number of standard and special MMPI scales measuring low self-esteem, feelings of inadequacy, dysphoria and obsessive worry, passivity, social anxiety, and withdrawal from others. In contrast, burnout scores exhibited no significant associations with demographic or practice characteristics, including sex, age, medical specialty, practice arrangement, hours worked per week, or percentage of work time spent in direct contact with patients. Alternative interpretations of these findings and their potential implications for reducing the risk of burnout among physicians are discussed.     

Personality antecedents of burnout among middle-aged physicians

Utilizing a prospective design, this study addressed the question of whether vulnerability to burnout among physicians is associated with certain longstanding, maladaptive personality tendencies that predate entrance into medical training and subsequent exposure to the intrinsic stresses of medical practice. Subjects were 440 practicing physicians whose personality traits and psychological adjustment had been assessed with the Minnesota Multiphasic Personality Inventory (MMPI) shortly before entering medical school who were followed up by mail questionnaire an average of 25 years later to evaluate current symptoms of burnout with the Tedium scale. Results revealed that higher burnout scores were significantly correlated with a number of standard and special MMPI scales measuring low self-esteem, feelings of inadequacy, dysphoria and obsessive worry, passivity, social anxiety, and withdrawal from others. In contrast, burnout scores exhibited no significant associations with demographic or practice characteristics, including sex, age, medical specialty, practice arrangement, hours worked per week, or percentage of work time spent in direct contact with patients. Alternative interpretations of these findings and their potential implications for reducing the risk of burnout among physicians are discussed.     

交通警察工作倦怠调查分析

目的调查交通警察工作倦怠状况及影响因素。方法对179名交通警察用工作倦怠量表（MBI-GS）进行测试。结果交警职业倦怠中情绪枯竭维度、玩世不恭维度、成就感低落维度评分分别为1．90土1．18、1．84±1．18、3．00±0．89。男性交警情绪耗竭和玩世不恭程度高于女性警察；年轻的、警龄短的交警情绪耗竭和玩世不恭比年龄大的警龄长的交警严重；未婚交警情绪耗竭和玩世不恭程度高于已婚警察；学历高的交警个人成就感低；外勤警比内勤警工作倦怠严重。结论交通警察工作倦怠状况不容忽视，男性、年轻、警龄短、未婚、外勤的警察应列为预防和防预的重点对象。     

ICU护士工作倦怠水平及其个性特征的关系

目的了解护士工作倦怠现状以及与人格特征的关系。方法采用Maslach倦怠量表,艾森克个性特征问卷成人版,对唐山市2所综合医院ICU 76名护士进行问卷调查。结果 1护士在情感耗竭、去人格化得分均数比提供的美国常模高,个人成就感水平比美国常模低;2情感耗竭与精神质呈正相关(r=0.324,P<0.05),与内外向呈负相关(r=0.439,P<0.01),与神经质呈正相关(r=0.460,P<0.01);去人格化与精神质呈正相关(r=0.324,P<0.05),与内外向呈明显负相关(r=-0.348,P<0.05),与神经质呈正相关(r=0.372,P<0.05);个人成就感与精神质呈负相关(r=-0.267,P<0.05),与内外向无相关,与神经质呈负相关(r=-0.294,P<0.05)。结论护士工作倦怠水平较高;且受个性特征的影响,神经质和精神质水平越高,越容易出现工作倦怠。     

Medicosocial Conflict and Crisis due to Illegal Physician Assistant System in Korea

The Korean Medical Association opposes the illegal attempt to implement the physician assistant (PA) system in Korea. The exact meaning of ‘PA’ in Korea at present time is ’Unlicensed Assistant (UA)’ since it is not legally established in our healthcare system. Thus, PA in Korea refers to unlawful, unqualified, auxiliary personnel for medical practitioners. There have been several issues with the illegal PA system in Korea facing medicosocial conflicts and crisis. Patients want to be diagnosed and treated by medically-educated, licensed and professionally trained physicians not PAs. In clinical settings, PAs deprive the training and educational opportunities of trainees such as interns and residents. Recently, there have been several attempts, by CEO or directors of major hospitals in Korea, to adopt and legalize this system without general consensus from medical professional associations and societies. Without such consensus, this illegal implementation of PA system will create new and additional very serious medical crises due to unlawful medical, educational, professional conflicts and safety issues in medical practice. Before considering the implementation of the PA system, there needs to be a convincing justification by solving the fundamental problems beforehand, such as the collapsed medical delivery system, protection and provision of optimal education program and training environment of trainees, burnout from excessive workloads of physicians with very low compensational system and poor conditions for working and education, etc.     

A career counseling program for dentists: effects on burnout

The effects on burnout of a career counseling program were measured among general dental practitioners. Out of a group of 171 dentists, identified with unfavorable scores on the Maslach Burnout Inventory - Dutch version (MBI-NL), nineteen chose to participate in the program. It consisted of individual counseling and group sessions, using cognitive and behavioral intervention techniques, over a 6-month period. One month after the last session, both program participants (N=17) and invited, but not participating, dentists (N=66) again filled in the MBI-NL. Comparison of participants' pre- and post-test scores showed significant statistical improvement on the MBI-NL scales emotional exhaustion (EE), and personal accomplishment (PA). Among the control group, a distinction was made between dentists who had self-initiated preventive measures (N=35) and those who had not (N=31). Self-prevention also appeared to have an effect on EE and PA. Among dentists who reported not to have undertaken preventive action, no change in burnout levels was found. With reservations, it can be concluded that the prevention program does have a positive effect on burnout scores among dentists, while different forms of self-initiated prevention activities also appeared to be effective.     

精神科护士职业倦怠与人格特征的关系研究

目的 了解精神科护士工作职业倦怠及其与人格特征的关系,进而提供一些有效的应对措施.方法 采用护士职业倦怠问卷(MBI)、艾森克个性问卷成人版(EPQ),对某精神病医院精神科临床一线80名护士进行了问卷调查.结果 精神科护士情感耗竭、个人成就感低于综合医院护士(P＜0.01),去人格化倾向高于综合医院护士(P＜0.05);情感耗竭同EPQ精神质呈显著正相关(r=0.543,P＜0.01);个人成就感与神经质呈负相关(r=-0.321,P＜0.05);性别、工龄与职业倦怠未构成显著差异性.结论 精神科护士职业倦怠水平较综合医院护士低且受个性特征的影响.     

Will my malpractice case be settled? The physician-defendant’s voice in the decision

Malpractice claims are an unavoidable part of the practice of clinical medicine. Physicians purchase professional liability insurance to protect themselves from financial and other adverse consequences of such claims. Insurance policies require the insurer to hire attorneys to represent, defend and advise physicians who are named as defendants in medical malpractice lawsuits. Insurance policies require insurers to pay the costs associated with defending the lawsuit and paying, within policy limits, any damages for which a physician is determined to be liable. The relationship between insurer, defense counsel and physician can be complicated by divergent interests, concerns and priorities. It is important for physicians to be knowledgeable consumers when they are in the market for malpractice coverage. Familiarity with types of coverage, controls placed on defense costs and policy terms that determine decision-making authority on settlement issues are essential to making an informed purchase of insurance coverage.     

Programa de Entrenamiento en el Cultivo de la Compasión en los estudiantes de Medicina

Physicians, residents and medical students experience higher levels of stress, depression and burnout than the general population. This mental deterioration determines a less compassionate care of patients. The proposals of the universities and hospitals to prevent this situation are scarce. For this reason, we decided to examine the efficacy of a Compassion Cultivation Training (CCT) program in preventing psychological distress and increasing well-being in a sample of medical students from the Complutense University of Madrid. Participants were randomly distributed into two groups: receiving CCT and waitlist list control. Both groups completed online surveys before the intervention, at the end of it and two months after its completion. The variables studied were compassion, empathy, psychological distress, well-being, mindfulness, burnout, resilience, emotional regulation, and concern about COVID-19. Those who received the CCT program had significant improvements in self-compassion, mindfulness, and emotional regulation and experienced a significant reduction in anxiety, stress, and emotional exhaustion. Some of these effects persisted at two-month follow-up. The CCT seems to be an adequate intervention to take care of the mental health of medical students and favor compassionate care of patients.     

Appraisal of the event as a factor in coping with malpractice litigation

The authors designed a study to explore medical malpractice litigation as a stressor, factors that contribute to doctors' appraisal of it, how they actually cope with it, and the potential effects on them and on their mode of practice. We interviewed 51 physicians who had been sued for medical malpractice. Those who identified litigation as their most stressful life event (Group 1, N = 11) experienced significantly more physical and emotional symptoms, especially those suggestive of a major depressive disorder, and used more emotion-focused coping mechanisms than those who identified some other event in life as being most stressful (Group 2, N = 39). The appraisal of litigation as one's most stressful life experience may be a useful predictor of coping response, with previous life experiences as a major contributing factor to this appraisal.     

医生职业倦怠的现状与分析

目的调查医生职业倦怠的现状。方法采用工作倦怠问卷(CMBI)对646名医生进行调查。结果医生中有31.6%轻度倦怠,36.4%中度倦怠,7.7%重度倦怠;各维度,34.1%情感衰竭,48.1%人格解体,45.4%成就感降低。男性医生情感衰竭和人格解体比女性更严重,而成就感更高;职称方面,初级职称医生职业倦怠更严重;内外科医生情感衰竭比精神科严重,而较之其他科室,外科医生成就感更高,精神科更低。结论医生职业倦怠现状严重,防治工作应关注男性、初级职称的医生,并针对不同科室的特点制定相关政策。     

Burnout in the intensive care unit professionals

Background:

Professional burnout has been widely explored in health care. We conducted this study in our hospital intensive care unit (ICU) in United States to explore the burnout among nurses and respiratory therapists (RT).

Materials and Methods:

A survey consisting of two parts was used to assess burnout. Part 1 addressed the demographic information and work hours. Part 2 addressed the Maslach Burnout Inventory-Human Service Survey.

Results:

The analysis included 213 total subjects; Nurses 151 (71%) and RT 62 (29%). On the emotional exhaustion (EE) scale, 54% scored “Moderate” to “High” and 40% scored “Moderate” to “High” on the depersonalization (DP) scale. Notably 40.6% scored “Low” on personal accomplishment (PA) scale.

Conclusion:

High level of EE, DP and lower PAs were seen among two groups of health care providers in the ICUs.     

陕西省护士工作疲溃状况及影响因素的调查分析

目的了解陕西省护士工作疲溃状况,探讨护士疲溃感的影响因素。方法采用分层随机整群抽样法,对陕西省9家二级医院,11家三级医院的988名护士进行问卷调查。结果护士的工作无成就感为高度,情绪疲倦感为中度,工作冷漠感为低度。护士情绪疲溃感与年龄(β=0.134,t=2.005,P<0.05)、护龄(β=0.237,t=3.603,P<0.05)、有无未成年子女(β=0.125,t=3.209,P<0.05)、病人护士比(β=0.075,t=2.373,P<0.05)、所在科室有关(β=0.067,t=2.127,P<0.05)。结论陕西省护士工作疲溃状况仍较严重,建议管理者能给护士更多的支持。     

医生心理资本在工作要求与职业倦怠间的调节效应

目的探讨心理资本在工作要求与医生职业倦怠间的作用。方法利用课题组编制的医生职业倦怠量表、心理资本量表、工作要求量表对山东省三地市(济南、潍坊、德州)1910名医生进行调查,采用描述性分析、相关分析、分层回归分析等方法进行资料分析。结果医生感到工作要求高,工作要求能正向预测职业倦怠。事务型心理资本和人际型心理资本既对医生职业倦怠有直接效应(β=-0.26,-0.11;P0.001),又在工作要求与职业倦怠间发挥调节效应(β=-0.08,-0.12;P0.01)。结论在严苛的工作要求下,通过提升医生心理资本水平可以有效控制职业倦怠。     

Appraisal of the Event as a Factor in Coping with Malpractice Litigation

Abstract

The authors designed a study to explore medical malpractice litigation as a stressor, factors that contribute to doctors' appraisal of it, how they actually cope with it, and the potential effects on them and on their mode of practice. We interviewed 51 physicians who had been sued for medical malpractice. Those who identified litigation as their most stressful life event (Group 1, N = 11) experienced significantly more physical and emotional symptoms, especially those suggestive of a major depressive disorder, and used more emotion-focused coping mechanisms than those who identified some other event in life as being most stressful (Group 2, N = 39). The appraisal of litigation as one's most stressful life experience may be a useful predictor of coping response, with previous life experiences as a major contributing factor to this appraisal.     

A survey of subjective sleepiness and consequences in attending physicians

This article surveyed attending physicians on their work hours, sleep schedule, daytime sleepiness, and the perceived relation of these factors to patient safety, quality of care, and personal well-being. Physicians answered demographic and workload questions and attitudinal questions regarding work-hour limitations; the Epworth Sleepiness Scale (ESS) was used to measure subjective sleepiness, and an 18-item Impact Questionnaire was also used. Of 180 participants, 41 (23%) attending physicians manifested abnormal ESS scores (11 or greater). Private practice- and surgically-based subspecialties had higher ESS scores. Reduced sleep, but not hours worked, was associated with increased sleepiness. Sleepy physicians were more likely to associate sleep loss with medical errors and driving impairment. Sleepiness may be attenuated by education regarding consequences of insufficient sleep and institution of effective countermeasures.     

An evaluation of the Rural Medical Education Program of the State University Of New York Upstate Medical University, 1990-2003.

PURPOSE: The Rural Medical Education Program (RMED) of the State University of New York (SUNY) Upstate Medical University is a 36-week clinical experience in rural communities for medical students that began in 1989. The authors sought to assess RMED's success in providing a valuable educational experience for students that assists rural communities recruit physicians. METHOD: In 2004, the authors used the Physician Masterfiles of the American Medical Association to compare practice locations of SUNY Upstate graduates who completed RMED with those who did not; surveyed former RMED students to assess their satisfaction with their practice location and the importance of RMED in helping them choose a location; interviewed hospital administrators in communities that have hosted RMED students to understand the impact of RMED on host communities; and compared United States Medical Licensing Examination Step 2 scores of RMED students with those of non-RMED students to evaluate educational attainment. RESULTS: A greater percentage of former RMED students practiced in rural locations [22/86 (26%)] than did non-RMED students [95/1,307 (7%)]. Ninety-one percent (69/76) of former RMED students were satisfied with their location, and 84% (64/76) believed that RMED was important in helping them choose a location. Hospital administrators viewed the program highly because it helped them recruit physicians and benefitted their medical staff. RMED students had higher adjusted mean Step 2 scores than did non-RMED students (212.3 versus 199.1). CONCLUSION: The RMED program has successfully met its goals of providing a valuable educational experience for medical students and assisting rural communities recruit physicians.     

Medicolegal liability in pathology: an international perspective

An inevitable outcome of modern Medicine in any country is that some patients will experience adverse events, some of which would have been preventable. Different nations have developed various approaches to such cases; their legal efficacies are probably dissimilar and dependent on a number of disparate variables. An international "snapshot" of the results of the interacting forces can be obtained by asking physicians in several countries how they view selected subjective facets of their tort systems. In the U.S., many physicians view the structure of malpractice torts as unfair, and that belief is shared by at least some pathologists. The American Medical Association has declared that a multiregional malpractice "crisis" exists which raises medical costs and threatens access to care. Furthermore, malpractice tort decisions are often flawed scientifically because lay jurors and judges cannot properly evaluate the quality of "expert" testimony given by adversarial witnesses. Despite these factors, there has been little effort to investigate the views of pathologists on malpractice actions outside the U.S. In this paper, the authors have collected the responses of an international group of pathologists to a questionnaire on that topic. The respondents practice in academic centers in 15 countries outside the U.S. As expected, a range of views was represented, with some pathologists reporting that malpractice litigation was uncommon and others noting a worrisome trend toward its growth. Interestingly, so-called "defensive medicine" was found to be relatively common in pathology in many countries.     

Physician burnout in Hungary: a potential role for work-family conflict

In a study among Hungarian physicians (N = 420), we tested the hypothesis that compared to men female physicians experience higher work-family conflict (WFC) and consequent burnout. As predicted, female physicians scored significantly higher on the emotional exhaustion subscale of the Maslach Burnout Inventory and significantly more female physicians experienced high levels of emotional exhaustion compared to male physicians. WFC emerged as a significant predictor of burnout (emotional exhaustion and depersonalization). These findings suggest a potential path from WFC to burnout in a scarcely researched population of physicians in a unique cultural setting and provide further data for cross-cultural burnout research.