Added to this, doctors are experiencing an explosion in clinical cases with greater complexity and more patient volume. These and a plethora of other stressful situations that a doctor deals with everyday results in burnout. “Burnout is overload of stress which is mostly in repetitive form. Usually burn out occurs with chronic repetitive stress or with severe intense stress for a short period of time,” says Dr Rohan Jahagirdar, Consultant Psychiatrist, Aditya Birla Memorial Hospital, Pune.
The symptoms of burn out are identifiable in four areas: emotional, cognitive, behavioural and physical. These can manifest themselves in a number of ways. “Burnout is an experience of physical, emotional, and mental exhaustion, caused by long-term involvement in situations that are emotionally demanding,” explains Dr Meena Gnanasekharan, Consultant Psychiatry, Columbia Asia hospital, Bangalore. “The doctors who experience burnout can manifest symptoms ranging from insomnia, depression to substance dependence,” she further adds.
How many doctors feel ‘burnt out’?
The mentality of doctors is such that they do not want to ask for help or show vulnerability. Thus it is very difficult to survey doctors about burnout symptoms and estimate the true incidence. (Many doctors I spoke to for this feature were unwilling to admit to burnout or even stress) However, researchers opine that at any given time about 1/3 of the doctors feel burnout.
A recent study published in the Archives of Internal Medicine reports that 45.8 per cent of physicians reported at least one symptom of burnout. The study found that burnout in physicians is more common than among other workers. Substantial differences in burnout were observed by speciality, with the highest rates among physicians at the front line of care access (family medicine, general internal medicine, and emergency medicine). Similarly, a study of general practitioners (GPs) in one area of South East England, published in BMJ Open suggested that levels of burnout in UK general practice are high. Male doctors, those who work in group practices, and those who repeatedly see the same patients seem to be at significantly greater risk, the research shows, prompting the authors to declare that “a significant group of doctors is in trouble.”
Are Indian doctors more prone to burnout?
Dr Neville Misquitta Consultant Psychiatrist, Pathfinder Clinic, Pune |
There is no India-specific data to suggest the incidence of burnout among doctors in the country, however anecdotal references suggest a high possibility. “We see doctors regularly. Usually works out to about 1-2 a week,” reveals Dr Neville Misquitta, Consultant Psychiatrist, Pathfinder Clinic, Pune.
Yet some experts feel that Indian doctors are less likely to be burnt out than their western counterparts. “I think that burn out in doctors in India would be much less compared to their US counterparts. This is because most doctors in India do not have to deal with mundane issues like paperwork, insurance companies and regulatory bodies that plague the US. This situation is fast changing and we will face the same problems very soon. It is better that we are proactive and train doctors how to deal with burn out now and help decrease their chances of suffering from it,” explains Dr Gnanasekharan.
Is long working hours the culprit?
It’s not that all doctors experience burnout. The ones that do are those who work long hours without break and feel like the weight of the world is pressing down on them. “Doctors generally in our country don’t have a fixed working time and that is major cause of dis-balance. If compared to other fields where some people practice five days a week and some have fixed time to work , doctors end up working a lot more without a fixed break,” says Dr Jahagirdar.
“I have experienced the signs of burnout on occasions but they are not consistently present and not for long periods,” accepts Dr Sreenivasa Murthy TM, Consultant ENT & Cochlear Implant Surgeon, Columbia Asia Hospitals. “In fact when things do not go according to the set plan, it is then when surgeries take longer, attending OPDs gets delayed, there are calls from the wards and emergency, when they over lap, it is at these times that I feel helpless, frustrated and irritated. Above all, there are some patients who expect us to work like a well oiled wrist watch, without understanding the unpredictable nature of problems that we have to handle,” he further adds.
Dr Lakshmi Gangadharan Consultant Emergency Physician, Columbia Asia Hospital, Bangalore |
Narrating his experience Rakesh Ranjan, Consultant, Neurosurgery, Aditya Birla Memorial Hospital, Pune says, “There would be occasional sense of fatigue and feeling of helplessness due to inability to control the schedule of work.” Similar views are expressed by Dr Lakshmi Gangadharan, Consultant Emergency Physician, Columbia Asia Hospital Bangalore, who says, “My work timings are uncertain, starting at 9 am, and many a times continues till late evening. I am on call 24 hours a day, 365 days of the year, unless I am out of station, when my colleague would attend the call. Even when on leave, I am responsible for all major decisions taken at the hospital in my absence.”
Are some speciality doctors more stressed than others
Dr Rammurthy Bingi Chief Cardiologist, BGS Global Hospitals, Bangalore |
It is commonly thought that specialised doctors feel more stress and therefore experience burnout. Dr Ramamurthy Bingi, Chief Cardiologist, BGS Global Hospitals, Bangalore agrees, “There is lot of burnout in cardiologists as we have to attend emergencies and life and death cases. You have to be available 24/7.” “Surgeons may be more stressed out than general physicians,” he further adds.
However there is no conclusive study on this subject and a lot of opinions exist. “No such statistics are presently suggestive of which medical professionals will have more stress but anaesthesia, oncology and psychiatry are common professions with higher incidence of work related stress,” declares Dr Jahagirdar. Talking through his experience Dr Misquitta says, “Surprisingly, the largest number come to us from ophthalmology.” However, Dr Gnanasekharan provides a different insight. She says, “In the recent survey in the US burn out was highest in the doctors who worked in the emergency room and family doctors. In a small study in India it was found that burn out is less in private practitioners compared to doctors working in hospitals.” To this Dr Misquitta adds saying, “It’s a combination of age and experience. The young intern is likely to experience burnout towards the middle of her posting, when she has demonstrated competence and is left to handle cases on her own. The mid-career specialist is overwhelmed by demands from the family and children and loses interest in everything that motivated her. Yes, its mainly (but not only) women doctors who seek help.”
Citing an example he elaborates, “We had an enthusiastic resident doctor in the hospital general ward. She was later taken to the ICU where she was relied as she was able to work well with the consultants. She was kept on for longer than the usual rotation and most instructions were routed through her. She took on excessive responsibility and would phone in when off duty to check on a patient. When she came to us she felt emotionally ‘drained out’, forgetful, unable to take decisions and wondered if she was in the wrong profession. We helped her back with wellness cycle stress management. She is now again enjoying her work. Hopefully, she’ll keep it in balance.”
Work-life balance is critical
To reduce stress and avoid burnout, the answer is to maintain a work-life balance yet most doctors are dissatisfied with work-life balance . “Sometimes it happens as you are too busy. At times even on weekends you are unable to give time to your family and take a break from work,” laments Dr Ramamurthy Bingi, Chief Cardiologist, BGS Global Hospitals, bangalore
“Most doctors in India do not know the meaning of a work-life balance. Fortunately, doctors trained abroad and the younger generations of doctors realise the importance of work life balance and limit their working hours and try to enjoy things other than work. This will really help them and their families in the long run,” averts Dr Gnanasekharan.
Agreeing Dr Misquitta says, “Statistics say so. However, most doctors we know are excited about their work and take time off to pursue other interests and be with their families. Its only a few of them who are so dissatisfied that it is a problem for them. Even for these, most recover with promotion of the wellness cycle.”
Tried and tested
Dr Nayaran Gadkar Interventional Cardiologist, Kohinoor Hospital |
Therapy is the solution for doctors who feel burnt out but there are a lot of tried and tested simple remedies which aid the process of self renewal. Many doctors feel that hobbies like music and reading help them remain sane. “Sharing some problems/feelings and looking at the lighter side of life, make things a little more bearable. Music, reading and spending time with my child helps me deal with stress,” shares Dr Gangadharan. While others feel that enjoying work keeps them going. “It is very important to enjoy your work. I enjoy my work and that completely takes care of my stress. I avoid taking up work that I do not enjoy. Work becomes fun when you enjoy what you do and fun never involves stress. Proper planning of the day’s work and proper communication with people around mitigates majority if not totally eradicate stress. My other hobbies like preparing for marathons helps to de-stress at work and gives an opportunity to look forward to something good in life,” says Dr. Narayan Gadkar, Interventional Cardiologist, Kohinoor Hospital.
“The passion to work in the field keeps you going, with gratification, with outcomes of patients, a bit of sense of humour and hobbies to de-stress one,” says Dr Ranjan. Still others find solace in academia. “On occasions when I feel I am going in no direction, I usually book myself into an academic course to upgrade my skills, which allows me to learn newer techniques/ subjects and gives me a break from the schedule which can be boring if it becomes monotonous. This also provides an opportunity to interact with peers, seniors and juniors – accounts for a social meeting and gives an opportunity to let the steam out. If nothing seems to work – take a break with family away from the city,” reveals Dr Sreenivasa Murthy TM.
Yet some like to spend time with family. “Dinner with family is the best time to reduce stress. I watch movies, travel and living and history channels on TV. I listen to music and read too. Another way of dealing with stress is by emotional outburst. My wife is the buffer,” discloses Dr Ramamurthy Bingi