Medical Matters:Each year, the professional bodies and trade unions hold their conferences and we are reminded of the difficulties of the various jobs and how little the general public understand them.
Stress and burn-out feature in most of the speeches. Surprising then that more analysis of these problems has not been made. Furthermore, the converse, what constitutes job satisfaction is also not often discussed. In fact it is difficult to find a major symposium devoted to this topic.
How is it that for a lot of people who commence their jobs and careers with great enthusiasm, this same job becomes a dread? Motivation for many is lost and burn-out results.
In a recent address at the Convocation of the American College of Surgeons in Chicago the president, Dr Edward Copeland, suggested that 80 per cent of people view their jobs as a means of supporting all their activities not related to their jobs. He was expressing the hope that the class would see their future careers also as a hobby. While this may be the aspiration of many it is also unrealistic and perhaps naive. For most, making a living takes priority over other considerations.
Any job or profession which does not allow diversification will result in many having few other talents outside their profession. In this regard Sir William Osler said "medicine is a jealous mistress" which can equally be applied to many other jobs and professions.
If asked about the origins of burn-out most would probably respond that they are physical, mental, financial, related to boredom, fear or outside pressure. In fact, all of these factors make life itself more difficult but with the exception of an unfortunate minority most do not give up on life.
In the work sphere a serious mismatch develops between the person and the work, between the individual's aspirations and the job's expectations.
Another significant slant was cast on this topic recently in the Journal of Advanced Nursing. This was a study by Glasberg and colleagues who attempted to measure burn-out. It was defined as a syndrome with three components: emotional exhaustion, depersonalisation which is a cynical or callous attitude towards others and negative assessment of one's competence and work.
It was carried out in northern Sweden among 625 medical personnel who had direct contact with patients. The influence of several factors was analysed. In her conclusions she found that emotional exhaustion among staff working in internal medicine, elder care, and primary healthcare centres was higher than among staff working in emergency care. Depersonalisation was higher in men than women.
However, a factor common to those with burn-out was what she called "stress of conscience". This resulted from lacking time to provide the care needed, from work being so demanding that it influences one's home life, and from not being able to live up to others' expectations. Gender differences were also noted. The necessity to lower one's aspirations to provide good care and to deaden one's conscience in the process, resulted in stress.
In the complex and very personal profession of medicine this aspect has received little attention to date. This has been expressed in a very succinct way by Rachael Naomi Rehman who said, "it is not that we don't care, we care too much".
While many are susceptible to burn-out there are also natural defences including resilience, self-esteem and experience. For many, burn-out can be prevented only by developing "detached concern" in which personal power is gained by "letting go".
This is especially important for those who work with people having serious or even impossible problems. An attachment to the notion of how things ought to be can induce a feeling of hopelessness. Many others have pointed out the salutary effect of teamwork. Talking to colleagues was often the most frequently mentioned way of coping with stress.
Indeed my own interest in this topic was generated by observing and admiring the remarkable teamwork that came into play with life-threatening emergencies at all hours - day or night. It often appeared to me that the team spirit was a major factor in a successful outcome. Also, for those with responsibility in working areas, creating a good atmosphere is as important as exerting authority.
Stress is a multifaceted problem which can be destructive to the individual and harmful to the workforce. Recognition of burn-out in its early stages is imperative since simply changing jobs or taking a vacation will not ensure a cure unless resolution has occurred beforehand. For the victim of burn-out, not only the job, but life itself is at stake.
Vincent Keaveny was a general and vascular surgeon at St Vincent's Hospital, Dublin, and more recently at the Blackrock Clinic. He is now retired.