Dr. Gauri Arora

Dr. Gauri Arora
Consultant Anaesthesiologist, Nagpur

As usual I was going through the WhatsApp messages in the morning and my eyes caught something which gave me a jolt. Obituary message of an anesthesiologist colleague, who I had known in my post-graduation days. I remember her as a high strung girl. I wondered, how can someone take such an extreme step? Something must have been terribly wrong which she couldn’t share with anyone! I met her family to condole and what I could learn from them is, she was a very hard working, busy anesthesiologist. Everything seemed hunky-dory but for last one year, when she was noticed to be constantly irritable. Occasionally she would talk of giving up the medical profession. Few months back one of her patients died due to sheer misfortune after which she remained upset for quite some time. She recovered from that incident but would lapse into depression frequently. Otherwise affectionate, she would have outbursts of anger on her children for trivial reasons. Her family and friends advised her to take a break from work, but she would brush it away by saying that she was fine. And now this disaster happened. On the way back all through, I kept on wondering, was she suffering from burnout syndrome?

What is burnout ? Cambridge dictionary says ‘If a fire burns out, it stops producing flames because nothing remains that can burn’, i.e. to become completely exhausted through overwork. According to the World Health Organization (WHO), “Occupational burnout is a syndrome resulting from chronic workplace stress that has not been successfully managed”.

It is characterized by three features:

  • Emotional exhaustion
  • Depersonalization
  • Reduced personal achievement

Manifestations may be in the form of depression, mood swings, anger, apathy, easy fatigability etc. 

Medical profession is very demanding as it involves human life and there is high expectation of positive outcome. Anesthesiology is the most stressful discipline of all, because their job concerns highest degree of precision in the shortest possible time which can be emotionally very exhaustive. The other contributory factors are long working hours, erratic schedule of working, sleep deprivation, the onus of accuracy, working in ill-equipped setup, dealing with emergency situations which may be beyond the competence level, inadequate remuneration, fear of criticism, peer rivalry, less recognition etc. Chronic exposure to stressful situation in turn can take a toll on emotional health. Work related fatigue sets in, resulting in low performance level which in turn can lead to adverse patient outcome and medical error. Unfavorable outcome of the patient can push towards professional negativity. If the personal accomplishment doesn’t match with the ambitions, it can lead to frustration and low self esteem. This ultimately leads to apathy towards self and others. Chronic exposure to all or some of these adverse factors working together lead to what is recognized as occupational stress and burn out. In Indian scenario it poses a grimmer picture. In our resource poor country merely a fraction of GDP is spent on healthcare which is one of the minimum in entire world i.e. 1.4% as compared to 17.9% of developed countries like US. The healthcare professionals are having to work under additional pressure as the expectations of results are similar to those of developed countries. One more point that must be mentioned is, increase in incidence of violence against doctors in India, as compared to other countries. The healthcare professionals are working under compromised conditions and yet strive to give uncompromised outcome. It puts them under constant distress. Slightest decline in the competence can have dire complications in the form of violence and litigation. This results in dislike for the profession leading to high rate of drop-out from profession, change of profession, premature retirement, depression and other health issues.

Apart from certain professions, the individuals with personality trait of neuroticism has been identified to have proneness to develop burnout. These personality trait individuals are more likely to experience the feeling of anger, fear, frustration, envy, guilt, anxiety, loneliness or depression. They are not able to cope up in stressful conditions and tend to give exaggerated reactions. The combination of individuals having personality trait of neuroticism, in a highly demanding profession predisposes them to develop burnout.

Though there are studies from other countries on this subject, studies on Indian healthcare professionals are just a few.  One study of anesthesiologists in India conducted by GMC, Amritsar, using a questionnaire which included Maslach Burnout Inventory, highlighted low job satisfaction in 47.7%, and depersonalization in 48.5%. The burnout syndrome prevalence was 10.4% and occurred mainly amongst men (64.2%) aged 30-50 years (64.2%) with children (57.1%). Title of specialist (42.8%) over 10 years in profession (64.2%), work in night shifts (71.4%) were other significant correlates. 

A similar study conducted on 1178 anesthesiologists in particular, in the form of questionnaire revealed, 69% of participants rated their stress in professional life as moderate, while 22% rated it as extreme and 9% had minimum amount of stress. This is of serious concern and needs to be addressed in right earnest. Moreover, these figures may represent just the tip of iceberg.

The most important remedial measure consists of an early detection of this insidious condition. Good family and social support system goes a long way to help these individuals. Intermittent break from work and lifestyle modification also plays a very important role. Sharing one’s anxiety and spending quality time with family and friends, relaxation exercises and pursuing a good hobby can help. Taking help of psychotherapist should not be shied away from. Literature supports the values of nurturing spirituality to help oneself and eventually extending it to others. Other effective measures include sharing of responsibility at workplace, knowing one’s own limitations and seeking timely peer help. Wisely choosing the right profession according to one’s temperament is highly desirable at early stages. Improvement of working conditions and increasing the safety profile can be insisted at organizational level. Once an individual becomes a victim of burnout, a systematic rehabilitation program should be initiated. At the governmental level, healthcare allocation should increase to make it at par with the developed countries so that healthcare improves and healthcare providers do not become victims of occupational stress and burnout.

                  “Make your lives a masterpiece, you get only one canvas.”