Physician Stress, Frustrations Can Lead to Depression, Burnout
November 1, 2018 4 minutes read
About half of general surgeons report experiencing burnout. Their levels of stress and frustration have reached the point where their mental health is at risk. (Read more about the American Medical Association’s research on burnout online at: http://bit.ly/2MIxNKs.)
“All of us, whether or not we have underlying tendencies toward depression, could stand a little less frustration in our lives,” says Sharmila Dissanaike, MD, FACS, FCCM, professor and Peter C. Canizaro chair, department of surgery, Texas Tech University Health Sciences Center in Lubbock, TX. “Learning to cope with daily frustrations is important ... one strategy is to learn to pick your battles; you need to know which areas to put your effort and energy and improve.”
For example, if a surgeon is working in a surgery center that never opens the OR on time, the surgeon can choose to be frustrated each day when the 7:30 a.m. start time slides into 8 a.m. or 8:30 a.m. Or, the surgeon can push for a change to make OR staff more timely.
“But that takes a lot of effort and energy. You might decide that’s not a battle worth fighting,” Dissanaike says. “Anticipate that the OR won’t start on time, and maybe you catch up on your paperwork, read your journals, or take a walk. Find something useful to do so you won’t sit in the lounge, frustrated.”
Dissanaike describes these additional ways stress can result in burnout and how to prevent them:
• Dealing with stress from the procedure. Experienced surgeons are less likely affected by stress from the procedures they perform. But this can be common when surgeons are in training, she says.
“As surgeons become more experienced, the stress level begins to drop,” she says.
Surgeons learn how to cope with stress from their work through practice and finding that they can cope with different surgical scenarios, including patients who bleed or experience complications during surgery. Knowing the surgical team also helps reduce this type of stress.
“Make sure you have a team you are familiar with. Know who everyone is,” Dissanaike suggests.
Surgeons can make surgical timeouts a standard practice. With these, they not only go over the patient and surgical site before beginning, but they also listen as team members introduce themselves, Dissanaike explains. “The surgeon knows the scrub tech by name.” This sets the tone for a convivial team and reminds everyone that they work together. It creates a more positive environment and helps reduce individual stress.
“Before the operation, discuss the potential things that could go wrong and how they’ll be handled,” Dissanaike suggests. “Go over the contingency plan at the beginning of the case. It helps to make sure everyone is prepared and there’s not poor communication in the room. It helps to ameliorate the stress of an adverse event in an OR.”
For new surgeons, another stress-reduction strategy is to ask an experienced colleague or mentor to assist when there’s a high-risk case. Or, ASC physicians might not take cases for which the risk is very high, Dissanaike says. “Know what types of cases are appropriate for that setting, and make sure you don’t do anything beyond what can be handled in that setting.”
• Coping with daily annoyances. “A lot of stress in a surgeon’s life is accumulated slowly and is due to peripheral annoyances,” Dissanaike says. “If you are never able to start the OR on time or you believe everyone is wasting your time, then that is a daily stress that can build up and lead to burnout.”
Time-consuming note-taking or documentation also can be a stressor. The key is to not let time-wasting activities or long waits drain a person’s energy. “Daily stress can build up and lead to depression,” Dissanaike says. “Either you try to fix the problem, or you find a different way to use your time. The worst strategy is sitting there and fuming each morning.”
• Handling difficult personalities. It is stressful to argue with people or to deal with a conflict, Dissanaike laments. Surgeons might not be able to choose every person working with them in the OR, but there are ways to improve these relationships and reduce conflict.
“The fundamental understanding has to be that we cannot change other people’s personalities,” Dissanaike says. “We can barely change our own. You have to decide whether this person brings value in other ways.” For example, the troubling co-worker might bring a varied skillset to the job and demonstrate a deep understanding of his or her job. If the person exhibits these positive attributes, then the conflict might be a personality conflict. The onus is on the surgeon to accommodate and accept that they will never be best friends with the person, but they can work together on a daily basis, Dissanaike explains. “You can learn to overlook the daily things that are irritating,” she adds.
An exception might be if the other person’s behavior is demeaning or disrespectful. For instance, perhaps one employee’s habit is to call everyone “sweetie.” The surgeon can wait for a calm moment to ask the person to stop this, saying, “I’d very much prefer you didn’t call me that. You can use my first name, instead.” Some things cannot change, such as a person who always speaks loudly. But if it is necessary to curb the irritating behavior, then it is important to focus on the behavior and not the person when speaking with the employee about correcting the problem, Dissanaike offers. Also, any attempt to change an employee’s behavior should occur in person.
“It’s very common now for people to send off angry emails when things don’t go well,” she says. “When you’re angry, you overstate the case and exaggerate it. Other people reading the email think you are not reliable because you overstated the case.”
Emails are an easy way to throw someone under the bus, and they cannot be taken back. Once an email is out there, it can be shared and live on forever.
Besides the stress of performing surgery, dealing with daily minor annoyances and clashing with colleagues can, over time, compound serious burnout.
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