Combating stress and burnout in surgical practice: a review.

Johns Hopkins Medical Institutions, Department of Surgery, 1515 Orleans St. Cancer Research Building II, Room 507, Baltimore, MD 21231, USA.
Advances in Surgery 01/2010; 44:29-47.
Source: PubMed

ABSTRACT The practice of surgery offers the potential for tremendous personal and professional satisfaction. Few careers provide the opportunity to have such a profound effect on the lives of others and to derive meaning from work. Surgeons choose this arduous task to change the lives of individuals facing serious health problems, to experience the joy of facilitating healing, and to help support those patients for whom medicine does not yet have curative treatments. Despite its virtues, a career in surgery brings with it significant challenges, which can lead to substantial personal distress for the individual surgeons and their family. By identifying the priorities of their personal and professional life, surgeons can identify values, choose the optimal practice type, manage the stressors unique to that career path, determine the optimal personal work-life balance, and nurture their personal wellness. Being proactive is better than reacting to burnout after it has damaged one's professional life or personal wellness. Studies like the ACS survey can benefit surgeons going through a personal crisis by helping them to know that they are not alone and that many of their colleagues face similar issues. It is important that surgeons do not make the mistake of thinking: "I must not be tough enough," or "no one could possibly experience what I am going through." The available evidence suggests that those surgeons most dedicated to their profession and their patient may very well be most susceptible to burnout. Silence on career distress, as a strategy, simply does not work among professionals whose careers, well-being, and level of patient care may be in jeopardy. Additional research in these areas is needed to elucidate evidence-based interventions to address physician distress at both the individual and organizational level to benefit the individual surgeon and the patient they care for. Surgeons must also be able to recognize how and when their personal distress affects the quality of care they provide (both in the delivery of care and in the emotional support of patients and their families). There is no single formula for achieving a satisfying career in surgery. All surgeons deal with stressful times in their personal and professional life and must cultivate habits of personal renewal, emotional self-awareness, connection with colleagues, adequate support systems, and the ability to find meaning in work to combat these challenges. As surgeons, we also need to set an example of good health to our patients and future generations of surgeons. To provide the best care for our patients, we need to be alert, interested in our work, and ready to provide for our patient's needs. Maintaining these values and healthy habits is the work of a lifetime.

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    ABSTRACT: Background Suicidal ideation is more prevalent among physicians, compared to the population in general, but little is known about the factors behind surgeons’ suicidal ideation. A surgeon’s work environment can be competitive and characterised by degrading experiences, which could contribute to burnout, depression and even thoughts of suicide. Being a surgeon has been reported to be predictor for not seeking help when psychological distressed. The aim of the present study was to investigate to what extent surgeons in Italy and Sweden are affected by suicidal ideation, and how suicidal ideation can be associated with psychosocial work conditions. Methods A cross-sectional study of surgeons was performed in Italy (N = 149) and Sweden (N = 272), where having suicidal ideation was the outcome variable. Work-related factors, such as harassment, depression and social support, were also measured. Results Suicidal ideation within the previous twelve months was affirmatively reported by 18% of the Italian surgeons, and by 12% of the Swedish surgeons in the present study. The strongest association with having recent suicidal ideation for both countries was being subjected to degrading experiences/harassment at work by a senior physician. Sickness presenteeism, exhaustion and disengagement were related to recent suicidal ideation among Italian surgeons, while role conflicts and sickness presenteeism were associated with recent suicidal ideation in the Swedish group. For both countries, regular meetings to discuss situations at work were found to be protective. Conclusions A high percentage of surgeons at two university hospitals in Italy and Sweden reported suicidal ideation during the year before the investigation. This reflects a tough workload, including sickness presenteeism, harassment at work, exhaustion/disengagement and role conflicts. Regular meetings to discuss work situations might be protective.
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    ABSTRACT: Background: Many studies analyze the diagnostic process, diagnostic errors and diagnostic excellence but few provide a broad, yet practical view of this complex and highly context-dependent challenge. Methods: A personal, experience and research-based selection of the principles of data collection, processing and clinical reasoning found to be most useful in achieving an efficient, timely, and patient-centered diagnosis. Results: Twenty-four principles were identified and each one is presented and followed by a brief commentary. Conclusions: No single strategy can provide a solution for all diagnostic problems. However, the 24 principles have proven validity and can be applied in varied settings, and as a scaffold in teaching diagnosis at all levels of medical education. © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email:
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