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  Table of Contents  
Year : 2020  |  Volume : 11  |  Issue : 5  |  Page : 816-817  

Burnout: The resident evil — Perspectives from the horses' mouth!

1 Department of Psychiatry, R.G. Kar Medical College, Kolkata, West Bengal, India
2 Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India

Date of Submission16-Apr-2020
Date of Decision13-May-2020
Date of Acceptance22-Jun-2020
Date of Web Publication19-Sep-2020

Correspondence Address:
Abheek Sil
Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, 1, Khudiram Bose Sarani, Kolkata - 700 004, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_262_20

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Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions- (1) feelings of energy depletion or exhaustion, (2) increased mental distance from one's job, or feelings of negativism or cynicism related to one's job and (3) reduced professional efficacy. Any profession where a certain amount of emotional work and empathy are expected renders a person vulnerable to being burned out. Resident doctors, who play the role of a primary care-giver and spend a great deal of time with patients, are most prone to suffer. However, early identification and necessary intervention would go a long way in making the three formative years of a doctor's life more worthwhile.

Keywords: Burnout, post-graduation, residency

How to cite this article:
Priyam P, Sil A. Burnout: The resident evil — Perspectives from the horses' mouth!. Indian Dermatol Online J 2020;11:816-7

How to cite this URL:
Priyam P, Sil A. Burnout: The resident evil — Perspectives from the horses' mouth!. Indian Dermatol Online J [serial online] 2020 [cited 2021 Oct 24];11:816-7. Available from: https://www.idoj.in/text.asp?2020/11/5/816/295565

   Introduction - A Relatable Scenario for Many Top

Bubble, much like her name, was an enthusiastic 25-year-old MBBS graduate. Academically brilliant, she got her favorite stream for postgraduation in the college of her choice, in her first serious attempt. Overjoyed, she joined work way before the last date of joining.

And then the carousel started turning.

OPD. Ward duty. Nights on call.

Work was fun.

Day after day. Night after night.

Till work became work.

Weeks and months rolled by.

Soon after it became so lackluster, she began questioning if she really wanted the stream she had chosen.

How can it be so for someone who was living the dream?

Many of us are in the same shoes as Bubble. What she was experiencing is termed as the “burn-out syndrome.”

Characterized by a sense of being unaccomplished, irritable, and feeling strung up, burn-out is fast turning into a widespread phenomenon, a scar on the resi-dream.

   History - A Look Back Top

Much like stress, the concept of “burn-out” was first used in the field of physics and engineering in the 1940s, to describe the stopping of a jet engine after prolonged use.[1]

The first mention of it with respect to humans was by an American psychologist Herbert Freudenberger in 1974. He used it to describe the consequences of severe stress and high ideals in “helping” professionals (doctors and nurses) sacrificing themselves for others, but often ending up being “burned out”. Based on the analysis of voluntary workers in a free clinic in New York, he described burn-out as “becoming exhausted by making excessive demands on energy, strength, or resources” in the workplace.[2]

   Existing Diagnostic Guidelines Top

Burn-out, unlike a depressive episode, is not categorized as a mental disorder. In the 11th revision of the International Classification of Diseases, it has been described as an occupational phenomenon, detailed in the chapter: “Factors influencing health status or contact with health services”—which includes reasons for which people contact health services.

It is characterized by three dimensions:

  1. Feelings of energy depletion or exhaustion;
  2. Increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and
  3. Reduced professional efficacy.

Burn-out refers specifically to the phenomena in the occupational context and should not be applied to describe experiences in other areas of life.

   Residency - A Risk Factor in Itself! Top

Burnout affects the dedicated and committed, more. Any profession where a certain amount of emotional work and empathy are expected renders a person vulnerable to being burned out.

Burn-out in doctors is not due to the lack of resilience. Years of tough training certainly ensures a healthy build-up of resilience. Residency is a transition period between being purely a student to gaining some autonomy in patient care. Inadequate infrastructure and staff, prolonged working hours, maintaining extensive paperwork, and security concerns within the hospitals, further compound the problem. As primary care-givers, residents spend more time with patients as compared to senior consultants. In certain specialties, residents face the challenge of conveying untoward information to the patient and their family. Eventually, this grueling task can take a toll on their mental health. What is crucial is, sometimes, their entire effort goes unappreciated. Amidst all the hustle-bustle, academic activities are always to be catered to, which with the time-crunch can be exigent. Added to it, life events like moving to a new city, mastering a new language, etc., which most experience or are about to, act to erode resilience, thus contributing to precipitating burn-out.

   Prevention and Treatment - the Way Out Top

But like every problem, there is a solution to this one too.

  1. The default mode of “busy” should be done away with from time to time. Unrealistic deadlines should be revised. Utilizing Covey's matrix in sorting out the highest priorities can help with time management. Mastering the art of “productive procrastination” to tide over the demands of the workplace can help ensure ample “me time”
  2. Focused short term goals help to keep the mindset positive. For example, the idea “I'll read a part of the rare presentation of a disease today” would be easier on an individual than “I've to finish off the entire chapter today.” It is important that the focus stays on the effort and not on the result
  3. Increasing physical activity may be helpful in getting rid of the aggression that builds up unconsciously. Setting aside some time for relaxation daily in form of yoga, meditation, breathing exercises etc., can be productive in reducing stress. To maximize the benefit, focus should be shifted to the body and how it feels as one moves—the sensation of one's feet on the grass, or the feel of the sunlight and wind on one's skin. The above activities can be coupled with putting off all electronic gadgets for a stipulated period of time every day in order to unwind peacefully
  4. To control who one works with is not possible for most. Negative minded people who are looking to find faults and pull others down should be smartly dealt with to avoid gas lighting. If they are to be worked with, time of contact with them should be limited. Being assertive and saying “no” becomes important in such situations
  5. Identifying a “stability zone” will help one relax and recuperate from all that has been going around. It could be anything— starting from a person to a book, a sport, a musical instrument, or a place of quiet
  6. The old method of “counting blessings” or gratitude journaling can be helpful in bringing to light the positives every day
  7. At any given point, if the need be felt, professional help should be sought.

   Conclusion Top

Even the stoutest rubber band will break, if it's stretched excessively. Stress remains a necessary evil. Identifying and addressing the burn-out issue would go a long way in making the formative years of residency a smoother sail. The secret lies in rediscovering the lost joys and making the years that shape our careers worthwhile. Life has to be more about living than just being busy. So take a break before you break down!

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Conflicts of interest

There are no conflicts of interest.

   References Top

Tan S, Yip A. Hans Selye (1907–1982): Founder of the stress theory. Singapore Med J 2018;59:170-1.  Back to cited text no. 1
Freudenberger HJ. Staff burn-out. J Soc Issues 1974;30:159-65.  Back to cited text no. 2


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    Introduction - A...
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