Tuesday, 26 May 2015

ClinicSpeak: Is your neurologist burnt out?

How real is burnout? #ClinicSpeak #MSResearch #MSBlog

"Last week was one of the hardest I have had working as a clinical academic, administrator, teacher and MSologist. My diary was simply sea of blue space with virtually no free time. I did manage to work from home last Wednesday on an urgent grant application; the deadline is the 3rd June and it will be touch and go if we make it. The grant is a large programme of research tackling progressive MS. Despite booking the day off work, I still had teleconferences and the endless avalanche of emails to deal with. After clocking in 18 hours at my desk I think we may have a chance of getting it in on time and in good enough shape to convince the reviewers to recommend funding it. May be I am fooling myself; the success rate with MRC grants is less than 10%."

"Thursday started with a strategy meeting on our MS sevice at Barts and finished with a very long and emotionally draining MS clinic. I had to rush home quickly to look after my daughter's needs as my wife was away at an important company meeting. I had to get up at 5am on Friday to get to the Sofitel at Heathrow airport to chair an International meeting on a policy paper to promote brain health in MSers and to treat MS holistically. We are hoping to launch the policy document at a satellite symposium at ECTRIMS this year. Overall, I think the meeting went well, but by the time I go back home I was exhausted. I am beginning to understand the meaning of burnout (see abstract below)."

"Saturday started with a quiet walk on the common with my dog, listening to a BBC Radio 4 debate on animal welfare. I was recommended by a colleague of mine and friend who recently retired from the hustle and bustle of academic life. It is well worth listening to if you have access to BBC podcasts."


At the end of May 2015, there will be a debate in a New York court about whether two chimpanzees kept in a university laboratory are being illegally detained, and should be released into a sanctuary. Laboratory research on chimpanzees is banned in most of the world, though the US, along with Gabon, still allows it. Hear a discussion on whether animals, including primates, should be used for research, and whether they are entitled to “rights” - or just “humane treatment”. The debate is chaired by Owen Bennett Jones and includes the leading philosopher opponent to the concept of animal rights Professor Carl Cohen, as well as a distinguished philosopher Colin McGinn, a lawyer and a leading animal rights advocate Steven Wise, a neurobiologist Sir Colin Blakemore and someone who grew up with Nim Chimpsky - a New York resident Jenny Lee. 


"Just when I thought I was free of thinking-MS I saw a man with a walking frame trying to walk his dog. He had a spastic paraparesis (weak in both legs) and a foot drop. He nearly fell several times getting from his car to the bench next to the bandstand on Clapham Common. He had a small dog, it looked like a Scottish Terrier, on one of those long extendable leads. The dog simply wound the lead around the bench and got it knotted around the walker. It was then I noticed the man was also very incoordinate and was having difficulty dealing with the lead and the his dog. The sad thing he was younger than me, I would have guessed in his early 40s, and based on simple deductive reasoning most likely had MS. It was clear to me that as hard as I tried the week was destined to be MS and nothing else. It was at this exact moment that I decided not to do any work over the weekend and almost got there if it wasn't for my usual insomnia that got me up at 2.30am on Monday morning. Thankfully, the remainder of yesterday was a holiday in England, the so called second May Bank holiday so I had the day off to spend with the family and friends visiting from Malaysia. I am about to leave for the airport to travel to the CMSC meeting in Indianapolis; I have two platform and several poster presentations, so it is back to my day job. I will keep you posted on what happens at the CMSC meeting."


Sigsbee & Bernat. Physician burnout: A neurologic crisis. Neurology. 2014 Dec 9;83(24):2302-6. d

The prevalence of burnout is higher in physicians than in other professions and is especially high in neurologists. Physician burnout encompasses 3 domains: (1) emotional exhaustion: the loss of interest and enthusiasm for practice; (2) depersonalization: a poor attitude with cynicism and treating patients as objects; and (3) career dissatisfaction: a diminished sense of personal accomplishment and low self-value. Burnout results in reduced work hours, relocation, depression, and suicide. Burned-out physicians harm patients because they lack empathy and make errors. Studies of motivational factors in the workplace suggest several preventive interventions: (1) Provide counseling for physicians either individually or in groups with a goal of improving adaptive skills to the stress and rapid changes in the health care environment. (2) Identify and eliminate meaningless required hassle factors such as electronic health record "clicks" or insurance mandates. (3) Redesign practice to remove pressure to see patients in limited time slots and shift to team-based care. (4) Create a culture that promotes career advancement, mentoring, and recognition of accomplishments.

40 comments:

  1. Make sure you keep carving some time out for yourself there Prof. There is a limit to what one person can do in a day.

    Appreciate all your efforts and would hate to see you on the wrong side of that abstract!

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  2. Don't take this the wrong way, but thank your lucky stars that you don't have a progressive neurological disease. Many of us had busy lives before MS barged its way in. Many of us have lost our careers, families, independence, future because of this disease. I would gladly swap my life for a busy, stressful life. You work incredibly hard, and I thank you for that. However, living 24/7 with a progressive neurological disease is also challenging and stressful.

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    1. Re: “….thank your lucky stars that you don't have a progressive neurological disease.”
      I have been reading quite a lot of health philosophy recently and there are many who are trying to define ageing as a disease. If that is the case we all have a progressive neurological disease, it is called life and gets worse as we age. If we medicalise ageing it opens up a new drug class for the pharmaceutical industry. Already there are several University spin-off companies hoping to cash in on the age disease. I am sure most big pharma companies are watching the space with interest and have age as part of their long-term strategies. I personally think age is not a disease; we simply have to accept it as part of life. However, we all have a responsibility to maximise our chances of ageing healthily. The latter is the essence of our of policy document. Brain health, how can we optimise it for MSers. If neurologists and other HCPs ask themselves this question they may treat MS differently.

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    2. "If that is the case we all have a progressive neurological disease, it is called life and gets worse as we age."

      Life is a sexually transmitted disease with 100% mortality.

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  3. I apologise as this is bound to put some noses out of joint, but this almost competitive notion of "at least you don't have..." baffles me. A) it's not a competition and B) what possible purpose does it serve?

    It's true that we have a bad disease, but that's life, there were never any guarantees. I deal with it as best I can, because there's no other sensible option. My rotten luck in no way makes me entitled to belittle the sacrifices others make.

    The people who choose to be in this battle with us and care about us (our partners, our dedicated researchers and campaigners) do so despite the many other sensible options out there for them.

    Playing the "you should think yourself lucky..." card is condescending, utterly pointless and demeaning to everyone.

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    1. Totally agree. I really do not like this type of comment. MS is crap for sure but I do not understand the need some individuals have to make negative comments like this. Like you, I feel having MS doesn't give me some bizarre right to belittle the people working to help.

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  4. Professor G. It strikes me that a sense of priority needs to fulminate in your, clearly, impressive brain.

    The order of things might be: your health, your family, your funding applications, your research, your lecturing, your patients.

    Without your health you are unable to be the man you aspire to be.
    Without your family you will regret the man you had let yourself become.
    Without funding you are unable to do the research that you seek to do.
    Without research you will be unable to influence tens of thousands of lives by finding a way to stop the march of this disease.
    Without lecturing your research will be caught in the dark and will not be transformative.
    Your patients must come last. The urge, of course, is for you to place them first. Their desire is for you to place them first. The noble impulse of humanity was what caused you to note the man in the park. But he is one of 100,000 people with MS in the UK. You cannot stop his progression just through humanity. But you might be able to stop his progression through research.

    With all the respect in the world, Professor G, I think you need to look again at your life. You are not superhuman. You cannot change the past pain of what blights our lives. You can, however, change the future. And perhaps, in so doing, you will relieve your great, great, great grandchild of a neurological hell.

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  5. Interesting the slides show there is a conference workshop on Taming stress: managing it's effects in MS. Yet NICE are not willing to acknowledge stress effects MS in guidelines for treating MS.

    I had a massive relapse triggered by stress and anxiety from phonophobia, this was before I knew I was very unwell with MS. It had left me unable to work and traumatised. That was my introduction to MS.

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  6. This becomes more cruel
    I suffer chronicaly with anxiety and ocd and the worry about Ms makes my anxiety and ocd worse! So I know I'm making IT worse which makes me stress more which makes it worse
    What a cruel cruel disease

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    1. The thing that has stopped the anxiety for me completely is meditation. I do this every morning and late afternoon, 20 minutes twice a day. I also do yoga sometimes which helps reduce stress and anxiety. It's an accumulative effect, it gets better and better. I make the time to do it as it is a priority for my health.

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    2. Caution may be needed regarding meditation as a panacea. Worth a read.
      http://www.independent.co.uk/life-style/health-and-families/features/meditation-is-touted-as-a-cure-for-mental-instability-but-can-it-actually-be-bad-for-you-10268291.html

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    3. Hi MD2, I agree that meditation is not for everyone, however, it can work for some. Personally, I've never been good at sitting still so I practice walking meditation. Sounding a bit hippy-dippy but being in green, leafy places for a few hours every day really calms my mind (yep, even in the rain and cold). Again not right for everyone with MS because of fatigue and mobility problems. There are other techniques involved in that current UK buzzword of 'mindfulness' that can help individuals with anxiety that do not involve meditation.

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    4. Thanks MD interesting to hear about it from another viewpoint.

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    5. Just playing Devil's advocate there ;-)
      If it works for you, keep doing it!

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    6. So what do you suggest mouse? And is there truth in stress worsening Ms? Would this support oxidative stress?

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    7. You have hit a nail here what is stress? physical stress, oxidative stress, mental stress.. they are all different

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    8. Please correct me if I am wrong but is it the vagus nerve that controls production of TNF, a protein which signals the body to mount an inflammatory response. It is triggered with infection and also anxiety. Anxiety and stress are bidirectional, stress can cause anxiety and anxiety can cause stress.

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    9. Is this true? This is the hardest part I think knowing that your contributing to the worsening of the disease by stressing and being anxious yet you can't change it! This is literally torture

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    10. stress is this amorphous term that can mean something tangible or something undefinable which is emotional stress. Stress hormones produced under physical stress and some types of mental stress are in fact immunosuppressive and quell disease.

      As to vagal nerve stimulation it is being investigated in arthritis. If the mechanism is TNF production then it would make MS worse rather than better as occurs in rthritis alledgely.

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    11. There are so many stress and anxiety reducing activities that are different to meditation and are calming from pilates, yogalates, gentle yoga, tai chi, EFT tapping to name a few.
      Tai Chi seems to benefit some MSers, I might try it myself.
      http://www.ncbi.nlm.nih.gov/pubmed/25145392

      BMC Neurol. 2014 Aug 23;14:165. doi: 10.1186/s12883-014-0165-4.
      Mindfulness-based interventions in multiple sclerosis: beneficial effects of Tai Chi on balance, coordination, fatigue and depression.
      Burschka JM1, Keune PM, Oy UH, Oschmann P, Kuhn P.

      RESULTS:

      Following the intervention, the Tai Chi group showed significant, consistent improvements in balance, coordination, and depression, relative to the TAU group (range of effect-sizes: partial η2 = 0.16 - 0.20). Additionally, life satisfaction improved (partial η2 = 0.31). Fatigue deteriorated in the comparison group, whereas it remained relatively stable in the Tai Chi group (partial η2 = 0.24).
      CONCLUSIONS:

      The consistent pattern of results confirms that Tai Chi holds therapeutic potential for MS patients. Further research is needed to determine underlying working mechanisms, and to verify the results in a larger sample and different MS subgroups.

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    12. Yoga, tai chi, meditation and similar practices might slow the heart rate via signals that travel down the vagus nerve. These same signals may dampen immune response. Please correct me if this is wrong.

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    13. MD would then be due to this immunosuppressive effect of hormones released during stress originated from the practice of physical exercises that some MSers that has conprometedoras motor sequelae not suffer so much with fatigue say feel good and control MS through the activities of practice physical?

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    14. Kris,
      Tai Chi seems positive for MSers in many ways including anxiety reduction.

      http://www.ncbi.nlm.nih.gov/pubmed/25488322
      J Evid Based Complementary Altern Med. 2015 Apr;20(2):143-53. doi: 10.1177/2156587214561327. Epub 2014 Dec 8.
      Tai chi as an alternative and complimentary therapy for anxiety: a systematic review.
      Sharma M1, Haider T2.
      From the abstract:
      Statistically significant results of anxiety reduction were reported in 12 of the studies reviewed.

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    15. The problem is defining stress....exercise is physical stress but the physical stress I was referring to is cortisol which is a stress hormone . I am sorry but i cant pretend that I understand the complexities of the stress axis, its not my thing and don't know enough

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  7. Maybe we all need to learn to pause from time to time, but from experience life is a competitive market and if you blink it might just pass you buy...

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    1. prof g can retire, ndg can take his place...circle of life and all that.

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  8. As an MSer lucky enough to be on Prof G's long list of patients, and who saw him for a good half hour towards the end of that exhausting Thursday clinic, I want to say a big thank you for your tireless work, genuinely caring attitude, and up to the minute expertise. The contrast with other neuros I have met (paternalistic, offhand, patronising, vague, risk averse etc) is immense. You and your colleagues on this blog really are making a difference. I hope you all get some rest / recovery time along the way.

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  9. Dear Professor G. and The Team

    I'd like to share my 'mundane' story with you as it seems that at some point life realised that I was too happy with what I had there and then, so it decided that I should struggle significantly more. As a result of that, this unwanted ominous foe visited me... It visited my world and decided not to go away any time soon. Then, I was forced to fight with it and I am still fighting because I can see that there are the people who know that it does make sense to fight. That's why, every day when I see that Professor G. and The Team mention, post, analyse, question, publish, confirm, submit, interpret, criticise, summarise and give us some either good or bad news, I know that it makes sense to open my eyes in the morning and live...
    What is this story supposed to tell you? Well, perhaps something or completely nothing, you are to decide, but the only thing is clear: you need to take your time, rest and show your families how much you love them, and I mean what I say.
    It is just one of thousands of comments that you read every day, but if you weren't here, who should be addressed as Professor G. and The Team who are the people that make a difference for everything? Who?

    Best Regards
    You really change the world...

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  10. Agreed
    But change it quicker!! Lol

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  11. I can tell that Prof G and the rest of the team strive to find a cure for this desease. the neuros I have seen don't have that desire or abition so therefore no stress.

    I love this blog because i feel that things are being done to help us by dedicated talented people.

    Thankyou again

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  12. My neuro talks to himself a lot and I often see him sticking himself with a pin instead of me. Should I seek another neuro? Maybe he is burnt out?:-)

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    1. Maybe they are just crap:-)

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    2. Oh yeah, he also plays Pink Floyd's "Comfortably Numb" in the office.

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    3. Not all bad then ;-) One of the greatest guitar solos of all time IMO.

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    4. Does he play Brain Damage?

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  13. If I couldnt see all the work being done for ms on the blog, I think I would be in a much darker place, this brings me hope which is hard to achieve whilst suffering with ms. I read the positive and negitive post's as at least I can see what work is being done.

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    1. That's why the blog was set up. I'm glad you find it of help.

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