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.

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