Tuesday, 25 April 2017

#ThinkSpeak & #AAN2017: burnout

Did you know neurologists are the specialists that are most likely to suffer burnout? #ThinkSpeak #AAN2017


I went to the opening, or plenary, session of the AAN meeting and heard Terrence Cascino, the President of the AAN, present the data from a national survey of US neurologists on well-being, burnout and career satisfaction. It was flabbergasted to hear that neurology is the speciality most likely to be affected by burnout and that ~60% of  respondents had at least one symptom of burnout. As this impacts negatively on their work, I wonder how it is affecting the management of their patients with MS?

When Terrence Cascino presented the list of symptoms of burnout I realised that I, and a lot of my colleagues, suffer from burnout; i.e. emotional exhaustion, feelings of cynicism and detachment (depersonalization), and a sense of ineffectiveness at work (low personal accomplishment). I realise that I need to do something about it, but what?   


Busis et al. Burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology. 2017 Feb 21;88(8):797-808.

OBJECTIVE: To study prevalence of and factors that contribute to burnout, career satisfaction, and well-being in US neurologists.


METHODS: A total of 4,127 US American Academy of Neurology member neurologists who had finished training were surveyed using validated measures of burnout, career satisfaction, and well-being from January 19 to March 21, 2016.

RESULTS: Response rate was 40.5% (1,671 of 4,127). Average age of participants was 51 years, with 65.3% male and nearly equal representation across US geographic regions. Approximately 60% of respondents had at least one symptom of burnout. Hours worked/week, nights on call/week, number of outpatients seen/week, and amount of clerical work were associated with greater burnout risk. Effective support staff, job autonomy, meaningful work, age, and subspecializing in epilepsy were associated with lower risk. Academic practice (AP) neurologists had a lower burnout rate and higher rates of career satisfaction and quality of life than clinical practice (CP) neurologists. Some factors contributing to burnout were shared between AP and CP, but some risks were unique to practice setting. Factors independently associated with profession satisfaction included meaningfulness of work, job autonomy, effectiveness of support staff, age, practicing sleep medicine (inverse relationship), and percent time in clinical practice (inverse relationship). Burnout was strongly associated with decreased career satisfaction.

CONCLUSIONS: Burnout is common in all neurology practice settings and subspecialties. The largest driver of career satisfaction is the meaning neurologists find in their work. The results from this survey will inform approaches needed to reduce burnout and promote career satisfaction and well-being in US neurologists.

30 comments:

  1. Ditto. I am an NHS consultant and feel the same way as you. I know it is affecting how I look after my patient. The guilt that goes with knowing you are not doing your best makes matters worse.

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  2. Technology will help in the coming years with decision making. Aren't they trialling AI at Barts already? (i thought an app made its way to the ER division).

    A lot of what an MS neurologist does (not everything) can be codified. Optimal treatment selection, switching strategies and monitoring (Automated MRI scan analysers coming soon I hear).

    Meanwhile, feel free to intern with us at our trading desk, not far from your office. City traders have one the lowest burnout rates (and the highest life accomplishment/satisfaction) in London as we all know...

    Tony F

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    1. Loath as I normally am to use this but LOL ;-)

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  3. I know this is very un-PC, but you / others need to man-up! My great uncle (a farm labourer) spent three years in the trenches in WW1. The things he saw and experienced were horrendous. However, he came back to England took over a small-holding, raised a family, and never complained once. Every profession / trade could do the same research and come up with the same results. We've become a nation of self-centred, self-obsessed people. Less navel-gazing and more focus on what you were trained to do is the solution. Your (Prof G) major fault is you can't say no - to a neurology conference, international lecture tour, expert for a panel overseeing a pharma drug in development. Why don't you say know to these three activities for the next 9 months? Focus on your clinic and research work. I suspect that, despite all the grumblings, you enjoy all three (ego / status issue).

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    1. Totally agree.

      And try gardening instead of all the exhausting running.

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    2. First off, this is reporting from the AAN 2017 in the USA.

      Secondly, its a problem. It's not a "man up" situation, its a situation where resources being directed at patient load are inadequate for starters at many clinical interfaces.

      SEVERAL clinics here over the past 6 months have went into the mode of each patient gets 15 minutes. This is not due to greed, it is due to patient load. A Neurologist does not simply treat MS, thats an MSologist.

      The continual need for education, therapy education, drive towards personalized care and considerably more NOT to mention the "coding" of visits has stretched things considerably and its not only in Neurology but other disciplines as well.

      A difference in neurology is a casual look at a folder is not enough to substantively provide best quality care. Atop that, neurologists tend see QUITE different impacts than nearly any form of medicine towards disease that "Takes people away." That is to say, "Brain disorders be that MS, Parkinsons, ALZ, Stroke, TBI on and on force someone to SEE DAILY impacts of said diseases/disorders.

      Too much heat get out of the kitchen? Yep, I know of several that did just that. They make more money as neurosurgeons and replacing them is REALLY difficult.

      Pretty difficult to provide personalized MS care with a 15 minute visit w/ an unprepared patient coming in the door. But, want the 30 minute visit? Ok. Instead of the appointment being 60 days from now, push that out to 120. Some patients, "Sorry... We dont have any openings."

      This is a brewing problem and it needs to be addressed by care systems.

      I've watched it first hand here and its nothing to do with "Man up."

      What a simply ridiculously uninformed response.

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    3. We can all accuse each other of being uninformed.

      Life is tough, but if you have your health and a lot of choices...

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    4. But people who live with multiple sclerosis do not have their health. If they did, no need for a Barts MS Blog or MS patient associations and then some++. Nor do people w/ Lupus, Stroke, TBI etc.

      Their PRIME interface to care is the neurologist.

      MS is one of the most complex neurological conditions to treat. Even patients dont tend "get that." Why? Because there are many treatment options for RRMS, more in the pipeline, including different courses of the disease. Due to where plaques are, disability accrued being completely as different as everyone's fingerprint providing symptomatic therapies makes a complex disease a WHOLE lot more complex.

      Slap atop all this diet, exercise, abilities/non-abilities, cognitive deficits, emotional deficits and last but not least "I read on the internet __ (Put nearly anything here) __, 15 minutes just DOES NOT allow for excellence in neurologic care. 15 minutes does not allow for it in stroke, even a sleep disorder.

      Physicians are human. They have emotions, lives... A soldier who comes back from battle may have emotional trauma. Might take just one incident in fact. Consistent exposure + stress + lack of resources + attempting exercise "good" medicine and do all things in 15 minutes is a real problem.

      I wanted my neurosurgeon be my neurologist. He is board certified. He's a freight train, no wish/wash. Tell's it like it is, like it or not. He wont touch MS. Not because he doesnt care. Instead, he cites several reasons:

      1. The disease is extremely complex to manage.
      2. It really requires a medical discipline of its own.
      3. Patients seldom adhere to strict wellness disciplines resulting in the neurologist trying to help someone who is rather unwilling help themselves or simply cannot due to disability which is frustrating.
      4. He cannot provide adequate care given time constraints.

      Constraints? Following care?

      I had to have neurosurgery. Every visit has resulted in 1.5 to 2.5 hours of interaction. Patients follow what the surgeon has to say because if they do not, they can well die. Just like that.

      People in MS are told, "Dont smoke, dont even smoke eCigarettes" but they do.

      But eCigs are safer? Really?

      Same neurosurgeon showed me medical imaging clearly showing arterial and blood vessel shrinkage due to enormous amounts of nicotine. That results in higher blood pressure/hypertension. Not a real good idea with any neurologic condition more or less not.

      If patients want "Best care" for their condition then they need understand what is required to do that. That means, be informed.

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    5. Hopefully the neurologist in question here is in good health. And if he wants, he can choose another path in life. Although many I'm sure will hope he remains in his current profession.

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  4. Not surprising. Most medical specialties see patients, identify the problem, treat accordingly and see recovery. Unfortunately, the human nervous system has limited ability for endogenous repair and there are no meds to treat the major neurological diseases apart from symptom management. Yes, in MS DMDs can slow progression but a cure remains elusive.

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  5. Wow. Some of these comments are really tone deaf.
    This blog is incredible, I appreciate everything done by team G on a daily basis, ( you guys even update on weekends! )
    I think anyone involved with this level of dedication and commitment is more than entitled to step back and breathe.
    Team G is made of people. People who deserve to take breaks, have full lives, and look for overall life satisfaction, like the rest of us.
    Be curtious.
    As a suggestion, maybe painting, picking up an instrument? Something that you have to focus on, isn't too stressful, will consume your time.
    Good Luck!

    P.S, although not your patient, I can say this blog has supplied me with literally all the information I could have asked for when diagnosed, nothing else improved my QoL like that did. So, Thank you

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    1. If you can't handle the heat get out of the kitchen. If you want personal aggrandizement get a dog. Neuro is a tough business.

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    2. It's not about the quality of the blog.

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    3. I think Prof G has a dog.

      http://multiple-sclerosis-research.blogspot.com/2015/05/clinicspeak-is-your-neurologist-burnt.html

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  6. This blog is amazing and I visit every day. Thank you!

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  7. Thank you team G for the information you provide on a daily basis. You do make a big difference, you are incredibly creative and inspiring.

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  8. Thank you for your dedication and hard work! What I learn from this blog educates not only me, but my care team who is not as current on MS approaches. I am Very appreciative. You deserve a break to get over your burn out.

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  9. Lol... convincing neuros that they are more burnt out than their colleagues is, frankly, just good business sense.

    After you are convinced your life is worse than your colleagues' it will be much easier to convince you to buy something that we will, supposedly, make you feel better.

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  10. Say not the struggle naught availeth
    The labour and the wounds are vain
    The enemy faints not nor faith
    And as things have been they remain

    If hopes were dupes fears may be liars
    It may be in yon smoke concealed
    Your comrades chase ten now the fliers
    And but for you possess the field

    Arthur H Clough

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  11. As a social worker and someone with MS I'd say my profession tops the charts. Huge pressure on health and social care professionals across the board.

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  12. Be careful not to dwell on your burnout symptoms now they have a label.
    Is there a welfare officer at work, if not can you arrange one? Counsellors have therapists to offload onto, perhaps neuros would benefit from that also.
    May be time to look beyond the science and see what else is going on inside your head. If you calm churning muddy water the dirt settles and the water becomes clear again, meditation will help. ;-)

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    1. If you haven't already seen it Prof G you may be interested in seeing the effects of meditation picked up on mri. As well as being a monk Matthieu Ricard has a PhD in molecular genetics and carried out the study in the US. You may wish to jump to 34:00 to get to the data.

      https://www.youtube.com/watch?v=L_30JzRGDHI

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    2. We'll give him a group hug when he gets back from his jolly ;-)

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    3. Make sure MD1 doesn't squeeze too hard. Prof G will moan about all the hours he has put in, but will he mention the posh restaurants, fine wine, neuro-bowl and the last night grand dinner and ball? I thought South Africans were tough until I came across Prof G.

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    4. Good news! Professor Alan Thompson thinks I am not burnt out. He informed me that what the Americans call burnout is just normal for a British neurologist. The moral of the story is to try and not self-diagnose yourself ;-)

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    5. LoL!

      Look... We have 100 days of literally non-stop Trumpeterring in the news.

      I think the entire nation is starting to have "TBI - Trump Brain Infuction" <--- Sorry :)

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    6. Knackered does not mean burnout. All NHS consultants are knackered (double knackered if you have MS as well) but not all are burnt out. To me burn out means you have lost your spirit and passion. That happens some days when patients are pouring in through the doors and we can't look after them well enough and feel jaded and cynical but other days are fine and we can truly help and support people.

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  13. MouseDoctorWednesday, April 26, 2017 11:23:00 pm
    Meaning do not go to Dr Google:-0

    What should we do instead? - trust neuros? lol

    Google is god F(for better or for worse). This includes Dr Google. The problem is interpretation (ie. people). Don't blame Dr Google for that.

    I shudder to think where my partner would be without Dr Google (still being lied to by her old neuro perhaps).

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