Managing Stress in the Orthopaedic Family

Abstract

Stress is a double-edged sword. When managed appropriately, it can lead to peak performance in high-pressure professions, while the potential negative effects of stress are well documented, being directly related to seven of the ten leading causes of death in industrialized nations 1,2 .A major psychological manifestation of stress is burnout. Validated assessment tools, such as the Maslach Burnout Inventory, can be utilized to quantify the three components of burnout: emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment 3,4 . Early signs of burnout, described by Quick et al., include declining professional performance and morale, physical and somatic symptoms, and behavioral changes. More advanced signs include self-medication and serious self-doubt 1 .In 2006, the results of a national survey of orthopaedic leaders (past, current, and acting chairs of orthopaedic departments, in addition to program directors) were presented to the American Orthopaedic Association (AOA) by Saleh et al. 5 . Numerous job stressors were identified, and the impact of these stressors was rated as moderate to severe in 70% of the leaders responding. High levels of emotional exhaustion and depersonalization were noted. A number of disturbing trends were identified. Only 15% were satisfied with their personal-professional life balance, and the percent dissatisfied with their job was increasing with time. Thirty-seven percent stated that they were moderately, very, or extremely likely to step down from their chair position within two years 5 .Stress and burnout have a substantial impact on patient care, especially an increase in medical errors. Fifty percent of physicians and 70% of the public believe that overwork, stress, and fatigue contribute to medical errors 6 . A recent survey of members of the American College of Surgeons assessed burnout among 7905 responding surgeons, 700 (8.9%) of whom reported committing a recent major medical error 7 . The commission of a major error correlated statistically with all three major burnout domains. Each 1-point increase in the depersonalization score raised the risk of error by 11%, and each 1-point increase in emotional exhaustion raised the risk of error by 5%. In addition, surgeons committing errors were twice as likely to have findings indicating depression. Factors frequently thought to be major drivers of medical errors, such as number of hours worked, frequency of night call, practice setting, and compensation, showed no statistical correlation with the likelihood of committing a major medical error 7 .In the years since the topic of stress had been discussed by the AOA, the relevance of the topic has only increased in importance. From 2007 to 2009, the Department of Justice investigation of orthopaedic device manufacturers resulted in a negative public image of the orthopaedic specialty and was the source of immense scrutiny and stress among many orthopaedic

Physician Burnout and Associated Factors: Orthopaedics vs Anesthesia

“…This challenges the common belief that surgical specialties carry a higher prevalence of burnout due to increased hours and a more stringent call schedule. A 2011 study of 384 orthopaedic surgery residents and 264 full-time orthopaedic surgery faculty reported residents work an average of 74.2 +/-20.2 hours per week and faculty 62.8 +/-18.2 hours per week [9]. This is compared to a 2013 study which found that 76% of anesthesiology residents work less than 70 hours a week and 24% work more than 70 hours per week.…”

“…In a study of three hundred and eighty-four orthopaedic surgery residents, Sargent, et al, found that 60% reported having at least one mentor. Levels of emotional exhaustion decreased and personal achievement increased as the frequency of contact between mentor and mentee increased [9]. Higher personal achievement, lower emotional exhaustion, and lower depersonalization scores were also found in those who reported it helpful to speak with their mentors [7].…”

Where does resiliency fit into the residency training experience: a framework for understanding the relationship between wellness, burnout, and resiliency during residency training

“…Burnout is a maladaptive syndrome specific to the workplace that results from chronic work stress. 10 -12 According to Maslach et al, burnout has three dimensions: emotional exhaustion, a feeling of one’s energy being depleted due to excessive psychological and emotional demands; depersonalization, a tendency to be detached from others, and view others in an impersonal or cynical manner; and a diminished sense of personal accomplishment, or feelings of inadequacy in the work environment. 13 The current “gold standard” for burnout assessment is the Maslach Burnout Inventory.…”

Risk for the surgical team during orthopaedic surgeries

“…So, they should not only be intelligent, but they must also have strong training, mentoring, and experience. 29,30 The burnout syndrome has been defined as a state of physical emotional or mental exhaustion caused by longterm involvement in situations that are emotionally demanding. We all know that due to increasing number of surgeries and lack of surgeons, staff shortage, high work overload, surgeons frequently experience stress, burnout, emotional exhaustion, depersonalization, and reduced personal achievements at the workplace.…”