Patient demands, lack of reciprocity, and burnout: a five‐year longitudinal study among general practitioners

Abstract

SummaryThis study among a sample of 207 general practitioners (GPs) uses a ®ve-year longitudinal design to test a process model of burnout. On the basis of social exchange and equity theory, it is hypothesized and found that demanding patient contacts produce a lack of reciprocity in the GP±patient relationship, which, in turn, depletes GPs' emotional resources and initiates the burnout syndrome. More speci®cally, structural equation analyses con®rmed thatÐboth at T1 and T2Ðlack of reciprocity mediates the impact of patient demands on emotional exhaustion. Emotional exhaustion, in turn, evokes negative attitudes toward patients (depersonalization), and toward oneself in relation to the job (reduced personal accomplishment). Moreover, this process model of burnout was con®rmed at T2, even after controlling for T1-scores on each of the model components. Finally, T1 depersonalization predicted the intensity and frequency of T2 patient demands, after controlling for T1 patient demands. This major ®nding suggests that GPs who attempt to gain emotional distance from their patients as a way of coping with their exhaustion, evoke demanding and threatening patient behaviors themselves. The theoretical and practical implications of these ®ndings are discussed.

Using the job demands‐resources model to predict burnout and performance

“…escape/emotion-focused coping; Latack & Havlovic, 1992). This model has been supported by several studies (e.g., Bakker, Schaufeli, Sixma, Bosveld, & Van Dierendonck, 2000;Cordes, Dougherty, & Blum, 1997). Thus, we assume that exhaustion fostered by job demands may evoke psychological withdrawal (cf.…”

“…Results showed that feelings of exhaustion were positively related to disengagement. This suggests that employees psychologically withdrew from their work in cases where they felt exhausted (see also Bakker et al, 2000;Leiter & Maslach, 1988). In addition, results showed that job demands were the most important predictors of exhaustion, which, in turn, contributed to explaining in-role performance.…”

A reciprocal interplay between psychosocial job stressors and worker well-being? A systematic review of the “reversed” effect

“…In terms of sampling strategy, studies either recruited workers from a specific profession (eg, dentists) or the same work organization (eg, a bank) or utilized data from regional registries (included diverse types of workers). Workers in healthcare settings (eg, clinicians and support staff) were investigated most often (N=10) (50)(51)(52)(53)(54)(55)(56)(57)(58)(59). Of the 18 studies originating from Europe (22, 29, 50-52, 54-67), 14 were from The Netherlands.…”

Influence Tactics

“…En su revisión bibliográfica, Zapf, Dormann y Frese (1996) identificaron seis de dieciséis estudios longitudinales en los que se hallaban relaciones causales inversas entre las condiciones de trabajo y el estrés. Estudios más recientes han proporcionado evidencia adicional sobre la causalidad inversa, por ejemplo, entre la despersonalización y la calidad de la relación médico-paciente (Bakker, Schaufeli, Sixma, Bosveld y Van Dierendonck, 2000) y entre el agotamiento mental y la presión laboral (Demerouti, Bakker y Bulters, 2004). Una posible explicación de estos efectos causales inversos es que los empleados que sufren estrés desarrollan comportamientos que derivan en una mayor carga de trabajo.…”

“…One possible explanation for reversed causal effects is that the behaviors of employees experiencing strain or disengagement place additional demands upon them like exhausted employees who fall behind with their work (Demerouti, Bakker, & Bulters, 2004) or depersonalized employees evoking more stressful and more difficult interactions with their future clients (e.g., Bakker, Schaufeli, Sixma, Bosveld, & Van Dierendonck, 2000). Another explanation is that job demands may also be affected by employees' perceptions of the working environment (Zapf, Dormann, & Frese, 1996).…”