fentanyl patch for several weeks prior to her death. 2 In this sense at least, the patient was not opioid nontolerant. Second, although we agree that the individual variation of tolerance is substantial, we were also quite surprised that a nonopioid-naïve patient could commit suicide with her standard patch. This may be an effect of the quicker rate of increase in blood concentration by oral ingestion, rather than the absolute concentration. And third, given that chronic pain itself is an independent risk factor for suicide, withholding pain therapy in acute episodes of any sort is probably not a good idea and an aggressive multimodal approach -as emphasised by Ruan and colleagues -is warranted.
Acknowledgements relating to this articleAssistance with the reply: none.Financial support and sponsorship: none.Conflicts of interest: none. This raises the question whether Dutch anaesthetists are more resilient or whether their organisations are more adequate, thus preventing them from developing higher levels of burnout? It would be worthwhile to perform a multicentre study in different countries to explore which are the characteristics of the countries with the lowest percentage of burnout. This research may in turn reveal important factors for burnout management, which depends not only on organisational factors but also on individual factors. The multiple organisational measures that have been widely recommended appear not to be effective in overcoming this problem. Moreover, anaesthesiology has inherent and unique characteristics that make it stressful. Studies including specific stressor evaluation in anaesthesia could be promising for a better understanding of true inducers of stress in the daily life of anaesthetists.
ReferencesMany factors contribute to the vast array of ways in which each individual experiences, reacts and regulates stress. One of these factors is personality traits. Consistent with studies in other areas 4 Van der Wal et al. found that burnout in anaesthetists is related to neuroticism; and drew attention to the fact that personality traits are usually considered stable over time and are hard to change.However, there is now increasing consensus that personality traits also continue to develop throughout adult life, 5 and personality theory also shifts in that direction. Van der Wal et al. suggest personality testing in the selection of anaesthesia residents to reduce burnout in future anaesthesiologists. As personality traits are not static and can be dynamically influenced by work life, assessing personality traits may be useful in detecting individuals at risk of developing burnout but should not exclude them. Physicians can evolve naturally or use psychological strategies to regulate stress and become good professionals.Neuroticism is a rather general, nonspecific trait that has been associated with multiple psychopathologies, thus it is not at all surprising to find an association with burnout. To better understand the processes underlying burnout, research should focus on recent, more r...