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Study reports high levels of “burnout” among GPs

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e880 (Published 04 February 2012) Cite this as: BMJ 2012;344:e880
  1. Helen Jaques, news reporter
  1. 1BMJ Careers
  1. hjaques{at}bmj.com

More than a third of GPs experience psychological “burnout,” with male doctors particularly affected, research published in BMJ Open has found (2012;2:e000274, doi:10.1136/bmjopen-2011-000274).

The study of 564 GPs in Essex found that 46% reported high levels of emotional exhaustion; 42% had negative and cynical attitudes towards their patients (depersonalisation); and 34% experienced a reduced sense of personal accomplishment in their work with patients.

However, GPs’ consultations with patients were not affected by their feelings of burnout, as rated by the patients themselves and by an independent observer, indicating that GPs are able to maintain a professional approach to patients despite any personal distress.

The authors describe these high levels of burnout in their sample as “worrying” and in need of action by doctors themselves, their medical colleagues, NHS employing organisations, professional bodies such as the royal college and the BMA, and the Department of Health.

GPs expend considerable psychological energy on a daily basis in dealing with stressed patients and in providing psychological and sociological support for patients and their families, say the authors. As a result, some doctors’ emotional reserves can become depleted, leading to burnout.

The authors suggest that working patterns in general practice should be adjusted so that GPs have more time with patients and that practices should develop case discussion groups and education strategies to build doctors’ skills in coping and stress management.

“The burnout levels observed in our study indicate personal distress, so these results deserve attention,” they say. “Whatever the reasons, a significant group of doctors is in trouble.”

The cross sectional study comprised a postal questionnaire containing the Maslach burnout inventory, which conceptualises burnout as an imbalance between “demands” (perceived work overload) and “resources” available to the individual (such as social support and coping skills). The questionnaire was sent to all GPs registered on the NHS Essex performers list, 564 (71%) of whom responded.

A total of 261 respondents (46%) scored highly on the “emotional exhaustion” element of the inventory, which reflects the respondents’ feeling no longer able to give themselves psychologically to patients. A similar number (236 (42%)) scored highly on the “depersonalisation” component of the questionnaire—the highest level recorded in similar surveys of primary care doctors in other countries, the authors say—and 190 (34%) reported low levels of personal accomplishment in their work.

Male doctors were significantly more likely to report depersonalisation than were female doctors, and doctors who had been registered with the General Medical Council for less than 20 years had higher depersonalisation scores than those who had been registered for longer.

The authors suggest that female doctors might be more resistant to depersonalisation because they tend to consult more slowly and are more likely to work part time. Female GPs also tend to be more patient centred than male GPs, they say, which may result in greater professional satisfaction and reduce the likelihood of depersonalisation.

Thirty eight doctors agreed to allow their patients to complete a survey on their interpersonal skills and to allow the consultation to be tape recorded and analysed. The researchers found no association between doctors’ levels of depersonalisation and their interpersonal skills as rated by patients or the patient centredness of their consultations—that is, whether they showed an understanding of the patient’s illness and an integrated understanding of the whole patient.

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