Research of GP burnout
Dr Peter Orton MD, General Practitioner and Aviation Medical Examiner, Aviation Medica
The concept of burnout was introduced in the 1970s to describe the experience of long-term exhaustion and reduced interest, and it remains extremely relevant to today’s working environments. Recent changes in the health care system and management have generated increased workload and stress for GPs, therefore increasing the likelihood for them to suffer from burnout. The syndrome is made up of a large variety of symptoms such as occupational stress, emotional exhaustion, depersonalisation, low productivity, feelings of low achievement, and several psychological problems. And of course, in health care, burnout may not only affect the GP’s own health but can also impact on patients’ health.
For the past 18 years, and with tremendous support from Sir Denis Pereira-Gray, I have been studying the impact of stress on GP well-being and how it affects their interaction with their patients. First, I monitored the level of burnout in NHS general practitioners in Essex and correlated the results with various parameters (age, gender, years in practice, etc.). I used the Maslach Burnout Inventory (MBI), a tool developed in 1996 which measures three fundamental aspects of burnout: emotional exhaustion, depersonalisation, and accomplishment, reflecting feelings such as “I feel emotionally drained from my work”. From 564 valid questionnaire participants, 46% (n=261) scored high on emotional exhaustion, and 42% (n=237) on depersonalisation. More surprisingly, I found that male and female doctors responded differently to both experience and emotional exhaustion: greater burnout levels were found in male doctors and in those registered for less than 20 years.
I then wanted to investigate if a significant level of burnout affects the consultations and GPs’ relationship with patients. Patient-centeredness is the aim of both parties in a healthcare relationship: patients want a personal and individual treatment and doctors want to do a good job. I selected a sample of 38 practitioners (19 with high and 19 with low emotional exhaustion). For each doctor I audio-recorded and timed twenty consultations, and each consultation was analysed for patient-centeredness. From those 760 consultations, I concluded that experienced male doctors shortened their consultations, whilst experienced female doctors’ consultations were unchanged. I identified eight factors associated with the shortening the consultation length in family practice, the most ever reported. Of particular interest is that the gender of the doctor, the doctor’s experience in years, and the doctor’s level of emotional exhaustion, are all strongly associated with the length of consultations. Overall, 74% of the variation in consultation length can be explained by these eight variables. (read the full article at http://bmjopen.bmj.com/content/2/1/e000274.short)
Stress in GPs is associated with poor explanation about patient problems presented within the consultation. It may also explain fewer referrals to secondary care, higher levels of prescribing, errors and consultation length. My findings indicate that burnout awareness and detection, and that support for family doctors and those managing practices, is a necessity and a priority.
In view of these results, national bodies need to work with the profession to review how this issue can be addressed. The NHS may wish to review their policies especially those affecting large groups of doctors.
Moreover, doctors in group practice may need to think more about stress in their colleagues. Developing specific education programs and coping strategies may be the way forward to prevent and tackle burnout more effectively.
Finally, more research is needed to investigate other factors that could impinge the relationship between GPs and their patients, such as self-employed/employed status, mental health of the practitioner, and importantly the consequences of these variable on the diagnosis and quality of care.
For more information on his research, you can contact Peter by email.