BURN OUT – THE SILENT EPIDEMIC Presented at the CCIH Annual Conference May 29, 2006 by Ron Mataya, MD, Chair, Department of Global Health Loma Linda University School of Public Health The Syndrome • Emotional Exhaustion • Depersonalization • Reduced personal accomplishment – occurs among individuals who do “people work” of some kind (Burnout: The Cost of Caring by Christina Maslach) • A type of job stress – arising from the social interaction between helper and recipient • Emotional overload • Subsequent emotional exhaustion – people feel drained and used up – emotional resources are depleted and there is no source of replenishment – people no longer able to give of themselves to others • Depersonalization – detached, callous and even dehumanized response signals – developing a poor opinion of people – expecting the worst from them – even actively disliking them • “I began to despise everyone and could not conceal my contempt. I find myself caring less and possessing an extremely negative attitude.” • Provider may: – derogate other people and put them down – refuse to be civil and courteous to them – ignore their pleas and demands – fail to provide the appropriate care or help • Reduced personal accomplishment – results from being down on others and eventually on oneself – feelings of guilt about the way they have treated others – gnawing sense of inadequacy about their ability to relate to recipients – resulting in a self-imposed verdict of “failure” • “It’s painful to say it, but maybe I ‘m just not cut out for this kind of work. I thought of myself as a sensitive and caring person, but often I’m not sensitive and caring when I’m with clients – so I’m really deluding myself about the real me.” • Crumbling of self esteem results in – depression in some people – seeking for counseling or therapy – change jobs • By abandoning any kind of work that brings them into stressful contact with people Real Life Situations • Teacher of a class of 30 students – must deal with their personal and social needs – discipline, influence, shape, manage and direct their behavior – face possible friction and hostility from parents – uncertainty of layoffs from administrators – ever-present budget cutoffs A Mother: • must care for several young children at home • without help or support from others • with no opportunity for a work break A Minister: • A source of refuge and support for anyone seeking help any time • Has no one to turn to when personal problems arise A Police Officer • deals continuously with seamy side of life • with lawbreakers and victims of crime • with violence and potential danger lurking in every encounter with a stranger A Physician • Wades in an unending stream of patients who are sick, upset, angry and frightened by their illness or its implications Reactions • The “Who?” question results in: – Blaming people • • • • provider of care recipient of care or both including self The “What?” question • Points us to the situation that is causing the burn out – What kind of tasks are they expected to do and why? – What settings do these activities take place? – What limitations or constraints exist for them because of protocol, rules, standard operating procedures? • “Although personality does play some part in burnout, the bulk of evidence I have examined is consistent with the view that burnout is best understood (and modified) in terms of situational sources of job-related, interpersonal stress.” Burnout – The Cost of Caring – by Christina Maslach, p. 14 How to handle burnout personal approaches • Working smarter instead of harder – – – – setting realistic goals doing the same thing differently breaking away taking things less personally • Caring for Oneself as well as for Others – – – – – accentuating the positive know thyself rest and relaxation making the transition a life of one’s own Social & Organizational Approaches • Social support – the companionship of colleagues – help – comfort – insight – comparison – rewards – humor – escape Improvements in the Work Place • Getting more resources • Doing it better – dividing up the work – changing the contact with clients – limiting job spillovers – taking time off – getting help The Serenity Prayer “God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference”.