Burnout: Are you at risk?

After 13 years in family practice, Susan Hutchinson was beginning to question whether medicine was for her after all. Her Irvine, CA, group had contracts with too many HMO plans, and she was running herself ragged.

"I was at the end of my rope and burning out fast," says Hutchinson. "I was irritable in the office as well as at home and unhappy every morning, dreading what the day would bring. My muscles were tight, I was having migraines, I wasn't sleeping well, and I was drinking in the evening. I saw no end in sight."

She was also worried about a malpractice suit. She was the only female physician in the practice, and in great demand. It was typical for women to have a six-month wait to see her for checkups and Pap tests. She was fearful that some day soon, a woman with irregular bleeding would have to wait too long to see her and then sue after a delayed cancer diagnosis. "It was only a matter of time."

Hutchinson was able to overcome her burnout without outside help. "I simply had to look around for a practice setting that suited me better," she says. To arrive at that decision, however, took hard work on her part. She needed to focus on her life and her options. To attain that focus, she says, she worked out at a gym and got involved with her church. Not everyone can take that I-can-handle-this-myself approach, though. Many doctors say that reaching out for help saved their lives.

That's not an overstatement. Burnout can leave you on the verge of disaster-physical, mental, emotional, and financial. John H. Wilters, chief of staff at Tennessee Christian Medical Center in Madison, reports that early in his career he observed physicians who were under enormous stress. "Three started using drugs, of those, two made it to a rehab program. The third was found dead in a hospital bathroom with a syringe in his arm."

And because burnout impacts patient care, it also carries a malpractice risk. Doctors headed toward burnout typically are irritable and abrupt with patients, and they don't listen. They make mistakes, and mistakes are too often followed by malpractice suits.

We'll tell you how to get the help you need. But first, we'll help you figure out whether you're headed for trouble.

The syndrome creeps up slowly Burnout is a severe state of exhaustion. Typically the result of excessive, prolonged stress, it's caused by such things as not having control over your workload, feeling unappreciated, and a bad job fit. Some experts think the condition progresses through stages-alarm (stress arousal), resistance (energy conservation), and exhaustion. If you're able to recognize symptoms early enough, you can take appropriate measures.

During the first stage, you're apt to be irritable, forgetful, anxious, and unable to concentrate. Physical symptoms may include hypertension, palpitations, bruxism, insomnia, headaches, and GI problems. In the energy conservation stage you compensate for stress with behaviors like procrastination, decreased sexual desire, social withdrawal, cynicism, apathy, resentment, and substance abuse.

It's typically not until the final, exhaustion stage that you realize that something is very wrong. Symptoms include sadness, extreme fatigue, severe headache, and even suicidal ideation.