Empathy and burnout: Is there a link?

Doug Hendrie

16/05/2018 1:58:01 PM

It has been suggested that greater levels of empathy among doctors may be connected to issues of stress and anxiety in the medical profession. Is that correct?

In the face of dealing with so many and varied patient issues, is there danger in doctors caring too much?
In the face of dealing with so many and varied patient issues, is there danger in doctors caring too much?

It’s a truism that patients want empathetic doctors. And many medical schools have tried to ensure they select future doctors based on both academic excellence and people skills.
But is there a dark side? Could the focus on training doctors able to empathise with their patients be linked to the well-documented issues of burnout, mental illness and physician suicides?
‘We would all stand by the idea that having more empathic doctors is good. Patients are more satisfied when they feel the doctor has really listened to them. I personally want an empathic doctor,’ Melbourne University lecturer and GP Dr Caroline Johnson, who has a longstanding interest in doctors’ mental health, told newsGP.
‘But if we support empathic doctors, we have to think about the level of support we’re providing, to stop them burning out.’
Dr Karen Price, co-Chair of the RACGP Victoria Women in General Practice Committee, told newsGP it is important to recognise the fact there is no clear and consistent definition of empathy.
‘We shouldn’t be choosing students based on a poorly defined and complex idea,’ she said. ‘[Empathy] is not a static construct. Many things affect it day to day.
‘[Professor of Psychology] Simon Baron-Cohen talks about empathy as a fluctuant and variable quality. If I’m under time pressure, or if something is going on in my day, there might be times I express it less well.’
A 2013 beyondblue survey of doctors and medical students found that rates of mental distress occurred in medicine at higher rates than other demanding professions. Doctors who were younger or female were found to be particularly at risk.
‘The discussion about high-achieving students being of a certain vulnerable personality type did not seem to occur in other professions where one might assume a similar level of high achievement,’ Dr Price said.
In a recent article on The Conversation, Open University health lecturer Dr Rajvinder Samra wrote that female doctors are at greater risk of burnout than their male counterparts. She suggested this might be linked to empathy.
‘Female doctors show more empathy than male doctors. They ask their patients more questions, including questions about emotions and feelings, and they spend more time talking to patients than their male colleagues do,’ Dr Samra wrote.
‘Some have suggested that this might make women better doctors. It may also take a terrible toll on their mental health.’
A four-year study in the Netherlands found that male and female doctors experience burnout differently. Male doctors tend to experience depersonalisation as the first sign of burnout, followed by emotional exhaustion. However, a sense of personal accomplishment keeps increasing for male doctors even as feelings of depersonalisation and exhaustion mounted.
By contrast, burnout among female doctors is more likely to be triggered by emotional exhaustion first, which leads to depersonalisation, followed by a sense of reduced personal accomplishment and competence.
Dr Price argues the problem is more to do with the system than empathy.
‘It’s generally observed that people choose [medical] specialities that suit their personality. So what we need to improve is the system that causes trauma to medical personnel. That trauma is not well addressed,’ she said.
‘We’re constantly told that medical students are a certain personality type, and therefore burning out from too much caring is a problem. But the system pressures from an industrialised model of care – that’s what causes people to fail.’
‘Making human beings and healthcare into a conveyor belt of industrialised medicine is likely to be harmful to all.’

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Libby Hindmarsh   18/05/2018 9:39:53 AM

I think GPs are often having to cope with challenging issues without much backup and support. It is interesting that all other groups such as psychologists, OTs, social workers have some form of supervision either individually or in groups. The most supportive thing I have experienced in GP is having regular peer support meetings and group supervision once per week with a mental health social worker as a fascilitator. I would encourage GPs to organise this support for themselves and I would encourage the RACGP to put more emphasis on this type of support.