Signs and Symptoms of Burnout 

Burnout is a pressing issue in the medical field; recognizing the signs and symptoms is critical for all medical professionals. While a recent survey quoted a 40% burnout rate in surgeons, studies suggest a higher percentage (51.1%) of neurosurgeons exhibiting burnout symptomology. In this overview, article, we discuss some alarming impacts of burnout such as medical errors, suicide, and substance use disorders. 

Four Dimensions of Health

The four dimensions of health is a framework to characterize the (1) physical, (2) social, (3) spiritual and (4) mental/emotional wellbeing of an individual. The signs and symptoms of burnout can be described using this framework.

Physical, Social & Spiritual 

Burnout has been associated with a wide range of physical, social  and spiritual symptoms including headaches, sleep disturbances, cardiovascular-related events and musculoskeletal disorders. Physician burnout is associated with broken relationships between family, friends and colleagues, as well as higher rates of divorce and early retirement, highlighting the far-reaching effects on both personal and professional levels.  

Mental/Emotional 

Apathy, a common symptom of burnout, is described as physicians treating their patients and colleagues as objects, rather than as human beings. Other symptoms of burnout include irritability, impatience and memory changes; each of these can lead to a decrease in the quality of health care and an increased risk of medical malpractice suits.  

Burnout has additionally been shown to lead to greater difficulties paying attention or concentrating, increasing the risk of medical errors; this is particularly concerning for surgeons. Research has shown a correlation between burnout and higher rates of medical errors among surgeons. With major medical errors being strongly related to the degree of burnout and quality of life, a circular pattern results that can be difficult to redirect. Surgeons who perceived having made a major medical error in the last three months had a 50% increased risk for screening positive for depression and a three-fold increase in their risk for suicide ideation when compared to surgeons who had not reported a recent error.  

Physicians with burnout are also more likely to suffer from psychiatric comorbidities such as depression. In a survey conducted by the American College of Surgeons on nearly 8,000 practicing surgeons, 40% met the criteria for burnout and 30% screened positive for symptoms of depression. Physicians in the U.S. have a higher rate of depression and suicide ideation; it is even greater in surgeons. A 2016 survey found that 6.3% of surgeons reported suicide ideation in the last 12 months. Alarmingly, 60% of those surgeons reported that they were reluctant to seek care because of concerns it would impact their medical licensure. While burnout is not the sole reason for an increase of suicide ideation, burnout is strongly associated with depression, underscoring the need for solutions.  

Burnout has also been significantly associated with higher alcohol and painkiller use among health care professionals. A recent study found that emotional exhaustion and depersonalization was strongly correlated with weekly alcohol and painkiller use in this group. Physician alcohol and substance abuse can have potentially grave consequences not only for the practioners, but also for their patients, patients’ families and society. If a physician’s substance use impairs their ability to perform routine tasks like driving, it vastly compromises their ability to execute the intricate and high-stakes procedures demanded in neurosurgery. 

Stages of Burnout 

After first documenting burnout in the 1970s, Herbert Freudenberger described burnout development as a 12-stage model beginning with the “compulsion to prove” and ending with “burnout syndrome”; this was later simplified to a 5-stage development.  

Stage 1 is described as the “honeymoon phase.” This involves the individual’s enthusiasm, with no signs or symptoms of burnout present.  The physician may be eager to help, excited about new roles and optimistic about the future.

Stage 2 is described as the “onset of stress” and involves feelings of stagnation. The physician feels that some days are more difficult than others and feel they don’t have enough time for their hobbies or people in their life.  

Stage 3 is described as “chronic stress” and the feeling of frustration. The physician’s frustration and stress levels are rising, they may feel persistently exhausted, and their job performance may decline.  

Stage 4 is described as “burnout”. This manifests as apathy or lack of feeling. The physician will be despondent and battle crippling exhaustion and feelings of inadequacy. 

Stage 5 is described as “habitual burnout”. During this stage, a physician will experience mental and physical fatigue as well as the risk of chronic sadness and depression.  

Each of these stages presents different signs and symptoms. With the intense and unpredictable nature of neurosurgery, neurosurgical faculty and trainees should be informed so that early intervention can ward off long term negative consequences.  

Conclusion 

While medicine is unique in its ability for its practioners to affect the lives of others, the prioritization of the health of the physicians cannot be understated. Although neurosurgeons train for a minimum of 11 years, 33% report that this previous formal training was not effective in managing mental/emotional challenges. Many reported coping by immersing themselves in work, calling into question the longevity and sustainability of this coping strategy. Without proper training and education on coping mechanisms, neurosurgeons will be unable to proactively defend themselves against burnout.

By creating support for ourselves and our peers, we can envision a neurosurgical future in which both physicians and patients thrive.