Tuesday, December 10, 2013

Desirable Personality Traits and their Relation to Burnout in the Medical Field

In Weekends at Bellevue, Julie Holland, a psychiatrist who worked the weekend night shifts in the Bellevue Hospital psychiatric emergency room for nine years, details the ways that she approached her taxing job. Early on in her career, she begins developing an identity that allows her to deal with the highly stressful environment and obligations of her work. She calls this identity her “hardened persona” and describes it as both “[her] blessing and [her] curse” (Holland, 189). While the persona that she has created allows her to be able to work in an extremely high-stress, high-risk job for many years, it also causes negative emotional and professional impacts on her and those around her. In the end, she realizes that, even with her persona, she cannot endure the hardships of her work, and she decides to quit. Holland’s memoir is a stark reminder that the medical profession is one that is unbelievably harsh and this idea is reinforced by the characteristics that are strongly desired and encouraged in the medical field. I will argue that the traits that are most desired are also the traits that can be the most destructive professionally and emotionally for the medic, and that over time, these “blessings” can evolve into “curses” and result in burnout. I will describe in detail Julie Holland’s account and through this, I will explain how initially positive personality traits can be destructive and how attempting to deal with stress in a negative manner can lead to burnout as well. I will then briefly reflect on possible solutions on how to prevent or ameliorate this issue and comment on their successes currently.
In her memoir, Julie Holland recounts the experiences that she has faced throughout her nine years working in the psychiatric emergency room in Bellevue, one of the most famous (and psychiatrically, notorious) hospitals in the United States. She makes it evident that the environment that she must work in is extremely high-risk, fast-paced, and saturated with grief—she receives countless patients every night, many of which are involuntarily sent either by family, the ambulance, or the law. They are mentally ill, violent, addicted, and homeless and frequently, their time spent in the ER is only a quick fix rather than a step towards long-term rehabilitation.  As someone who has a “hair-trigger empathy switch” and “emotional incontinence”, she realizes that if she is to continue working at Bellevue, she must stifle her kindness and empathy in order to protect herself from the constant barrage of negativity (Holland, 51). Her emotionally exhausting work causes her to form a persona that allows her to deal with the overwhelming obligations for nine years. For this reason, she calls her “hardened persona” a “blessing”. She dons a fa├žade of callousness and toughness and learns to focus only on what is crucial—whether the patient is a danger to himself or others and whether he should be let go or kept. However, her persona does not come without consequences, for it causes serious issues, both professionally and emotionally. As she realizes her limitations in aiding her patients, she becomes more confrontational, aggressive, and rude toward them. Her attitude toward the mentally ill in general is insensitive, dehumanizing, and objectifying—she calls her patients “crazy” (Holland, 50) and refers to them as “live ones” (Holland, 3). Her behaviour not only negatively affects the care that she provides, it also physically endangers her. She is threatened and physically assaulted by patients who she has behaved to in an aggressive manner and toward the end of her stay at Bellevue, she is forced to recognize the danger that she continues to put herself in because of her conduct. Holland’s persona also causes an emotional inability to deal with problems outside of her workplace—when her good friend and colleague, Lucy, develops cancer, Holland cannot bring herself to visit her at the hospital and refuses to deal with her impending death. This also causes a rift between herself and another friend of Lucy’s, Daniel, and this widens considerably when Daniel becomes Holland’s superior. She recognizes the damage that her persona has caused and acknowledges that it has turned her into an individual and a doctor that she detests by calling it a “curse”. She attempts to ameliorate her behaviour by seeing a therapist, but she cannot impede the progress of emotional exhaustion that she ultimately faces. Holland becomes burnt out and decides to resign from Bellevue.
From Holland’s account, one can see how initially beneficial personality traits, such as empathy and compassion, or “blessings”, can transform into “curses” because of the way they force one to develop a personality that is detrimental to the well-being of many. Nevertheless, these traits are strongly desired and encouraged in the medical field. For example, the American Medical Association notes that a few of the characteristics that are required for student success in medical school are integrity, cognitive ability, reliability, dependability, dedication, and motivation (Casey, 2). HealthECareers, a site that medical professionals can use to find available jobs in their chosen fields, states that the five most important traits that a nurse practitioner should have are good physical endurance,  good communication, patience, a caring nature, and to be encouraging (HealthECareers). In addition, a medic should have perseverance, emotional endurance, empathy, fast adaptation skills, leadership and teamwork skills, the ability think clearly and quickly in grave situations, the ability to take criticism or failure, a willingness to take risks, and fast adaptation skills. All of these characteristics are sensible and realistic if one is to be successful in one’s line of work (“blessings”). However, when one places a person with these traits in certain situations or specific environments (usually involving high levels of stress) frequently, there usually occur negative ramifications for the professional, their work, and their personal life (“curses”). In addition, an excess of the traits mentioned above and the exploitation of them by others adds to their “cursedness”. For example, if one is too patient and accommodating, learning to say “no” may be difficult and one might overextend oneself to the point where one would get burnt out very quickly. Having good physical endurance and perseverance might cause short and long-term health issues if one were to take these traits to an extreme. For example, having the ability to work on limited amounts of sleep and nutrition is not ideal for a doctor because it can cause impairment of one’s ability to make proper choices. Excessive ambition and determination might cause an individual to lose track of his priorities and engage in professional competitions which may cause a lack of empathy toward colleagues and potentially patients. One might also become biased toward other opinions and this might cloud one’s judgment concerning patient care. As Julie Holland shows, experiencing kindness and empathy might overwhelm one emotionally. If one has good leadership skills, one may feel pressured to constantly make a decision and one may not take other opinions into consideration well. On the other hand, if one has good teamwork skills, one might be so comfortable not taking the lead that if a situation arose in which this action was necessary, problems might ensue. Risk-taking in itself is a dangerous situation—not risking enough or risking too much may result in an extremely serious mistake. Finally, concerning adaptation skills, there is a possibility that one may not be able to completely process the adaptation at the time, and this may lead to dependence on harmful coping mechanisms. The necessity of having to portray and balance most, if not all, of the characteristics mentioned above in a trying environment leads to professionals using certain coping mechanisms in order to deal with their stresses (Straker). For example, Julie Holland uses humour, distancing, acting out, avoidance, provocation, and compartmentalization (by attempting to separate her different jobs and personas into different bags) as her coping mechanisms (Holland, 189). The personality traits that she develops from these coping mechanisms are what make up her “hardened persona”. Thus, the negative manners in which Holland chooses to handle her situation and her abundance of empathy are what exacerbate her inappropriate behaviour and lead to her burnout.
The phenomenon of burnout is described by Christina Maslach as “a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do ‘people work’ of some kind” (Maslach, 3). Holland is an apt example of this kind of burnout, portraying what might occur as a result of overextending oneself emotionally, or of being overly empathetic. Other physicians have explained that burnout is due also to “excessive workloads […], subsequent difficulty balancing personal and professional life, and deterioration in work control, autonomy, and meaning in work” (Dyrbye, Shanafelt). In addition, Ryan Flesher, the director of “The Vanishing Oath” explains that for him, an emergency room doctor, burnout is also caused by the inundation of bureaucratic demands and performance anxiety. This issue is extremely common in the United States, with 30% to 40% of physicians experiencing burnout at any given time (Fortney, Luchterhand, Zakletskaia, Zgierska, and Rakel, 412) and with up to 70% of specialists experiencing it on a general basis (Nido, Grimshaw, SayGan, Jensen, Williamson). There are serious consequences related to the syndrome– besides depersonalization, reduced personal accomplishment, and emotional exhaustion, doctors are more likely to leave their practices, and become depressed and suicidal. Professionally, doctors suffering from burnout are more prone to making medical mistakes and the quality of their care is considerably lowered, thus lowering patience satisfaction and further deteriorating doctor-patient communication (Drummond). In essence, this condition is caused by the excessive use of destructive coping mechanisms in order to deal with the stressful environment that negatively influences the personality traits that are strongly desired in medical professionals.
As the crisis of burnout has become more prevalent in the past century, there have been more efforts in attempting to improve and prevent it. Recent studies and medical opinions suggest that essentially, what is needed to counteract the issue is the application of more constructive coping mechanisms. Examples include: managing one’s time more effectively, taking time for oneself throughout the day to reflect on one’s mindset, becoming more self-aware, engaging in mindfulness training (Drummond), staying connected to loved ones, establishing healthy physical habits, attending therapy (Laws), keeping up with activities that one enjoys, and learning to say “no” (Nido, Grimshaw, SayGan, Jensen, Williamson).. More drastic examples include resigning or changing one’s field of medicine. However, there have been no holistic studies that prove that these recommendations decrease burnout on a large scale and there must be more research implemented in order to more definitively conclude that the ideas mentioned above succeed.
Works Cited
“5 Traits Employers Seek in Nurse Practitioners  – 4/29/2013.”HEALTHeCAREERS Network. 29 Apr. 2013. Web.
Casey, Barretta R. Enhancing Attention to Personal Qualities in Medical School Admission. Rep. 2008. Print.
Drummond, Dike. “Physician Burnout: Why It’s Not a Fair Fight.” The Happy MD. 2013. Web.
Dyrbye, Liselotte N., and Tait D. Shanafelt. “Physician Burnout: A Potential Threat to Successful Health Care Reform.” Journal of the American Medical Association (2011). Web.
Fortney, Luke, Charlene Luchterhand, Larissa Zakletskaia, Aleksandra Zgierska, and David Rakel. “Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study.”Annals of Family Medicine 11.5 (2013). Web.
Holland, Julie. Weekends at Bellevue. New York: Bantam, 2009. Print.
Laws, Jenny. “Start Early: Avoiding Physician Burnout Begins in Medical School.”LeadDoc. American College of Physician Executives, 21 Mar. 2013. Web.
Nido, Derek, John Grimshaw, Jasmine SayGan, Lauren Jensen, and Brandon Williamson. “Avoiding Professional Burnout.” The Mobile Physician. Web.
Nido, Derek, John Grimshaw, Jasmine SayGan, Lauren Jensen, and Brandon Williamson. “Professional Burnout and Physicians.” The Mobile Physician. Web.
Straker, David. “Coping Mechanisms.” Changing Minds. Web.
The Vanishing Oath. Dir. Ryan Flesher. Perf. Ryan Flesher. 2009. DVD.