Dr Wonderful ‘Burns Out’

This 32-year-old single woman has been an associate in a general practice for two years, and is considering a partnership. She lives in a rented unit. She is popular with staff and patients, and is an 'asset' to the practice. She attends to patients extremely well, although she might be fostering their dependence on her. On a number of occasions over a period of some months, she becomes upset and tearful. She copes by 'working harder' (ie longer hours). At a Monday morning debriefing meeting, she announces tearfully that she has decided that she doesn't 'have what it takes to be a doctor' and is giving up Medicine.

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Dr Wonderful demonstrates many features of 'burnout', a response to stressful occupations usually associated with providing services to others. It can have a number of components:

1. a reduced sense of personal accomplishment ('No matter how hard I work, it doesn't make any difference');
2. emotional exhaustion caused by investing considerable emotional energy in providing care, without replenishing emotional reserves through attention to one’s own needs. This is often accompanied by feelings of depression and failure. It is commoner in doctors with direct patient contact, particularly when dealing with patients with complex psychological needs, in rural GPs and in female doctors;
3. depersonalisation or 'switching off' to the emotional aspects of a patient's presentation. This is common when working with constant high stress levels. The danger is that, when the stress abates, the doctor continues to use depersonalisation in interactions with patients. This component of burnout is commoner in males, and may explain the stereotypical male doctor who 'is a great technician, but has a lousy bedside manner'.

Dr Wonderful needs help to develop strategies to prevent and manage burnout. If she succeeds, she is likely to find her work rewarding and fulfilling again, and to have a more positive self-image.