BURN OUT – THE BURN OUT – THE SILENT EPIDEMICSILENT EPIDEMICPresented at the CCIH Annual ConferencePresented at the CCIH Annual ConferenceMay 29, 2006 by Ron Mataya, MD, Chair, May 29, 2006 by Ron Mataya, MD, Chair,

Department of Global HealthDepartment of Global HealthLoma Linda University School of Public Loma Linda University School of Public

HealthHealth

The SyndromeThe Syndrome

• Emotional Exhaustion• Depersonalization• Reduced personal accomplishment– occurs among individuals who do “people

work” of some kind (Burnout: The Cost of Caring by Christina Maslach)

• A type of job stress– arising from the social interaction between

helper and recipient

• Emotional overload

• Subsequent emotional exhaustion– people feel drained and used up– emotional resources are depleted and

there is no source of replenishment– people no longer able to give of

themselves to others

• Depersonalization– detached, callous and even dehumanized

response signals– developing a poor opinion of people– expecting the worst from them– even actively disliking them

• “I began to despise everyone and could not conceal my contempt. I find myself caring less and possessing an extremely negative attitude.”

• Provider may:– derogate other people and put them down– refuse to be civil and courteous to them– ignore their pleas and demands– fail to provide the appropriate care or help

• Reduced personal accomplishment– results from being down on others and

eventually on oneself– feelings of guilt about the way they have

treated others– gnawing sense of inadequacy about their

ability to relate to recipients– resulting in a self-imposed verdict of

“failure”

• “It’s painful to say it, but maybe I ‘m just not cut out for this kind of work. I thought of myself as a sensitive and caring person, but often I’m not sensitive and caring when I’m with clients – so I’m really deluding myself about the real me.”

• Crumbling of self esteem results in– depression in some people– seeking for counseling or therapy– change jobs• By abandoning any kind of work that brings

them into stressful contact with people

Real Life SituationsReal Life Situations

• Teacher of a class of 30 students–must deal with their personal and social

needs– discipline, influence, shape, manage and

direct their behavior– face possible friction and hostility from

parents– uncertainty of layoffs from administrators– ever-present budget cutoffs

A Mother:A Mother:

• must care for several young children at home• without help or support from others• with no opportunity for a work break

A Minister:• A source of refuge and support for anyone

seeking help any time• Has no one to turn to when personal

problems arise

A Police OfficerA Police Officer

• deals continuously with seamy side of life

• with lawbreakers and victims of crime

• with violence and potential danger lurking in every encounter with a stranger

A PhysicianA Physician

• Wades in an unending stream of patients who are sick, upset, angry and frightened by their illness or its implications

ReactionsReactions

• The “Who?” question results in:– Blaming people• provider of care• recipient of care• or both• including self

The “What?” questionThe “What?” question

• Points us to the situation that is causing the burn out–What kind of tasks are they expected to do

and why?–What settings do these activities take

place?–What limitations or constraints exist for

them because of protocol, rules, standard operating procedures?

• “Although personality does play some part in burnout, the bulk of evidence I have examined is consistent with the view that burnout is best understood (and modified) in terms of situational sources of job-related, interpersonal stress.” Burnout – The Cost of Caring – by Christina Maslach, p. 14

How to handle burnout - How to handle burnout - personal approachespersonal approaches• Working smarter instead of harder– setting realistic goals– doing the same thing differently– breaking away– taking things less personally

• Caring for Oneself as well as for Others– accentuating the positive– know thyself– rest and relaxation– making the transition– a life of one’s own

Social & Organizational Social & Organizational ApproachesApproaches• Social support– the companionship of colleagues– help– comfort– insight– comparison– rewards– humor– escape

Improvements in the Work PlaceImprovements in the Work Place

• Getting more resources

• Doing it better– dividing up the work– changing the contact with clients– limiting job spillovers– taking time off– getting help

The Serenity PrayerThe Serenity Prayer

“God, grant me the serenity to accept the

things I cannot change, courage to

change the things I can, and wisdom to

know the difference”.