Published in the July 2017 issue of Today’s Hospitalist
THIS COLUMN marks my fourth or fifth installment on burnout, depending on how you count. Thus far, I’ve taken a soft, third-person approach. But now it’s time to strike closer to home and consider how personality predisposes people to burning out.
To backtrack just a bit, burnout is a syndrome caused by job-person mismatch. The person is a poor fit for his or her position or vice versa (or, more realistically, a little bit of both). Burnout is characterized by emotional exhaustion, depersonalization and a low sense of personal accomplishment. (For a fuller description, see my “How’s your relationship with work?” column in the April 2016 issue.)
Neuroses are making something of a comeback.
Most hospitalists jump quickly and hard on the job side of that equation: hours worked, patients per shift, EHR annoyances and so forth. These are certainly part of the problem, but they sometimes distract us from examining the person. Denial, as they say, is a powerful psychological defense.
If you were like most med students, you probably tuned out during the psychology lectures in your first and second year. Mine were given by a plump, affable fellow with a beard. He held forth on luminaries like Piaget and Erikson—stuff that we were assured would be on Step 1 of the boards, along with the coagulation cascade and histopathology slides. (Might have been; I can’t recall.)
Here’s the lecture that should have been in the curriculum, but wasn’t: something on the Big Five, the prevailing paradigm for personality. It’s also called the Five Factor Model, so named for its components:
- agreeableness, and
If that first one sounds Freudian, well, it is. American psychiatry tried to dump the term way back in 1980 with the third edition of the “Diagnostic and Statistical Manual of Mental Disorders.” But neuroses are still alive and well. If anything, they’re making something of a comeback.
But what, exactly, is neuroticism? David Barlow, PhD, an eminent psychologist at Boston University, defines it this way: “the tendency to experience frequent and intense negative emotions in response to various sources of stress.” That last word is key and suggests the possible connection to burnout. More on that in a bit.
How would you know if you’re neurotic or extraverted or any of that? This is where psychological tests come into play—brain biopsies, as I call them.
The pros use validated personality tests. The one that I administer in my office is called NEO, an acronym for the first three components in the Five Factor Model. Quick-and-dirty self-assessments are also available online. Psychology Today, the magazine, serves one up for $6.95 that’s pretty decent. (Usual proviso: Neither this column nor a Web site are substitutes for professional medical advice. Please see a mental health provider if you have distressing emotional symptoms or freak out when you receive your online personality profile.)
I’ve been using myself as a case study in my burnout columns. Below is “My personality profile” for my low-budget personality assessment.
Personality predicts burnout
With those preliminaries addressed, let’s move onto a seminal—and I think overlooked—study on burnout. The investigation, conducted by Chris McManus , MD, PhD, and his colleagues in the U.K. starting in 1990, was eventually published in BMC Medicine in August 2004.
Dr. McManus and his collaborators obtained baseline data on several thousand 17and 18-yearolds before they entered medical school. They then re-measured at various time points over the next 12 years. The last data were acquired after study participants were full-fledged doctors who had been practicing for five or six years.
Study measures included instruments that looked at stress, burnout, career satisfaction, learning style, approach to work, workplace climate and personality. The investigators eventually mashed up those data using something called path analysis, which is a statistical technique to assess the relationships between variables.
After years of watching and waiting, Dr. McManus and his colleagues determined that “doctors who are most stressed showed higher levels of neuroticism, both currently and previously, and those reporting [the] most emotional exhaustion also had higher neuroticism levels, as well as being more of an introvert.” They also found that low agreeableness was associated with high levels of depersonalization.
Here’s a sentence from their paper that could serve as a Twitter summary: “Perceived work climate, and its pathologies such as stress and burnout, are predicted mainly by personality.” And another: “Stress is not a characteristic of jobs but of doctors.”
Blame the victim?
So is burnout self-inflicted? Nope. Personality develops at a young age and is largely determined by genes and early life experiences. There’s no one to blame, but you do need to deal with it.
This hooks into my column from last month (“Bend, but don’t break“). Resilience is often suggested as an antidote for burnout, and it is one of the first steps is to get a handle on personality. More on that in coming months.
David A. Frenz, MD, runs a small private practice and health care consulting firm in Minneapolis. He was previously vice president and executive medical director for North Memorial Health in Robbinsdale, Minn. You can learn more about him and his work at www.davidfrenz.com or LinkedIn.