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Study examines doctor stress, patient care relationship

Despite perceived link between stress and low quality of care, researchers find no correlation

A paper recently published by a University researcher reports on the causes of burnout among doctors, as well as the impact of burnout on the quality of patient care.

Associate Professor of Clinical Medicine Joseph Rabatin, lead author of the article, worked alongside faculty from universities across the United States to provide a framework for understanding the causes of physician stress and the effects on their patients.

“Burnout is described as a combination of stress, emotional exhaustion and a lack of a sense of personal accomplishment,” said senior author Mark Linzer, director of the division of General Internal Medicine at Hennepin County Medical Center in Minneapolis. While burnout rates vary between different medical fields, they are all generally high and have appeared to be increasing over the last few years, he added.

The paper, published Sept. 28 in the Journal for Primary Care and Community Health, details the findings of two studies conducted between 2002 and 2003 involving 422 family practitioners and general internists. The research team evaluated physician mental health and the success of outcomes in their patients with conditions such as high blood pressure and diabetes, Rabatin said. After running statistical analyses on the compiled data, the group found several correlations between environmental factors, such as time pressure and chaotic workplaces, and physician burnout, he added.

But in regards to the impact of burnout on patient care, the researchers found that there was no correlation between the two. According to the paper, “Care quality thus appears to be preserved at great personal cost to primary care physicians.”

Under the current health system, doctors will continually set patient health above their own, compounding burnout, Linzer said. When stress reaches an unbearable level, a physician may leave the workplace and perhaps even the medical field itself because they do not want to risk the well-being of their patients.

Declines in the number of people choosing certain careers in fact led Linzer to begin researching the health field in the 1980s, he said. This inquiry eventually worked its way up into investigating physician mental health in the workplace.

Rabatin said his employer, the Veterans Administration in Providence, “makes very good accommodation for both patient visit times and physician health.” He added that he hopes other institutions will follow suit with changes to reduce doctor burnout while maintaining quality of care.

Many organizations have recognized the need to improve conditions for their own physicians, wrote Neda Ratanawongsa, associate professor of medicine at the University of California at San Francisco, in an email to The Herald. These choices are practical for the institutions as well: “if you want outstanding care, you want to go where the health care team members are healthy and have healthy relationships with one another,” wrote Ratanawongsa, who was not involved with the study.

Ratanawongsa highlighted the positive effects of support groups and relationship-centered care but noted that awareness of self-care in the medical field is still not yet fully recognized.

But Linzer is nevertheless “quite optimistic” about the future of health care. He said he believes it is a “wonderful career” and that he sees a new generation of medical students and residents rising up to change the infrastructure of health care to benefit both doctors and patients.


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