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Recent research: psychologist & doctor impairment & burnout

"Quis custodiet ipsos custodes?"    Juvenal

The last-but-one edition of the journal Clinical Psychology: Science and Practice published several articles on psychologist stress and burnout.  Interestingly the edition is currently available with full text articles downloadable for free.  Smith and Moss review the psychologist impairment literature (see below for all abstracts and links) and consider " ... rates of impairment, identifying distress and impairment, intervening with an impaired colleague, barriers to treatment, and preventing impairment."  Good et al argue that "In actuality, our level of functioning varies continuously due to multiple factors. We examine factors influencing psychologists' level of functioning, and offer recommendations for individuals and the profession ... In sum, wellness and impairment should not be viewed as an "Us and Them" issue, but rather as an "Us and When" issue."  Barnett & Cooper go further to provide " ...  specific recommendations for individual psychologists, for those who train graduate students, and for professional associations. A rationale is provided for the recommendations made and further guidance is provided for creating a culture of self-care in the profession of psychology." 

As a balance to this focus on psychologists, I've also included details of a good recent paper by Iversen and colleagues on management of stress primarily in junior doctors.  Research over the years suggests that " ... the proportion of (junior) doctors experiencing psychological distress has remained constant, at about 28%, compared with about 18% in the general working population."  Figures for distress amongst more experienced hospital specialists are also worrying.  This article makes useful practical suggestions as well as giving links to a variety of helpful resources. 

Smith, P. L. and S. Moss (2009). "Psychologist Impairment: What Is It, How Can It Be Prevented, and What Can Be Done to Address It?" Clinical Psychology: Science and Practice 16(1): 1-15.  [Free Full Text
Research indicates that psychologists self-report a variety of problems related to their personal and professional functioning, such as depression, substance abuse, and burnout. These difficulties not only lead to psychologist distress, but can also result in impairment and have a negative effect on patient care. This review of the psychologist impairment literature provides information on the historical movement toward colleague assistance, rates of impairment, identifying distress and impairment, intervening with an impaired colleague, barriers to treatment, and preventing impairment. It is suggested that, through education of psychologists and graduate trainees, impairment may be prevented or its effects minimized.

Good, G. E., T. Khairallah, et al. (2009). "Wellness and Impairment: Moving Beyond Noble Us and Troubled Them." Clinical Psychology: Science and Practice 16(1): 21-23.  [Free Full Text]
Psychologists tend to view wellness and impairment in dangerous dualities. In actuality, our level of functioning varies continuously due to multiple factors. We examine factors influencing psychologists' level of functioning, and offer recommendations for individuals and the profession. In addition, we explore topics too often considered taboo in discussions of psychologist impairment, such as depression and suicide, with the hope that such discussions can help prevent future problems. In sum, wellness and impairment should not be viewed as an "Us and Them" issue, but rather as an "Us and When" issue.

Barnett, J. E. and N. Cooper (2009). "Creating a Culture of Self-Care." Clinical Psychology: Science and Practice 16(1): 16-20.  [Free Full Text]  
Psychologists are vulnerable to the effects of distress, which if left unchecked may lead to burnout, vicarious traumatization, and impaired professional competence. Smith and Moss (2009) provide a convincing call to action for the profession of psychology to give adequate attention to these important issues. This commentary adds to their excellent review and provides specific recommendations for individual psychologists for those who train graduate students, and for professional associations. A rationale is provided for the recommendations made and further guidance is provided for creating a culture of self-care in the profession of psychology. The importance of this approach as an ethical imperative is presented and strategies and recommendations are provided.

Iversen, A., B. Rushforth, et al. (2009). "How to handle stress and look after your mental health." BMJ 338(apr27_1): b1368-.  [Extract/Full Text
Junior doctors can take action to avoid stress and depression associated with their workload. This article explains how, and gives advice on who to seek help from if the need arises ... Twenty years ago Firth-Cozens reported that among doctors in their first year of graduating 50% were estimated to have emotional disturbance and 28% fulfilled criteria for depression. Since then, working hours have decreased, and the way that doctors are trained and managed has changed substantially. Despite this, the proportion of doctors experiencing psychological distress has remained constant, at about 28%, compared with about 18% in the general working population. For junior doctors, 79% of those caught up in the recent problems of MTAS (the UK medical training application service, an online system for the selection of junior doctors) scored above the threshold for psychological distress and 21% had significant distress. Psychiatric morbidity and burnout among hospital specialists in the UK are also increasing, rising between 1994 and 2002 from 27% to 32% and from 32% to 41% respectively ... Key points: Stress is common among junior doctors.  A proportion of stressed doctors will develop mental health problems.  Factors that contribute to stress can be identified and modified.  Many confidential and free sources of help are available for doctors

 

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