The Neurobiology of Burnout: Stress, Sleep, and Cognitive Load

00:00:00: Welcome to The Psychiatric Mind, the official podcast of the European Psychiatric Association.

00:00:05: Your space

00:00:06: for expert conversations

00:00:08: on contemporary psychiatry!

00:00:15: I am David Burria Salas and today we are exploring a topic that matters not only for the clinician well-being but also for patient safety... ...and future health care itself.

00:00:28: What happens to chronic occupational stress?

00:00:31: It is allowed to accumulate in our health workers who care for others.

00:00:37: We have today two guests, we will clarify.

00:00:42: which options do we have from the neurobiology and occupational health to go over all these burnout issues?

00:00:52: that in media is taking a lot of time on our newspapers.

00:00:59: I am happy.

00:01:08: She's Neurologist and Consultant of the GenF Memory Center in the Gen F University Hospital.

00:01:16: As well, I'm delighted to present Ingeborg Jödsdottir.

00:01:20: she is Professor of the Institute for Medicine at the Medical Faculty of Godburg as well as Director of the Institutes for Stress Medicine.

00:01:32: Welcome!

00:01:35: Thank you for this introduction.

00:01:37: When it comes to the early signs, I mean burnout is a process that takes quite a long time.

00:01:44: And there are some signs of the exhausting tiredness and then quite a lot of somatic symptoms as well.

00:01:55: mental symptoms like depression anxiety almost all people with burnout.

00:02:01: they have sleep problems and eventually you will have some cognitive problems that are very difficult to deal with.

00:02:09: And as it goes along, from being sort of the symptoms then be in clinically burnout and something is like falling apart so you can't really do anything else than rest.

00:02:26: So... It's a process which can take

00:02:28: months

00:02:29: or years.

00:02:33: Thank you so much for organizing this timely and very important podcast.

00:02:37: And thank you for the invitation, I think what we can also add is that there have been different frameworks.

00:02:43: they tried to describe burnout.

00:02:45: one of them was used as the mass like framework and the use of the must-like burnout inventory, where you have three aspects that are assessed to identify the presence of symptoms related to burnout.

00:02:58: And they're emotional exhaustion, depersonalization, and depleted sense of personal accomplishments.

00:03:04: That is true.

00:03:04: there also other frameworks but this one that's mostly used in quite a comprehensive way what Ingeborg was describing from the clinical point of view in terms of symptoms, and it gives us also a measure to assess the presence of burnout.

00:03:24: We may be discussed more in detail afterwards with limitations on having single inventory for different frameworks that are used as burnout.

00:03:35: And then from the neurobiology point-of-view I think Ingrid has done much research on this so maybe we can hear more about her on the neurobiology of burnout, but I cannot intervene if...

00:03:49: I think you both have like different approaches because as you said.

00:03:53: You have this occupational health at least and Ingyborg was especially helping in our research to help the understanding of these stress-related exulsion And we were also discussing it's an issue in neurology psychological and psychiatric societies, what is exactly a burnout?

00:04:16: What is the definition?

00:04:17: maybe we could add in this discussion when is a burnout real syndrome.

00:04:23: And when it's an early warning sign of for example affective disorder.

00:04:37: I'm also working in, half of the institute is working in a patient health area.

00:04:44: We are working with promotion and prevention or burnout and organization on social environment then also clinical part when it comes to biology and cognition.

00:04:54: The thing here's that we have to remember must like establish this around the seventies And more people for that matter.

00:05:05: And things have changed.

00:05:09: Now there is a European consortium, or international consortium of forty-four countries working on defining burnout for all countries as sort of common definition in line with the health organisation's definition and it is Wilma Schäufelius leading that work.

00:05:35: The dimensional is that you mentioned from Maslak, they are two of the dimensions have been removed.

00:05:43: And there's a focus on the excess in exhaustion and tiredness... ...and the condition What I feel interesting also when it comes to biology That we can take a parallel on depression.. ..that not very well defined either.

00:06:01: Anxiety isn't very well-defined.

00:06:04: We don't have biological marker for these either.

00:06:08: I mean, depression is a very undefined condition.

00:06:13: but there's like.

00:06:14: we have demands that burnout should be more or better defined than any other clinical condition in psychiatry.

00:06:27: so it is an interesting discussion.

00:06:30: what do you say about that Alice?

00:06:33: Yeah, I totally agree and i read a paper that was published in two thousand eighteen where they looked at the different definitions of burnout In different studies.

00:06:41: so they look at one hundred eighty-two Studies And They found a hundred forty Two Different Definitions Of Burnout.

00:06:48: So as you mentioned there is also an important matter related to definitions because when we have more precise definition then More precise definition Lead Also To Better Research Because We can Have better Inclusion Criteria and that can help us also to advance in terms of discovering the neurobiology a bit, but also possible interventions at different levels.

00:07:10: That can actually prevent or reduce the burnout prevalence.

00:07:15: so I think it's quite central The matter of definition And both from the clinical but also from their research point of view as in keyboard words was suggesting an things have changed since the seventies, so measures need to change alongside and also we need to have larger populations where we can test these inventories or other scales.

00:07:41: That's a really important point because we are seeing at least from my practical viewpoint that lots of patients are regarding that they have burnout ,they've had pre-dead, this local newspapers magazines but it is difficult.

00:07:56: It is really a burnout.

00:07:57: And of course, we are just thinking in this new classification in ICD-Eleven but all our paperwork let's say in our country still with ECB-TEN and the point it will be from... ...of these translations that they said are stress related disorder at the moment is another condition?

00:08:22: That's the challenging part!

00:08:25: What from this original, as you said in your board definition is still staying?

00:08:32: In the mindsets of the general population.

00:08:35: what would be our role?

00:08:36: to make it more understandable in order To have more and more participants for these clinical studies?

00:08:43: where do You think we can attract More insight For this new definition?

00:08:49: That's

00:08:52: a good question.

00:08:54: I would think that when it comes to answering the question about the clinic, When does it become a clinical condition?

00:09:03: We could think this is same as all psychiatric diseases.

00:09:07: That you have sort of symptoms but then... ...when these symptoms are at point where they can't really function.

00:09:16: You need see healthcare and your not able work And somewhere around that line It is obvious that you have a clinical condition.

00:09:27: And maybe we should not think differently about burnout, like the depression or anxiety... Or other conditions for that matter.

00:09:37: so it could see us quite similar.

00:09:41: The thing about burnout because it's really closely related to pressure and anxiety Because of its comorbidity.

00:09:49: You need to be sure the condition is due to stress exposures.

00:09:55: that has been going on for a long time and it has not been dealt with.

00:10:00: So, that's like framing the burnout situation.

00:10:05: this due to that And therefore all intervention in management should be focusing on except of symptoms To deal with situations which have put you into sort of clinical condition, and that is usually the workplace.

00:10:24: So if we are not dealing with that then we could as well call it depression or anxiety.

00:10:29: so... That has to be really important.

00:10:32: what has put you in this position?

00:10:35: because that's the management of the situation.

00:10:41: I totally agree with that.

00:10:42: And i would like also to be a little bit provocative and take a step back talking about culture and stick my around not only mental health, but especially burnout.

00:10:54: And I recently read the essay The Burnout Society from the Korean-Germany philosopher Byung-Chul Han .And i retained three aspects... Three reflections that he uses in his essay That are also relevant for us ,and related to culture that has been developed the imperative to perform.

00:11:16: So he wrote this essay in two thousand and ten, but it's still valid ten years later.

00:11:20: so what he argues is that In contemporary societies there are imperatives to perform Which has gradually shifted from an external force That being like visible roles, hierarchies etc.

00:11:33: To one internal one.

00:11:35: What basically individuals And also healthcare professionals experience?

00:11:40: a constant pressure to produce more improve themselves surpass the previous achievements, which to a certain extent can be good.

00:11:48: But the problem is that when it reaches the limit then basically you're pushing yourself

00:11:54: too hard

00:11:55: and you don't even realize this as a negative aspect because in the end you internalize that imperative to perform has a personal restoration and responsibility And you cannot really escape for that Because if not managing To always improve yourself to continually surpass your achievement then it is a personal failure.

00:12:18: So that also interesting because if you look at all the measures have been assessed, most of them are based on individual measures and still comes back this idea people have internalized these imperatives to perform, and they just blame themselves that too weak.

00:12:37: They're not able to fulfill their aspirations when actually it comes from an external force pushing us to continuously perform better and be better?

00:12:48: And then the other two aspects I think are related to our society is the blurred definition of like worth balances.

00:12:54: And technology doesn't help with this.

00:12:56: if you can consult your work email at nine PM When You Go Back From Work this is not a very good boundary with the work.

00:13:05: And even though sometimes these behaviors are felt as being like, they're results of purely individual choices.

00:13:12: most of the time my impression that they reflect social norms and organizational expectations embedded in many professional environments especially in the healthcare system.

00:13:25: The last one Yeah, that continues on the same line of blurred definition or work life boundaries is identification.

00:13:34: Of the personal identity with your professional role and leaving out other aspects of your life.

00:13:40: so I think to really if you want to really tackle burnout we need change culture when it's reduced stigma.

00:13:47: We need to educate people on burnouts And also provide resources So that people feel safe to disclose about their sentence.

00:13:58: So I read the report, two-two thousand twenty five reports of the European Agency for Safety and Health at Work And he showed that around fifty percent of individuals Realized it and disclosed.

00:14:10: if they talk About mental health condition with managers With colleagues these can have a very negative impact on Their career.

00:14:18: so this means we really need change the culture and stick my rounds, not only burnout but I think more generally also mental health issues.

00:14:29: It's really a remarkable point of discussion at least because especially that you have lots reports about even manager publications...I was thinking now when we were talking about Harvard Business Review.

00:14:43: they are how to make an environment protective, how to manage this fluctuation.

00:14:50: How do you find identification with the world that it doesn't go with this feeling under pressure all of a time?

00:14:57: So my question for you both would be like to discuss from which point is burnout kind-of healthy answer to a six system?

00:15:07: if framework is so difficult in order to develop ourselves, because we are talking about this cognitive load.

00:15:14: We're talking about these exhaustion and sleep management or being reachable all the time.

00:15:22: What would you begin in order to make the system more feasible for people like us?

00:15:28: Health workers who were anyway vulnerable?

00:15:32: I think that working quite a lot with work environment is almost half of research at the institute and it is obvious that like Alisa's saying, work environment is very important.

00:15:50: But we have to remember in this.

00:15:52: there are also people who have their personalities and backpacks from a whole life situation but they also live outside of work.

00:16:06: And our research shows that when looking into what is really causing the clinical burnout, then we find it's mostly work combined with a live situation outside of work.

00:16:20: It's like your whole situation you're not... The demands on this whole situation are too large but basically The employer can do is quite a lot because we also see that if it's working at work, the organisation and social work environment are working then burnout is quite uncommon.

00:16:43: So so if you can work on the organisational level with the work environment And uh... We have been focusing quite alot of job demand researches about model but there was also Effort, reward and balance models.

00:16:59: There's another psychological security is one of the factors that this really important That you have a fearless workplaces that you can actually be able to speak out if something Is not right.

00:17:12: we also had the manager conditions but in healthcare We are been focusing The last months together with other Nordic countries on emotional demands being perhaps one of the very significant workload factors.

00:17:33: that has not been, we have not been able to measure that well for validated scales in healthcare sectors.

00:17:41: So we need to focus on like a whole situation and not only how much you have to do with work-like job demands.

00:17:49: so it's really important.

00:17:50: And on the prevention side I totally agree.

00:17:56: It's mostly prevention and organizational levels, but of course individual measures are needed when you're within the healthcare working with your symptoms.

00:18:07: So we have to sort out... We have be able think two thoughts at a same time.

00:18:14: And it is our point because we come from this helping professions like in my practice clinical life, I noticed that all these helping processions social workers teachers medical doctors nurses are really affected of burnout.

00:18:30: and the point is when you're beginning.

00:18:33: because if your vocation one of this professions would be an approach how to make it preventable.

00:18:41: How To Make These First Months Of This Residency Of This Training Of This Nursing Study More Variable.

00:18:48: So, one is of course the backpack as in your experiences and the second part will be how day-to-day life can be adaptable to make it manageable.

00:18:59: To speak out when emotional demands are increasing And also have a safe space Maybe from you point of view at least because You're on charge this task force of well being which are colleagues of the neurologist addressing to you regarding what we discussed so far.

00:19:21: So in general, I think there are many common themes but also other things that have related To the specificities on the type of job That you do.

00:19:30: one of them all that I find quite useful There are different models that used describe burnout is the job demand resources?

00:19:40: disembalance in between the demands related to your job and the resources that are available.

00:19:45: And with regards, you have different levels.

00:19:49: so you have a quantity of demand like working hours, night shifts high patient volume which is specific not only for specialty but also to the subspecialty or rotation.

00:20:01: it's very different if you're doing an emergency department rotational if you aren't consultations because there the also, the uncertainty when you're in the emergency room to receive a call.

00:20:10: You don't know exactly what is going to come whereas In the consultations we have planned consultation.

00:20:16: so that helps you also to organize better your time and give you a sense of autonomy And The possibility To manage yourself this time.

00:20:23: So This Is one Of the Aspect That has been seen in the literature as being protective.

00:20:27: Then You Have Cognitive Demands.

00:20:30: Having Constant Decision Making Interruptions Information Overload definitely a negative impact on your ability to cope with stress and can be one of the factors that leads then to burn us.

00:20:44: Then as was mentioned by Ingeborg, you also have emotional demands.

00:20:49: So, issue working with patient suffering.

00:20:51: If you have many times discussion around death or delivering bad news that has an impact on yourself and if you don't have emotional buffer to deal with it can be very difficult manage by your self.

00:21:02: I mean a team supports you but not the dedicated psychological support because is going seen as you been weak too.

00:21:15: ask for help.

00:21:16: This is also another factor that can have an impact, and this what we see among neurologists.

00:21:22: And then I think i would like to add on other aspect which hasn't been touched upon yet it's the moral demands.

00:21:27: So as David was saying when you enter medicine or specialty You want help people.

00:21:33: Then you face administrative workloads Other issues but also more issues in a sense where your ideal of how you'd be at work And you have some limitations that come for organizational aspects, but also from other reflections that are related to profit coming in pharmaceutical industries.

00:21:58: But also the hospital itself doesn't use.

00:22:03: The hospital uses measures that sometimes are not really adaptable to the healthcare system.

00:22:08: So being efficient, this is not always possible in any consultation or in any type of jobs.

00:22:14: so I think these are the aspects that came out from our side.

00:22:17: but if you look at the literature it's same as we also see in general Not only in health care and professional environments known to be vulnerable.

00:22:29: And then when it comes to resources, as Ingibor was saying there is the individual level.

00:22:33: So your competency, self-efficacy but also your personality and team levels.

00:22:39: so if you are in an environment where your peers or supportive colleagues give a sense of psychological safety that this is positive aspect at the organisational level.

00:22:50: The last point is meaning related resources.

00:22:54: You feel like your job is meaningful for yourself.

00:22:56: So these are a little bit the things that I think we came out in our meetings within the task force.

00:23:03: and then, you also find it is literature.

00:23:08: Maybe just asking exactly... It's really complete same in the psychiatric demands like regarding all this night shifts at all?

00:23:18: This question okay some moral.

00:23:21: It's morally like representatives to do this job with these conditions, especially if you are working with what we call harm reduction.

00:23:29: You're not healing people... ...you try and deal with a chronic disease in both specialities, neurology and psychiatry such of such importance.

00:23:38: And for me the point would be which other resources?

00:23:41: You were talking about okay team work willing their own thrives you have as a person, which other resources are like in the litter too?

00:23:52: In your clinical practice that can kind of protect or reduce this burnout risk for you both.

00:24:03: So within the task force we're doing a systematic review on measures that I've been used in the healthcare setting especially for physicians and looking at physician-in-trainings that can prevent burnout or help actually reduce the prevalence of burnout.

00:24:21: As I mentioned before, most measures are related to individual aspects and this is as you can imagine it's related And this can include mindful-based interventions, for example having a professional coach keeping a gratitude journal exercise yoga between social connections.

00:24:44: The problems of these studies is that they're very limited in terms of sample size and frequently don't have control group.

00:24:52: so it's difficult to draw general reflections and general indication suggestions based on these studies, because as I mentioned the literature under the data available is limited.

00:25:06: Then there are the aspects related to the organizational level And for this that have less studies?

00:25:19: larger resources and sometimes also changing the culture within an institution.

00:25:24: And the measures that have been seen as being more effective are reducing working hours, because what we see is a burnout intensity prevalence is related one of the factors that influences this work in ours.

00:25:38: there's many studies where they show that reducing working-hours adding more staffing reduce significantly burnout over many years, then reducing the administrative workload.

00:25:49: So that was done with basically helping physicians with non-physical team players who were helping them for the administrative work and now would maybe be a new large language model?

00:26:02: Maybe we will find another way to also support physicians from the other side than there is the leadership level.

00:26:08: so having support the leadership around this and that is educated about burnout.

00:26:13: And it will support you identify, help you identify early signs of burnouts.

00:26:18: very important as I mentioned before.

00:26:21: but we really need to work on culture in making possibility for trainees or attending physicians to talk freely about their symptoms and difficulties.

00:26:38: But I think that maybe Ingeborg has more to add as she's doing research as well on this field.

00:26:44: I'm thinking, often when i give a lecture in this area... ...I have picture of boat-a big sailing boat.

00:26:53: It is sailing from France and Spain or whatever.

00:27:01: On the boat there are lot people working And they're combined into group And then there is a leader, the captain of boats.

00:27:13: The communication and information about where we are sailing... ...are not known by all people working on the boat.

00:27:22: The structures in this boat are very unclear so you have different informations with which harbour to end or which road to go.

00:27:32: The captain of the boat is... constantly getting a lot of reports to fill in, they are just being thrown into the boat.

00:27:41: The adnurser team is working on it.

00:27:43: so the captain has no time to sail the boat because there's always something new coming in.

00:27:48: and uh...the team is eh..a bit informed but yet not about where we're going?

00:27:55: And what I'm doing?

00:27:56: this taking quite some time and cognitive load.

00:28:00: So In This Case!

00:28:01: Actually It Turns Out that one of the sails are missing.

00:28:07: The precondition to be able to sail the boat is not there, we're not able too do our tasks.

00:28:15: so in this case it will not matter how many people have been doing yoga mindfulness crossfit or stress management because that's not going fix a sale at all.

00:28:32: and The tricky part here is that when it comes to the organisation intervention you mentioned, Alice, they cannot be done in randomised controlled double-blind studies.

00:28:46: We are always thinking that medicine is the golden standard and all of this study's done with medicines.

00:28:52: so we're like moving... ...that we have to do these same studies doing the evidence in organisations' research.

00:28:59: That's not possible because its about a process And you cannot do a randomized control study.

00:29:06: So, but you can see that the sale is not there and... ...and you can do something about it.

00:29:13: It's enough of yoga and mindfulness.. ..and its good people are in shape!

00:29:18: They're really mindful and they are sleeping and everything is working But the sale still missing.

00:29:26: Totally agree with such insight answers, because we need in our trainings for the general public hearing us a bit of context what is going on and it's such good image that with the vote okay where Is It Going?

00:29:42: What is happening and how We can find Our safe space.

00:29:46: Our sense In this work preparation in This day-to-day life Because its what you taught as well.

00:29:55: at least like always thought about this productivity There's not so much like research about how to make it more feasible, How To Make All These Structures In A Way More Resilient I would say.

00:30:10: Like more against a ways as you said in your work again something unexpected because we are really working in order that okay there is no unforeseen event but if Something Is Happening Then It Begins Everything To Shake And that would be like as well, my open questions for you.

00:30:31: What could it be if those medical institutions like the hospital or a GP not only think in productivity but all these neurobiological aspects.

00:30:43: we were discussing about what they will think of how this human wellbeing and framework is going to feel safe?

00:30:57: Developing a learning collaborative atmosphere.

00:31:00: How would that hospital, how will it that place look like?

00:31:05: Let's think out of the box!

00:31:09: I...I would think they'd be looking at sailing boat with all the sails in place.

00:31:14: That is about psychological safety and its' about structures.

00:31:20: The structure.

00:31:21: you are in workplace that the organization or social environment is working that people know the task, they know what their doing.

00:31:31: They are communicating about the tasks.

00:31:34: there is a support from managers and managers have precondition to be able do work getting supports of superior managers.

00:31:44: everything is clear when it comes to mandate decision making And people knows how to do this.

00:31:55: It's really basic.

00:31:57: Reasons have shown that, I mean the cognitive load is if things are uncertain it's costing you like forty percent of your working performance.

00:32:09: That you can use to deal with patience.

00:32:11: instead It's misunderstandings its conflicts communication not working... ...that is taking a lot of toll when it comes to cognitive.

00:32:21: and this also about put up sales and make sure that they are actually working to be able to sail the boat, through the paces.

00:32:32: I really like your metaphorical board of the boats!

00:32:34: I think i will still use it also for future.

00:32:39: You provided quite a comprehensive response but always strikes me as you mentioned is very easy if you think rationally easy measures to consider If conditions to sail on the boat should not be sailing or work on those conditions to meet them and then sale.

00:32:57: So that may be in the case.

00:32:58: there are many other aspects, maybe coming back to the initial point I was making – cultural aspect as an impact because if they measure it so easy or logical why not implemented?

00:33:14: We're coming back a little bit, I think to the point of changing that culture would also help us improve our work environment.

00:33:22: And as David was saying not only considering the number of working hours but is and as Edward were saying as well consider in emotional demands, cognitive demands related with this type of task.

00:33:34: But there are recovery opportunities between tasks.

00:33:38: So these other aspects which i think are very important.

00:33:41: and third education.

00:33:43: So, being aware of early signage burnout and being aware as the importance of seek help early on before the condition evolves more.

00:33:53: Yeah that's still a little bit work to do!

00:34:00: We were really having discussion point about cultural background regarding protective factors for developing burnout.

00:34:11: we are all living in countries facing the what we call international medical graduates, nurses other professions coming from country A to country B in order of developing themselves.

00:34:28: In professional point-of-view maybe because family.

00:34:33: so we face that We have different kind of mindsets Different personalities in a very high sensitive workplace like in hospital or work.

00:34:45: What are your experiences and which hints we can develop of that?

00:34:53: Is there any experience?

00:34:54: you said, okay maybe this intercultural approach can help to learn from each other.

00:35:00: It is difficult to treat or prevent if everyone has different coping strategies.

00:35:08: I'm not so sure that, just...I was writing a paper and there's usually reference that said that regardless of country.

00:35:19: That it within the European countries but still regard as a country?

00:35:24: The workload when it comes to job demand, resources, effort-rewarding ballads all this It is

00:35:32: very

00:35:33: similar in different countries doesn't

00:35:35: strike

00:35:36: you differently at different countries?

00:35:38: And it's also similar when it comes to males and females.

00:35:41: So if you are under a lot of demands, regardless in which country you live or where you come from... ...and the demand for the load is higher than that you can cope.

00:35:54: then there might be symptoms.

00:35:59: Of course being tired isn't being burned out.

00:36:02: so I mean some other people who are tired have stress but they're still not being burnt-out.

00:36:07: But it strikes us quite similar.

00:36:10: I was just reading a paper from both Latin America and Africa, And i felt in that paper from Africa That they actually don't forget European countries and Western countries.

00:36:23: We are also dealing with burnout Because there's a lot of pressures.

00:36:29: It might be different when it comes to the economic situation The employment situation a person under such load that you're not coping with.

00:36:40: It seems to be quite international,

00:36:45: but of

00:36:45: course we come from different cultures and have different coping strategies... But when it comes the work environment I would think this is the same or similar.

00:36:55: What do you say Alice?

00:36:57: Yeah, I totally agree and i was looking at the studies that assess burnout prevalence in minorities In different European countries.

00:37:03: And there were as you mentioned no many differences.

00:37:05: There are not so many studies that assessed it but they're not difference related to culture or from Your country of origin?

00:37:11: I think what we know From research is generally that having a diverse environment helps To improve the quality Of research and I guess in a way It also helped us to improve structures and to improve institutions.

00:37:23: when You have different regards, I mean view on a topic.

00:37:28: Usually this is quite enriching and it helps you to see the dark spots that maybe haven't seen as you've been training in the system for many years.

00:37:35: so i think it's very important to have diverse eye on structure of how work is organised.

00:37:42: And then we need also be attentive and immigration, the countries where doctors or nurses come from.

00:37:50: They can be depleted of staff.

00:37:52: so we need to also consider that... From an international point-of view does it expose those institutions in those countries?

00:37:58: To reduce staffing and increase workloads And then leading to increased prevalence of burnout.

00:38:04: We need to be considerate about this even though the mechanisms are the same in any country.

00:38:12: Thanks a lot because it gives so much like impressions about how to in our day-to-day lives To make change.

00:38:19: what I can also notice.

00:38:21: Like talking again About the captain of the boat, like also leadership is changing A lots.

00:38:26: like may make it more adaptable.

00:38:30: And I guess a point Is that we are noticing under this hike will load More safety problems happening for example medications those age.

00:38:39: It's about adverse events and as well lower patient satisfaction.

00:38:45: If you are reading a study especially about nurse burnouts, this quality of care it could be possible change if we try to convene in our clinics or providers that changing these emotional strain, uncertainty, lack control in redesigning the work would be feasible and beneficial for our institutions or healthcare work.

00:39:19: I guess, this discussion will also be very important.

00:39:23: to know how to rebalance all these demands we were talking about in the resources that could have been in our organization should be taken into account.

00:39:42: Like what could we say in the next three weeks, if we are regarding this model of job demands and resources?

00:39:51: Which kind of these resources should we ask for or develop to have less risk of

00:40:00: burnout?".

00:40:02: Okay I can start!

00:40:10: That's my one hundred dollar guess.

00:40:13: It has to do with both senior physicians and all the staff, students that they sort of come together in workplace meetings raising awareness about the conditions at work place And making sure that the psychological safety is at the workplace and it's actually working, communication.

00:40:39: You can start with small things.

00:40:42: you can just start to say do we have psychological safety at work place?

00:40:45: Can we say whatever we need to say without having people looking at us?

00:40:57: or are we communicating in a healthy manner?

00:41:01: Do our manager has conditions for doing their job?

00:41:05: I mean, it's a small thing to start working with the improvement of workplace.

00:41:11: Yeah, totally agree as Ingevore you were saying before that they both can say actually first.

00:41:16: so thinking all those boxes and i think another aspect that also see frequently in my experience is there are these cultural aspects related to idea that its generational things we tend to complain more or less adaptable.

00:41:35: There are many studies that shows there also attending physicians affected by burnout, especially problems.

00:41:41: And we need to face this as workforce altogether.

00:41:47: not blaming specific people for their weakness but recognizing burnout is a multifactorial condition related different aspects of the type work at the organization individual and cultural level.

00:42:02: I guess it's recognized recognition, this awareness will help us in our cultures and our job to have a bit of shift.

00:42:11: And especially to regard what are the first steps to go on?

00:42:18: I am very satisfied that we could discuss all these issues because there is not only this personal coping strategy.

00:42:26: It isn't about failure or resilience You can have in these high states of responsibility because you are in charge of our patient's life as a medical doctor to perform it, so that we could go home with security and safety.

00:42:52: With this I'm really looking forward for the next episodes regarding early psychiatrists to different sectors of colleagues looking for solutions, looking for hints regarding mental health.

00:43:11: Thanks a lot for your participation in Giborg and Alice!

00:43:14: And have a good time!

00:43:21: Thank you for listening to Psychiatric Mind

00:43:23: the official podcast

00:43:24: at The European Psychiatric

00:43:26: Association.

00:43:27: Make sure follow us on our social media and join us next time For more conversations on contemporary psychiatry.