When Clinicians Say “I’m Burned Out”: Clinical Boundaries, Safety, and Workplace Harm

00:00:02: Welcome to The Psychiatric Mind, the official podcast of the European Psychiatric Association.

00:00:10: Your space for expert conversations on contemporary psychiatry!

00:00:27: Hello and welcome to The psychiatric mind.

00:00:30: My name is Serentan Yirkayohan And I'm an early career psychiatrist working in Turkey.

00:00:36: This season's topic is Anatomy Of A Burnout.

00:00:39: In todays episode we will talk about when clinicians say that they are burned out clinical boundaries, safety and workplace harm.

00:00:48: My guest today is Dr.

00:00:50: Julian Beaselt.

00:00:52: He's a consultant in emergency psychiatry at Northgate Hospital Great Yarmouth United Kingdom and Secretary General of the European Psychiatric Association where he has been serving on board since.

00:01:07: He has served on the EPA Ethics Education and Publications Committees, was a founding member of the EPA Early Career Psychiatrists Committee.

00:01:17: A past president of European Federation of Psychiatric Trainees is also an honorary senior lecturer at University East-Anglia Norwich Medical School.

00:01:28: He has authored over a hundred and ten publications on topics including mental health law, medical error and burnout.

00:01:37: And his work has been recognized by the EPA The American Psychiatric Association under Royal College of Psychiatrists.

00:01:45: Welcome Julian!

00:01:47: Thank you for joining us today.

00:01:48: Hi Esselin thank you so much For this opportunity.

00:01:52: It's such an important topic So I'm looking forward to our conversation.

00:01:56: Thank you.

00:01:56: So today we are in the gray zone because burnout is one word for very different problems, when a clinician says I'm burned out it might be overload but can also be depression anxiety trauma symptoms or moral injury.

00:02:15: There are different risks and different responses.

00:02:17: So today we focus on clinical clarity, what to ask?

00:02:22: What red flags to spot And what reduces harm for the clinician and service?

00:02:29: Let's start with the core.

00:02:30: In mental health services, burnout has become a common shorthand.

00:02:35: Clinically.

00:02:36: why does it matter?

00:02:37: we are precise about what we mean and how can we define it?

00:02:41: So I think its obviously important to understand what you're talking about because We want make sure that we communicate properly with the issues in our training plan To do something.

00:02:53: while we talk about this same thing What is burn art ?

00:02:59: One way of watching that is burn out is not officially a mentally mental disorder, but it is certainly condition with symptoms at indicate psychological strain or psychological distress.

00:03:12: And they three main symptoms are the classically comprised burnout?

00:03:17: The first one there is the sense of emotional exhaustion for sensor being over well.

00:03:23: to second one is depersonalization or cynicism where people feel kind of removed from the work and don't care, I think their effort is worthwhile.

00:03:36: And then in a third part of that triad it's the sense of loss or personal efficacy.

00:03:45: In other words feeling whatever i do makes no difference.

00:03:51: so you have this triad with three feelings emotions.

00:03:57: And when those build up and overwhelm people, that's where the problem starts.

00:04:03: Yeah this triad you're mentioning helps because it makes burnout observable and discussible... ...and people can recognise in themselves as well as teams.

00:04:17: I would like to ask about when a clinician says they are burned out What were your first questions practically?

00:04:25: To clarify what is really going on?

00:04:27: So, I mean obviously there's always depend on the context and who you are when they're talking to insane that they feel better what your role is.

00:04:39: But if the first thing is obviously to understand what they need work with watch isn't it makes sense say that all their reflecting one or more aspects of this trial just referred too?

00:04:55: Or is it something else?

00:04:56: because of course people could for example be developing depression and describe that as burn out or they couldn't at the same time be suffering from grief.

00:05:08: You know many other things could cause someone to not feel okay and then this described its burnout.

00:05:15: so one needs to try and turn down what's happening.

00:05:18: when i did that just use one of the recognize bernard, Rating scales or inventories.

00:05:25: Probably the most well-known one is the Maslach burn after inventory, but there are many others.

00:05:31: They all measure roughly the same thing in slightly different ways.

00:05:35: So perhaps using one of those to try and define what's happening But off course though the overriding fingers its communications talking to a person understanding What's going on checking that you've understood it properly and then trying to make a judgment what's happening.

00:05:53: From there, perhaps it can be done?

00:05:56: So burnout is the starting word not an end point.

00:06:00: you clarify your picture check safety match response in regard this.

00:06:07: let us stay with that.

00:06:13: if burnout can't be something else its'a starting words.

00:06:18: The next question is about risk assessment and escalation.

00:06:22: What are the red flags that tell you?

00:06:25: it's no longer in the work stress territory, but we need a more urgent clinical approach?

00:06:32: So I think one way to think of burnout as its early warning symptoms or if something has not done... ...the person may go on to develop a more substantial psychiatric disorder,... suffering.

00:06:50: that's important because there is no good evidence to chose that burn out as associated with poor performance at work.

00:07:00: so it's a patient safety issue.

00:07:04: It's the huge cost economically to system and someone i mean i think in their, United Kingdom, there was a study recently which estimated that burnout costs the national health service something more than two and half billion pounds per year just in direct costs from lost productivity.

00:07:27: But going back to your question about the red flags I think if you Try it and do you think of different things associated with that so.

00:07:38: You could sing call.

00:07:39: physical warning signs are things like not sleeping properly feeling exhausted all the time.

00:07:46: Frequent illnesses being off work for short periods or even not been off-work but suffering from a symptom so recurrent headaches pain muscle tension nausea and so on.

00:07:59: Emotionally, warning signs would be things like cynicism and detachment.

00:08:04: so loss of the ability to care or show empathy at work feeling emotionally numb.

00:08:13: Feeling negative towards colleagues will work in general becoming more irritable.

00:08:19: common manifestation.

00:08:23: Snapping a colleague's been rude to patients etc.

00:08:28: using motivation So not feeling comfortable taking on tasks and just not wanting to go to work, dreading it when a Monday comes.

00:08:39: And you have to go back to work after weekend.

00:08:41: And perhaps the sense of failure this loss of self-efficacy or sense of fail failing at your useless truck etc.

00:08:52: but there are also other maybe behavioural science things like withdrawal Not being involved in things isolating procrastination with work.

00:09:06: Reduce performance.

00:09:07: so it could be seen to your patients.

00:09:09: will you taking much longer to see each one and so on?

00:09:14: or the one that's often an issue of doctors is unhealthy coping habits turning towards alcohol other drugs even So those are all kind of things that could be considered as red flags.

00:09:31: If you see them in yourself or if they're a colleague, perhaps burnout is going on...

00:09:41: And you also talked at the beginning about safety issues.

00:09:47: Could you elaborate on that?

00:09:49: How is it affecting the person, the clinician who's burnt out and how can we assess this?

00:10:00: So I think assessing an individual level is more difficult.

00:10:07: But there are studies which show that burn out is associated with increased rates of medical error.

00:10:14: With poor judgment was bad treatment to patients.

00:10:19: I mean our efforts.

00:10:19: irritability before, which has something that patients will very much feel and it's unlikely to be associated with good care in a few very irritable you're likely to be doing your job very well.

00:10:36: So it's quite difficult to identify that kind of thing at an individual level.

00:10:44: But ways of trying to keep and awareness of this, because I think one other things really important understand with burnout is burn out should not be considered or thought over as an individual problem.

00:11:03: It's The burnout is my problem the burn out.

00:11:07: Is an organizational problem?

00:11:10: Because Bernat has heavily dependent on the context in which people work and the stresses and strains of working environment, which then needs to burn up.

00:11:19: so it is absolutely an organizational responsibility should take steps to prevent burn out

00:11:27: by

00:11:29: creating jobs that are doable.

00:11:32: I mean, you know one way of thinking burnout is it's a normal human reaction to being in an impossible situation where You cannot do your job properly don't have the resources.

00:11:44: He doesn't have that time.

00:11:46: They are too many competing pressures etc.

00:11:48: etc.

00:11:48: and that leads to these things.

00:11:50: so It's an organizational responsibility To do something to prevent it happening.

00:11:56: So how can you try monitor pick up that?

00:11:58: That might be an issue.

00:12:01: One of tools that is probably a pretty good tool for this, the use of anonymous staff surveys.

00:12:10: So where stuff can fill in feedback on various related topics regarding work but due to no way it's anonymous.

00:12:23: so they give honest feedback and not feeling constrained by fear or persecution that their promotion won't go through or whatever.

00:12:33: So anonymous feedback can really help an organisation identify if something's going wrong in a particular team, more particularly workplace?

00:12:43: And you talked about the work place situation.

00:12:48: that leads to burnout and it is an organisational thing... us a little bit more about what does exposure mean in the workplace that can lead to burnout inclinations?

00:13:08: I think i'd go back to the idea of being, in effect been in the wrong place at the wrong time.

00:13:18: So you've been exposed to demands that a lack of resource so you can't do what you need to do properly.

00:13:30: are you being exposed to lack of time?

00:13:33: so perhaps too many things should be.

00:13:35: Too little time helps not enough administrative support to do it and so on.

00:13:42: its very interesting to note in surveys of doctors generally burn out rates higher than the general population, But in surveys of doctors who do their specialist training, it's even higher.

00:14:00: And there are now multiple surveys and different countries' different medical specialties which all suggest underlying burnout rate of severe or serious burn out in like thirty to forty percent at least half having some level of burnout, which is even if people wish to think about it as an individual problem.

00:14:32: If one just thinks that the impact on health service and cost of mistakes or performance are costs of absenteeism then there's no problem And it helps the organization if they can prevent that.

00:14:55: When we talk about this rates, high rate of burnout in the healthcare workforce and specialists.

00:15:04: I was also wondering specific kinds of exposures such as harassment Do you think is it common?

00:15:14: Is one of the common reasons for burnout and how would you think about that.

00:15:21: I think harassment in a workplace, its not same as burn out.

00:15:28: so harassment could contribute to burn-out but it's.

00:15:36: I'd also imagine my experiences that people can endure considerable levels of harassment but not suffer from burnout, they might suffer from other things.

00:15:47: They could become depressed or anxious and so on... But rates of harassment or bullying are very high amongst doctors particularly among postgraduate trainees.

00:16:02: uh doctors who do their specialist training where it surveys.

00:16:06: multiple different countries show that at least fifty percent of experience this in the last year.

00:16:12: and again, this is across countries across specialties.

00:16:17: It doesn't appear that this is linked to particular specialties, that for instance surgery's worse than psychiatry or anything like.

00:16:25: This seems to be a feature of human behavior rather then the particular work context.

00:16:36: Just as an interesting aside, there are lots of different forms of harassment because of course there's harassment from people like bosses or colleagues.

00:16:46: There is a particular form of harassment which may be worse for medical doctors who work more closely with patients and that stalking where patient develops affixation on a doctor, for instance follows them or bombards him with emails or texts.

00:17:11: Or whatever.

00:17:13: and it's interesting that we did a survey some years ago looking at rates of stalking lot of different countries.

00:17:22: amongst trainees are postgraduate trainees in psychiatry?

00:17:27: And the figure that I remember is something like seven and a half percent of trainees had experienced stalking.

00:17:36: And stalking can be pretty devastating because it's persistent in its there whether you're at work or not, so harassment bullying stalking all this is big deal.

00:17:51: obviously contributes to increasing personal vulnerability.

00:17:58: Things like depression anxiety impairing performance at work burn out and so.

00:18:05: Yeah, so there are not really rare exceptions and they're very frequent.

00:18:12: And we have to expect it also ask about that.

00:18:17: So what I'm wondering next is how can we suspect exposure related to burnout other than just chronic overload at work?

00:18:31: These kind of things

00:18:33: I mean, an organisation that functions well will have regular contact between staff.

00:18:44: So people who are in your peer group so perhaps working similar jobs at a level or rank or profession but actually amongst the broader staff groups including managers and seniors as And if there is that kind of regular and by regular, I mean at least once a week.

00:19:09: Preferably more frequent but it's as they're kind-of regular contact formally or informally then It allows one to see more easily.

00:19:20: in some an individual has suddenly started behaving differently perhaps the most drawn up say or sick more often, perhaps I have these unexpand physical things and so on that i referred to earlier.

00:19:38: Perhaps i procrastinate anymore.

00:19:40: they don't want the email so quickly... but it can be difficult from my personal experience of work with doctors who've had problems because doctors see themselves as being people should be performing high at a higher level.

00:20:03: They don't want to admit that they have personal problems, so there hide them and it can be really difficult to see even in someone who's working close with those two you um So how do you deal with?

00:20:17: That I think is about trying to create a culture where people Can say that they're struggling or something uh And know that will be supported and know that they will not be disadvantaged or even punished in some way.

00:20:37: So having a support of culture is really important?

00:20:41: Yeah, yeah... That's really important as you say.

00:20:47: I'm also wondering about the reporting.

00:20:51: such experiences In your workplace organization Do think how can reporting be made more safe or what are the minimum conditions for that?

00:21:07: because of the hierarchy and organization.

00:21:11: How would you say?

00:21:16: it's often a feature bad systems, teams or authoritarian situations and so on that people do not report problems because they know that there will be punished.

00:21:30: There'll be some form of retribution if I do report some kind of problem.

00:21:37: So the opposite to that is a culture where anyone reporting a problem whether it's with them perceived as trying to help the organization improve.

00:21:54: So they are supported and their report is welcomed because it helps make things better for everyone, so on.

00:22:04: It's a difficult issue Because of human nature.

00:22:08: lot of people very uncomfortable with admitting any kind of problem.

00:22:16: They perceive it as a personal failing rather than that they are just human and struggling with the sort of thing anyone would struggle.

00:22:23: Yeah,

00:22:26: now we're talking about prevention and responsibility for the systems, organizations preventing burnout.

00:22:37: I would also like to hear your comments on the roles of seniors and leaders in terms of accountability, making these systems work.

00:22:50: As you know earlier on I made this comment that burnout is a system's problem rather than an individual problems.

00:22:56: so from that perspective Incredibly important in terms of trying to prevent burn out or if i'm not present and try to do something too.

00:23:14: Get rid of it in a good way.

00:23:16: um this is again about cultures about the organization having a culture that understands that people are supported, What they are supposed to do that the whole organization benefits.

00:23:40: but beyond that because we clinicians the patients benefit.

00:23:44: I'm off you put it in a sort of slogan is like happy doctors or good, you know happy doctors make happy patient something like that.

00:23:55: Or happy stuff.

00:23:56: because of course it's not just doctors i mean we talking as doctors today.

00:24:01: but burn out is absolutely not just a doctor problem.

00:24:05: And if you had to turn all of this into one message for services what would be that would sound like?

00:24:15: I think fixing burnout is there when everyone because the individual suffering from bernard the burnout has prevented, or the burn out goes.

00:24:27: They obviously better often happier and feel more efficacious at work by a few less emotions all stirred they feel less cynical that people may be more empathy and so on.

00:24:40: And it's good for patients because then get better treatment.

00:24:44: and I can feel the difference Because if you're patient to me see doctor who's burnt out versus If he see your doctor is not it's going to feel very different.

00:24:55: experience and interaction.

00:24:58: And we know that a large part of the interaction with patients is not just about drug or therapy but its personal interactions.

00:25:07: so if you are in good place as happy, not burnt out doctor then patient will do better for organization because staff They will keep the staff to stop for be more productive stuff won't be resigning stuff when you sit so much.

00:25:27: And the patients will be happy and they'll be sure.

00:25:30: complaints of your medical errors and so on.

00:25:33: so it's good for everybody, and then you know that the opposite side of that coin is such if u have a burn out problem in organizations going cost every body in these different ways.

00:25:47: So, fixing burnout is a win for everyone.

00:25:51: Thank you very much Dr Julien Wieselt... ...for joining us today.

00:25:55: Celine has been great talking with you!

00:25:57: Thank you so much.

00:25:58: Three

00:26:02: key takeaways from our discussion with Dr Juliet Wiesel today.

00:26:07: Burnout is a doorway not a diagnosis.

00:26:10: it's important to assess risk and clarify what is really going on.

00:26:15: And if there are harassment, protection matters support alone won't hold while exposure continues.

00:26:23: It's very important that we make a safety system in the organisation with trusted reporting routes immediate protections and credible follow-through.

00:26:33: You've been listening to Anatomy of a Burnout, a podcast series from the European Psychiatric Association.

00:26:40: Our thanks to our expert Dr.

00:26:42: Julian Beesold and our final message – take burnout seriously!

00:26:47: Check safety, clarify what's driving it... ...and reduce exposure where harm is happening.

00:26:54: If you're listening & struggling please don't stay with this on your own.

00:26:58: If you feel at immediate risk, call one-one two anywhere in the EU.

00:27:03: And for confidential listening and support we've listed European options on the show notes including One-One Six One Two Three Where Available and Local Crisis Services.

00:27:14: This episode can't replace personal medical care if your worried reach out to local services or a trusted clinician.

00:27:22: Stay safe have great day!

00:27:28: Thank you for listening to The Psychiatric Mind, the official podcast of the European Psychiatric Association.

00:27:36: Make sure to follow us on our social media and join us next time.