EMPATHY AND BURNOUT: AS OBVIOUS AS IT SEEMS

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EMPATHY AND BURNOUT AS OBVIOUS AS IT SEEMS?

• Edward Latif
• A/Prof Carmelle Peisah
• Prof Kay Wilhelm
• School of Psychiatry, Faculty of Medicine,
  University of NSW
• Sydney, Australia

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Empathy

• Definition
• Cognitive and emotional insight
• Demonstrate gain of insight
• Unlike sympathy, pity, detachment
• Significance
• Role in doctor patient communication
• Many positive outcomes including satisfaction,
  compliance, fewer lawsuits

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Burnout

• Complex of three dimensions
• Emotional exhaustion
• Depersonalisation
• Decreased personal accomplishment
• 25-60 of doctors affected
• Many negative outcomes including depression,
  medical error, early retirement

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Burnout and Empathy

• High empathy thought to relate to high burnout
• This remains untested

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Burnout and Empathy (Cont.)

• One study has been conducted
• In 545 US medical students, finding
• Empathy inversely correlates with burnout
• Burnout independently predicted empathy
• i.e. theorised causation worked in reverse

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Project Aims

• Identify the relation, if any, between empathy,
  burnout and psychological distress in experienced
  doctors
• Increase understanding of practicing clinicians
  opinions of empathy
• Increase awareness of boundary issues for doctors

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Hypotheses

• A relationship between empathy, burnout and
  psychological distress
• Empathy will correlate positively with burnout
  and psychological distress
• Doctors will encourage use of empathy
• Doctors will report boundary issues associated
  with using empathy

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Data collected

• Quantitative data
• Jefferson Scale of Physician Empathy
• Maslach Burnout Inventory
• Kessler 10 Psychological Distress Scale
• 15-30 minute semi-structured interview
• Selection criteria
• Doctors from broad cross section of specialties
• Currently practicing registrars and higher

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Demographics Data
Response Rate158 respondents to questionnaire,
51 also did Interviews Questionnaire Response
Rate 158/250 i.e. 63.2
Statistically Significant Difference (plt0.01)
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Results (Quantitative)

• Empathy was not associated with burnout by trend
  or correlation (p0.232)

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Results (Quantitative) (Cont.)

• Empathy was negatively correlated with
  Psychological Distress (p0.018)

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Results (Quantitative) (Cont.)

• Psychological Distress and Burnout were
  positively correlated (plt0.001)

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Results (Quantitative) (Cont.)

• Empathy was
• ? in Drs working longer hrs (plt0.05)
• ? in Females (p0.001)
• ? in private practitioners (plt0.005)
• ? in GPs and Oncologists (p0.024)

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Results (Quantitative)

• Psychological Distress
• ? in older and more experienced Drs (plt0.001)
• ? in private practitioners (plt0.05)
• Burnout subscales
• ? in private practitioners (plt0.05)
• ? in older and more experienced Drs (plt0.05)

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Results (Qualitative)

• Thematic analysis of 51 interviews identified 6
  themes
• Defining empathy
• Comparing doctor empathy to general public
  empathy
• Patients who evoke empathy
• Changes in empathy over time
• Teaching empathy
• Barriers and protection
• Interest in doctors perceptions of empathy, not
  their view on its relation to burnout

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Results (Qualitative)

• Defining Empathy
• 1/3 defined empathy accurately
• Remainder didnt recognise the element of
  detachment
• Empathy desirable in care
• 82.4 said being taught as a JMO would have
  enhanced their practice to date
• 70 noted doctors empathy is unique, primarily
• Technique Professional obligation to use empathy
  to seek information
• Circumstances Better medical understanding of
  patients experiences

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Results (Qualitative)

• Literature focused on doctor factors influence on
  empathy, doctors focused on patient factors
• ? empathy compatible personality, Dr sees self
  in patient
• ? empathy personality clash, over demanding
  patients
• Holding back Manipulative patients, lost
  causes, over-relating
• Doctors werent unequivocal on empathys use
• 72.5 made spontaneous comments about empathy and
  protecting oneself
• 75 believe hazardous to clinical judgement
• Concern about using empathy and being overwhelmed
• Some suggest avoiding empathy altogether

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Discussion

• Quantitative data demonstrates empathy has no
  relationship to burnout
• Qualitative data contests this
• Doctors are concerned regardless
• Doctors are choosing protection over empathy
  need for more education?
• Empathy inversely related to psychological
  distress why?
• Empathy protects from psychological distress
• Psychological distress ? reduced empathy

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Discussion Cont.

• Older doctors have lower burnout and
  psychological distress
• Doctor factors associated with differences in
  empathy, patient factors too.
• Work conditions GPs highest Long term Dr-Pt
  relationship, private practice
• Patients role Dr-Pt interaction is bipartisan
• Doctors view empathy as a fluid concept, a tool
  they can utilise, a quality they can turn on or
  off literature has a more rigid interpretation

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Conclusions

• This study challenges the conventional wisdom
  about empathy and burnout
• Role for greater emphasis on providing
  understanding of empathy and boundary issues
  throughout medical careers
• Longitudinal studies are needed