October- December, 2015/ Vol 1/ Issue 2 2455-5436 Review Article International Journal of Surgery & Orthopedics Available online at: www.surgicalreview.in 28 | Page Stress and burnout among doctors Rabindran 1 , Gedam DS 2 1 Dr. Rabindran, Consultant Neonatologist, Billroth Hospital, Chennai, Tamilnadu, India, 2 Dr D Sharad Gedam, Professor of Pediatrics, L N Medical College, Bhopal, India. Address for Correspondence: Dr Rabindran, E mail: rabindranindia@yahoo.co.in ………………………………………………………………………………………………………………………............. Abstract Occupational stress is increasingly faced by doctors. Upto some extent, stress improves performance but when excessive, it becomes harmful. Doctors have more stress related mental health problems than general population. Burnout is inability to cope with emotional stress at work. It consists of 3 domains; emotional exhaustion, depersonalization & lack of personal accomplishment. Various models like demand–control imbalance, effort–reward imbalance & support model explain evolution of work related stress. Common causes of stress are related to patient care, decision making, taking responsibility, increasing use of technology, continuing rises in health care costs, turbulence within work environment, long working hours & over-working. Stress causes physical symptoms, mental derangements, emotional & behavioural disturbances. Research suggests that high stress levels may impair immune system with increased risk of cardiovascular disease & cancer. Stress can be modified by appropriate stress management skills like avoiding cynicism, reading, joining a support group, attending a wellness conference, strengthening communication skills, addressing to spiritual needs, meditation & decreasing caffeine. Burnout prevention should be done both on both personal & organizational levels. Appropriate interventions like improving inter-professional relationships, changes in work environment, modifying off duty time & streamlining decision making should be done to mitigate the effect of stress on doctors. Keywords: Stress, Burnout, Stress management. ………………………………………………………………………………………………………………………............. Introduction Occupational stress is now being increasingly faced by health care workers [1]. Stress has a physiological association with illness. It is a relationship between person & environment that is appraised by the person as taxing the resources & endangering wellbeing [2]. It is a process which precipitates individuals to believe they are unable to cope with the situation facing them. However something which may be overtaxing to one person may be exhilarating to another, hence personality traits influence the stress equation [3]. Upto some extent, stress improves performance & quality of life, but when excessive, it becomes harmful. Prevalence of stress related mental health problems in physicians are higher than in general population [4]. A study among UK hospital specialists showed that between 22-46% exhibited significant psychiatric morbidity [5]. Most sensitive to stress are doctors working in emergency departments & at intensive care units (ICU) [6], where routine work Manuscript Received: 14 th November 2015 Reviewed: 25 th November 2015 Author Corrected: 15 th December 2015 Accepted for Publication: 30 th December 2015 demands highly technical environment & specialized doctors [7]. Physiology of Stress reaction: Stress reaction results from outpouring of adrenaline into blood stream resulting in a fight-or-flight response. Changes during this response include tachycardia, raised blood pressure, tachynea, tensing of muscles, increased mental alertness, increased sensitivity of sense organs, redistribution of blood flow to brain, heart & muscles. There is an increase in blood sugar, fat, cholesterol & a rise in platelets & clotting factors [8]. Burnout: Burnout syndrome was identified in early 1970s [9] among human service professionals, mostly healthcare workers [10]. It is common among physicians with rates ranging from 25-60% [11], depending on the working conditions &medical specialty [12]. Burnout is an inability to cope with emotional stress at work [13] or as excessive use of energy / resources leading to feelings of failure & exhaustion [14]. Maslach Burnout Inventory described