A STUDY OF BURNOUT AMONG CLINICIANS AS CAREGIVERS IN A CHRONIC MASS TRAUMA SITUATION Mushtaq A. Margoob MD, Uzair A. Haji MBBS****, Abdul Majid, M.D., Yasir A. Malik MBBS., Akash Yousuf Khan MBBS, Muhammad Mudasir Firdosi MBBS, Huda Mushtaq MA*, Basharat Munner Banday MBBS, Mufti Muzamil MBBS, Shifan A. Khanday MBBS**, Abdul Samieh Deva MBBS, Taha Mustafa MS***, Irfan Jehangir MBBS Working as a clinician in a conflict zone confronts them with unremitting demands on their time and skills, which in light of excessive workload, inadequate staff support and unstisfactory returns results in a lot of frustration and compromised pateint care. A survey was conducted on 185 clinicians to assess the burn out level amongst them. Maslach Burnout Inventory (MBI) with subscales of Emotional Exhaustion (EE), Depersonalization (DP) and Personal Accomplishment (PA) were used to assess the burnout levels in the subjects. The clincians selected were from primary care centres (37.29%) and secondary/teritiary care centres (62.71%). Most of the respondents (49.20%) were in the age groupof 26-35 years. Males (83.25%) outnumbered females (16.75%), and most of the respondents (62.7%) had less than 9 years of experience. Using MBI scale it was found that 56.22% had a low score on EE and 66.48% had low scores on DP sub scale, whereas 41.08 % had high scores on PA subscale indicating low degree of burnout in the overall sample. This study, however had a major limitation in the fact that the senior and junior residents, who usually bear the brunt of emergency patient care, had only a little representation in the study. (JK-Practitioner 2006;13(Suppl 1):S94-S97. Keywords : Clinicians, burnout, Maslach Burnout Inventory, emotional exhaustion, depersonalization, personal accomplishment. Introduction: Material and methods: We live in an age of constant stress: further under the prevailing circumstances, doctors face unremitting demands on their time, attention and skills. In view of a considerable international evidence that doctors are suffering from high level of stress, the past decade has seen an increased concern over the health of doctors. Besides an excessive work load, in adequate staff strength, poor academic and research work culture, poor salaries, indifferent administration, bureaucratic red tapism, unwarranted political interference cum political bossism and thoughtless reservation quotas are some of the several disincentives that discourage a talented competent medical professionals in the government sector. It is already documented in literature that psychological stress or trauma can cause structural damage in organ systems resulting in serious disability or even death. The inherent nature of medical practice in which doctors are expected to function competently, work hard and relieve suffering and distress, imposes a heavy strain on them . Those involved in direct patient care especially interns and registrars have the added stress of sleep deprivation , uncertainity about their own role performances , social isolation and increased responsibility . They share with their parents the insecurity of not being fully qualified . The high rates of depression, suicide , drug and alcohol abuse and psychiatric illness , marital disharmony and high divorce rates , bear testimony to the stressful nature of their occupation. Life and death are the daily issues faced by the staff of intensive care units, post operative wards, trauma management units, and emergency and observation wards. For a patient and his/her family, a stay in the ICU is a stressful experience of the greatest magnitude, warranting constant honest explanation, information and reassurance. These demands combined with administrative and bureaucratic frustrations frequently lead to medical staff burnout . There is a dearth of reports on the reactions or behavior of medical staff in mass emergency situations . It is apparent that disaster situations completely disrupt their usual routine, increase responsibility and excessive demands made on them. Despite a façade of detachment in an emotionally charged and extremely demanding situation, it should not be assumed that doctors are immune to the emotional impact of the disaster . This facade may hide the coping mechanism which typically include denial and detachment. Feelings of fear and vulnerability may remain unaddressed in a medical culture that does not seem to permit their expression . This detachment may not only be from the patient but from other staff, and more importantly the doctors themselves . In our study in a situation of mass trauma of more than 15 years duration we tried to assess daily stresses, doctors as medical caregivers are confronted with and their effect on their daily routine activities. We tried to asses if they observed a change in their personality and evaluate whether they themselves experienced any traumatic evenst. The present study was undertaken on doctors working in different primary, secondary and tertiary care health institutions at different positions with varying period of experience. Three different questionnaires were used to assess 3 4 5 6 7 4 8,6 9 10 11 12 12 13 14 JK-Practitioner2006;13(Suppl1) S94 traumatic stress