{"id":782,"date":"2011-11-21T11:50:03","date_gmt":"2011-11-21T01:50:03","guid":{"rendered":"https:\/\/theveterinarian.com.au\/?p=782"},"modified":"2011-11-01T11:53:39","modified_gmt":"2011-11-01T01:53:39","slug":"burnout-an-occupational-hazard-we-cannot-ignore","status":"publish","type":"post","link":"https:\/\/theveterinarian.com.au\/?p=782","title":{"rendered":"Burnout: an occupational hazard we cannot ignore"},"content":{"rendered":"It is well established that veterinarians suffer a higher suicide rate than the general adult population. <\/span><\/span>\r\n\r\nResearch by former Australian Veterinary Association President Helen Jones found that veterinarians were four times more likely to take their lives when compared to non-veterinarians.<\/span><\/span>\r\n\r\nIn absolute numbers, the number of veterinarians who commit suicide is not high, however, compared with the average suicide rate for the general population, it is high. Suicide in our profession is the tip of an iceberg that none of us can afford to ignore. It is likely that far greater numbers of veterinarians suffer from burnout – physical and psychological fatigue brought about by chronic stress and anxiety.<\/span><\/span>\r\n\r\nIn a study of Finnish veterinarians, 40 per cent reported moderate symptoms of burnout and just under 2 per cent reported severe symptoms. In a Belgian study, almost 16 per cent of veterinarians suffered from high burnout. Studies are underway to determine the prevalence of burnout in Australian veterinarians, but there can be little doubt that burnout is a cause of significant morbidity in veterinarians in this country.<\/span><\/span>\r\n\r\nWhat is it about our profession that predisposes us to burnout?<\/span><\/span>\r\n\r\nAccording to Jones, veterinarians become stressed because of the volume and nature of their work.<\/span><\/span>\r\n\r\n\u201cVets do work so hard, especially rural vets,\u201d she said. \u201cSome have real problems coping when the phone constantly rings, especially in one-person practices. People are dependent on veterinarians \u2013 particularly rural veterinarians \u2013 and the vets feel responsible, so I think they take the world\u2019s problems on their shoulders.\u201d<\/span><\/span>\r\n\r\n<\/a>Jones also believes that some veterinary degree admission procedures only favour high achievers – some of whom cannot cope with failure. <\/span><\/span>\r\n\r\n\u201cI think that some of these bright young things simply don\u2019t know how to fail. I think in the past veterinary graduates have had some unrealistic expectations so that when they could not perform perfectly in practice or when something died unexpectedly, they couldn\u2019t cope.\u201d<\/span><\/span>\r\n\r\nCounsellor and veterinarian David Foote, best known for his bereavement counselling service for pet owners, has been working in the field of stress, burnout and suicide in veterinarians for 12 years in addition to offering a bereavement counselling service for pet owners.<\/span><\/span>\r\n\r\n\u201cBurnout is the result of a long period, typically years, of chronic stress so sufferers are usually exhausted physically, emotionally and psychologically. Some people recover, albeit slowly, while others never fully recover and are often forced to make difficult decisions including leaving the profession.\u201d<\/span><\/span>\r\n\r\nSigns of burnout are many and varied but include fatigue, a broad range of medical problems which are initiated or exacerbated by stress, chronic musculoskeletal problems, insomnia, depression, anxiety, cognitive impairment (such as memory loss), hypervigilance, work errors, absenteeism and, in some cases, substance abuse. <\/span><\/span>\r\n\r\n“Having recently attended the funeral of a colleague who took his own life I have been painfully reminded that perhaps the greatest danger in burnout is that it can be potentially part of a continuum that leads to suicide,\u201d Foote said. \u201cTo hear his family struggle to speak as they paid tribute to a much loved father, husband and brother was overwhelmingly sad and gut wrenching.\u201d<\/span><\/span>\r\n\r\n\u201cI see a lot of people with autoimmune disease,\u201d he said. \u201cWhile there is no proven link between burnout and autoimmune disease it is something I\u2019ve observed anecdotally. Many people also feel an inappropriate sense of embarrassment or shame at being somehow \u2019weak\u2019 which, in reality, is far from the truth.\u201d<\/span><\/span>\r\n\r\n\u201cPut simplistically people become burned out because of choices they have made and not made. Typically in our profession these are people who are overworking, heavily invested emotionally in work, and who feel that if they pull back or leave the work situation they have somehow failed.\u201d<\/span><\/span>\r\n\r\n\u201cBurnout has profound effects on the brain so people in burnout often have cognitive distortions which lead to them closing off options and choices especially if they are carrying the sense of shame previously mentioned. A big part of what I do is help clients question these beliefs, open out choices again and understand that taking care of themselves is just as important as taking care of their clients, patients and loved ones. If they aren\u2019t addressed then an individual, once feeling better and more energised again, is likely to repeat the same patterns again.\u201d<\/span><\/span>\r\n\r\nFoote provides a safe, confidential environment to talk about those issues and facilitates the process whereby those suffering burnout can turn their lives around.<\/span><\/span>\r\n\r\n\u201cIt\u2019s about helping them to bring their life back into balance. This includes reducing workload, learning stress management techniques (especially mental and physical calming techniques like mindfulness), prioritising all aspects of self-care including sleep, diet and down time and seeking appropriate medical support. Finding a sense of joy and fun again is also very important.\u201d<\/span><\/span>\r\n\r\nFoote also helps people unpick the deeper issues. <\/span><\/span>\r\n\r\n\u201cThe personal traits, attitudes and behaviours that lead to burnout are formed in our developmental years. We can end up with strong beliefs that, to be worthy or of value, we must strive relentlessly to achieve, be perfect in every way and always put others needs before our own. <\/span><\/span>\r\n\r\nVeterinary education can reinforce these beliefs.<\/span><\/span>\r\n\r\n\u201cWe attract a high number of people who are high achievers and \u2018caretakers\u2019, highly invested in meeting the needs of others through kindness and compassion but not so good at identifying and meeting their own.\u201d Foote said. <\/span><\/span>\r\n\r\n\u201cIn combination with this our profession is set up with some powerful potential stressors including long hours, a high level of responsibility, client expectations and exposure to patient death and client grief. Clients\u2019 high emotional investment in their animals increases our sense of responsibility again.\u201d<\/span><\/span>\r\n\r\nThat makes it challenging at times to distinguish a healthy work ethic, care and professionalism (normal professional functioning) from potentially unhealthy professional functioning.<\/span><\/span>\r\n\r\n\u201cWe have to keep clients happy, we have to foster good relationships and work to the highest standard we can. The catch is when our self esteem becomes too strongly attached to these things or when work takes up too much of our life.\u201d<\/span><\/span>\r\n\r\nAccording to Foote, basic self care and stress management, including how to have boundaries around work, should be taught at an undergraduate level. <\/span><\/span>\r\n\r\n\u201cIt\u2019s about educating people in how to keep balance in a profession that has a lot of demands that can pull them off balance. Fostering the development of life skills and adaptive coping strategies in undergraduates can be a powerful preventative measure.\u201d he said.<\/span><\/span>\r\n\r\nTo this end, Foote regularly lectures undergraduates at the University of Sydney. He is also director of the Intern Mentoring Program for final year students.<\/span><\/span>\r\n\r\n\u201cMentoring plays a very important role in that it creates a culture of giving and receiving support, encouraging people to seek support early and understand that asking for it is not a sign of failure.\u201d<\/span><\/span>\r\n\r\n\u201cIt really is about creating a culture of giving and receiving support, encouraging people to seek support early and understand that asking for it is not a sign of failure.\u201d<\/span><\/span>\r\n\r\nVeterinarian Paul Davey, President of the AVA\u2019s WA division and previous coordinator of the AVA\u2019s Graduate Support Scheme for 11 years, is also a strong believer in the value of mentors.<\/span><\/span>\r\n\r\nHis involvement began with the loss of a fellow veterinarian in 1996.<\/span><\/span>\r\n\r\n\u201cHe was a classmate of my brother, due to start work with me on the Monday,\u201d Davey said. \u201cUnfortunately on the Sunday before he chose to end his life. There are various theories as to what resulted in him making that final decision, we can only assume it was a combination of disappointment in where he found himself and the stresses of career choice.\u201d<\/span><\/span>\r\n\r\nDavey believes mentors can help prevent such tragedies.<\/span><\/span>\r\n\r\n\u201cThey act basically as a sounding board, a trampoline if you like, a protective net that a new graduate can use in that first critical year or so of practice.\u201d<\/span><\/span>\r\n\r\nBut Davey advocates mentors for veterinarians at all career stages.<\/span><\/span>\r\n\r\n\u201cOver the years it has become obvious that it is not just new graduates at risk of stress and burnout, but there seems to be a peak at two years [after graduation], again at around seven years and again at retirement age or thereabouts.\u201d<\/span><\/span>\r\n\r\n\u201cIf you can improve resilience and give people skills to make the right choices about career paths and lifestyles early then you may be able to prevent some of this.\u201d<\/span><\/span>\r\n\r\nAccording to Davey, one of the biggest factors contributing to stress and burnout in veterinarians is euthanasia.<\/span><\/span>\r\n\r\n\u201cIt\u2019s said that we deal with death seventeen times more often than a GP. That obviously has to take its toll. Personally speaking I think it takes a little bit of us each time.\u201d<\/span><\/span>\r\n\r\nAnother common cause of stress is poor clinical outcomes.<\/span><\/span>\r\n\r\nDavey said that poor clinical outcomes are second only to employment issues as a topic discussed between mentees and mentors.<\/span><\/span>\r\n\r\n\u201cI wonder whether it should be compulsory to have a lecture stream at every conference called \u2018when good cases go bad\u2019 \u2013 it is important for veterinarians to understand that even in the best hands things don\u2019t always go according to plan.\u201d<\/span><\/span>\r\n\r\nMentors and colleagues can be a valuable sounding board when things go wrong.<\/span><\/span>\r\n\r\n\u201cI believe fairly strongly about talking about these things and expressing our feelings,\u201d Davey said. \u201cPerhaps not always with workmates. I\u2019ve got a group of close friends I can talk to. Just knowing that someone has experienced similar feelings, particularly things like compassion fatigue, makes a big difference.\u201d<\/span><\/span>\r\n\r\nDavey argues that work\/life balance is key in preventing burnout.<\/span><\/span>\r\n\r\n\u201cBeing a vet makes it challenging to maintain work\/life balance but it isn\u2019t impossible \u2013 it just makes our decisions even more important. Our resolve about things such as keeping our sporting interests or hobbies going is going to be tested.\u201d<\/span><\/span>\r\n\r\nLike dogs and cats with chronic renal failure or mitral valve insufficiency, veterinarians may suffer from subclinical burnout for years before symptoms become unmanageable. But there is always a danger that severe stress will trigger decompensation.<\/span><\/span>\r\n\r\n\u201cA lot of vets are dealing with subclinical mental illness. I think it is important that we get the message out there, get people talking about it, and disseminate information to the rest of the profession.\u201d<\/span><\/span>\r\n\r\nFormer West Australian Turf Club veterinarian Peter Symons survived three brain haemorrhages, two brain surgeries and two cardiac arrests \u2013 but claims that his experience of burnout or depression was worse than all of those experiences put together.<\/span><\/span>\r\n\r\n\u201cIt was particularly demoralising because I could not understand what was wrong with me,\u201d he said. \u201cAfter suffering for six months I saw a doctor and was told I had major depression. Despite never feeling sad or depressed.\u201d<\/span><\/span>\r\n\r\nAnti-depressant medication helped, but was only part of the solution.<\/span><\/span>\r\n\r\nSymons, together with Clyde Jumeaux, developed what is now known as the Brain Fuel Depletion model for explaining the condition currently called depression (and previously called names such as \u2018nervous break-down\u2019 and \u2018melancholia\u2019.).<\/span><\/span>\r\n\r\n\u201cBrain Fuel Depletion has many disguises,\u201d he said. \u201cIt goes by a variety of names including \u2018burn-out\u2019\u201d.<\/span><\/span>\r\n\r\nThe central tenet of this model is that when we are stressed, the brain suffers a depletion of neurotransmitters (or \u2018brain fuels\u2019), and a concurrent increase in adrenaline.<\/span><\/span>\r\n\r\n\u201cThe increased level of adrenaline explains common symptoms such as anxiety, panic attacks, insomnia, and “fight or flight” symptoms like irritability, frustration, remoteness or withdrawal,\u201d he said.<\/span><\/span>\r\n\r\n\u201cThe depletion of neurotransmitters explains the forgetfulness, phobias, sadness – depletion of neurotransmitters in the limbic system – , and some of the physical symptoms such as Irritable Bowel Syndrome – depletion of neurotransmitters in the hypothalamus.\u201d<\/span><\/span>\r\n\r\n\u201cVets, amongst many other professionals, are predisposed to Brain Fuel Depletion because they are big brain fuel users.\u201d<\/span><\/span>\r\n\r\nAs Symons explains, vets are often doers (working to get through many jobs in a busy day), perfectionists ( a trait required to get good marks to enter the course, and to survive the intensive tuition), and carers (the reason why they were drawn to the profession in the first place).<\/span><\/span>\r\n\r\n\u201cPeople with this combination of personality types \u2018chew through\u2019 a lot of neurotransmitters; especially if they work very long hours or do after-hours work.\u201d<\/span><\/span>\r\n\r\nSymons believes that medication is very important in allowing the brain to replenish its levels of neurotransmitters\/brain fuels, but emphasises that medication should never be taken to support an unsustainable lifestyle. <\/span><\/span>\r\n\r\n\u201cYou take medication to feel better, and then do a complete assessment of the lifestyle that got you in this position, then change the lifestyle and\/or modify your personality to ensure that you are no longer predisposed to it.”<\/span><\/span>\r\n\r\nSymons\u2019 journey, and the Brain Fuel Depletion model, are outlined in his forthcoming book \u2013 co-authored with Jumeaux \u2013 <\/span><\/span>Brain Fuel Depletion: At Last Making Sense of Anxiety and Depression<\/em><\/span><\/span>, to be published electronically next month.<\/span><\/span>\r\n\r\nIn it he argues that the key to brain fuel repletion is simplifying one\u2019s lifestyle. Now Director of the Positive Workforce Foundation, Symons said he is much tougher about protecting himself.<\/span><\/span>\r\n\r\n\u201cI used to do eight things, now I do three,\u201d he said. \u201cI can still be effective. If you do too much and work 80 hours a week you end up feeling bad and you\u2019re no good to anyone.\u201d<\/span><\/span>\r\n\r\n\u201cI used to think anything was possible, now I realise there are some things I just have to let go. I\u2019m much more ruthless because I am not prepared to pay the price. Outside work I don\u2019t take on as much, if I am busy I tell people I can\u2019t fit something in.\u201d<\/span><\/span>\r\n\r\nSymons adds that burnout is not a syndrome exclusive to veterinarians. He recalls a recent speaking engagement with a group of young lawyers.<\/span><\/span>\r\n\r\n\u201c[My talk] seemed to strike a chord with a room full of motivated lawyers \u2013 quite a number of whom told me they were going back to the office after the event. Everybody knows they need to protect themselves, but long-term ingrained habits and personal characteristics are hard to change, because \u2013 after all \u2013 they are the attributes that have got you to where you are.\u201d<\/span><\/span>\r\n\r\nSymons’ advice is to identify and change the habits that may lead to burnout \u2013 before they irrevocably change us.<\/span><\/span>\r\n\r\nResources<\/strong>\r\n\r\nLifeline 24 Hour Crisis Line 13 11 14 or online chat <\/span><\/span>www.lifeline.org.au<\/span><\/span><\/a><\/span><\/span> <\/span><\/span>\r\n\r\nAustralian Veterinary Association telephone counselling service 1800 337 068<\/span><\/span>\r\n\r\nInformation on the VetHealth Initiative can be found at <\/span><\/span>www.ava.com.au\/veterinarians<\/span><\/span><\/a><\/span><\/span>\r\n\r\nThe British Veterinary Association provides information on health and welfare of veterinarians at <\/span><\/span>www.vetlife.org.uk<\/span><\/span><\/a><\/span><\/span> <\/span><\/span>\r\n\r\nInformation on the AVA WA Division Graduate Support Scheme can be found by contacting the WA Division Office at <\/span><\/span>avawa@ava.com.au<\/span><\/span><\/a><\/span><\/span>\r\n\r\nDavid Foote, counsellor and veterinarian, can be contacted via <\/span><\/span>www.davidfoote.com<\/span><\/span><\/a><\/span><\/span> He provides individual consultations as well as educational seminars and workshops.<\/span><\/span>\r\n\r\nFor more information about the Brain Fuel Depletion model, visit <\/span><\/span>www.brainfueldepletion.org<\/span><\/span><\/a><\/span><\/span>\r\n\r\nReferences<\/strong><\/span><\/span>\r\n\r\nHansez I, Schins F and Rollin F (2008) Occupational stress, work-home interference and burnout among Belgian veterinary practitioners. <\/span><\/span>Irish Veterinary Journal<\/em><\/span><\/span> 61(4):233-241.<\/span><\/span>\r\n\r\nReijula K, Rasanen K, Hamalainen M, Juntunen K, Lindbohm M, Taskinen H, Bergbom B and Rinta-Jouppi (2003) Work environment and occupational health of Finnish veterinarians. <\/span><\/span>American Journal of Industrial Medicine<\/em><\/span><\/span> 44:46-57.<\/span><\/span>\r\n\r\nANNE FAWCETT<\/strong><\/span><\/span>","protected":false},"excerpt":{"rendered":"

It is well established that veterinarians suffer a higher suicide rate than the general adult population. Research by former Australian Veterinary Association President Helen Jones found that veterinarians were four times more likely to take their lives when compared to non-veterinarians. In absolute numbers, the number of veterinarians who commit suicide is not high, however, […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[67],"tags":[196,30,473,464,472,465,469,460,461,462,467,474,419,418,470,471,466,330,463,468],"class_list":["post-782","post","type-post","status-publish","format-standard","hentry","category-features","tag-196","tag-anne-fawcett","tag-brain-fuel-depletion-model","tag-burnout","tag-clyde-jumeaux","tag-coping","tag-david-foote","tag-depression","tag-feature","tag-helen-jones","tag-help","tag-neurotransmitters","tag-october","tag-october-2011","tag-paul-davey","tag-peter-symons","tag-strategies","tag-stress","tag-suicide","tag-workplace"],"rise-blocks_total_comments":0,"rise-blocks_categories":[{"term_id":67,"name":"Features","slug":"features","term_group":0,"term_taxonomy_id":68,"taxonomy":"category","description":"","parent":0,"count":63,"filter":"raw","cat_ID":67,"category_count":63,"category_description":"","cat_name":"Features","category_nicename":"features","category_parent":0}],"rise-blocks_excerpt":"It is well established that veterinarians suffer a higher suicide rate than the general adult population. Research by former Australian Veterinary Association President Helen Jones found that veterinarians were four times more likely to take their lives when compared to non-veterinarians. In absolute numbers, the number of veterinarians who commit suicide is not high, however, compared with the average suicide..","blog_post_layout_featured_media_urls":{"thumbnail":"","full":""},"categories_names":{"67":{"name":"Features","link":"https:\/\/theveterinarian.com.au\/?cat=67"}},"tags_names":{"196":{"name":"2011","link":"https:\/\/theveterinarian.com.au\/?tag=2011"},"30":{"name":"Anne Fawcett","link":"https:\/\/theveterinarian.com.au\/?tag=anne-fawcett"},"473":{"name":"Brain Fuel Depletion model","link":"https:\/\/theveterinarian.com.au\/?tag=brain-fuel-depletion-model"},"464":{"name":"burnout","link":"https:\/\/theveterinarian.com.au\/?tag=burnout"},"472":{"name":"Clyde Jumeaux","link":"https:\/\/theveterinarian.com.au\/?tag=clyde-jumeaux"},"465":{"name":"coping","link":"https:\/\/theveterinarian.com.au\/?tag=coping"},"469":{"name":"David Foote","link":"https:\/\/theveterinarian.com.au\/?tag=david-foote"},"460":{"name":"depression","link":"https:\/\/theveterinarian.com.au\/?tag=depression"},"461":{"name":"feature","link":"https:\/\/theveterinarian.com.au\/?tag=feature"},"462":{"name":"Helen Jones","link":"https:\/\/theveterinarian.com.au\/?tag=helen-jones"},"467":{"name":"help","link":"https:\/\/theveterinarian.com.au\/?tag=help"},"474":{"name":"neurotransmitters","link":"https:\/\/theveterinarian.com.au\/?tag=neurotransmitters"},"419":{"name":"October","link":"https:\/\/theveterinarian.com.au\/?tag=october"},"418":{"name":"October 2011","link":"https:\/\/theveterinarian.com.au\/?tag=october-2011"},"470":{"name":"Paul Davey","link":"https:\/\/theveterinarian.com.au\/?tag=paul-davey"},"471":{"name":"Peter Symons","link":"https:\/\/theveterinarian.com.au\/?tag=peter-symons"},"466":{"name":"strategies","link":"https:\/\/theveterinarian.com.au\/?tag=strategies"},"330":{"name":"stress","link":"https:\/\/theveterinarian.com.au\/?tag=stress"},"463":{"name":"suicide","link":"https:\/\/theveterinarian.com.au\/?tag=suicide"},"468":{"name":"workplace","link":"https:\/\/theveterinarian.com.au\/?tag=workplace"}},"comments_number":"0","wpmagazine_modules_lite_featured_media_urls":{"thumbnail":"","cvmm-medium":"","cvmm-medium-plus":"","cvmm-portrait":"","cvmm-medium-square":"","cvmm-large":"","cvmm-small":"","full":""},"_links":{"self":[{"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=\/wp\/v2\/posts\/782","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=782"}],"version-history":[{"count":2,"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=\/wp\/v2\/posts\/782\/revisions"}],"predecessor-version":[{"id":1033,"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=\/wp\/v2\/posts\/782\/revisions\/1033"}],"wp:attachment":[{"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=782"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=782"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/theveterinarian.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=782"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}