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The recent articles and commentary on surgical stress/anxiety and burnout are to be welcomed.1–3 As a senior surgeon who has been through many stressful situations without support it is especially welcome. At the time of my training and practice in the 1990s stress was considered part and parcel of being a surgeon. There are now many research articles discussing surgical stress and its effects. There is also scope to share personal experiences, the intensity of which cannot be underestimated. The descriptions may have potential benefit for both trainee and qualified surgeons. This letter is an attempt to start a more personalised discussion, based on the academic foundation that has been now established around burnout and its causes and treatment.

A surgical mentor once told me that complications would occur, but part of being a great surgeon was not letting that get to you. The lesson back then in the late 1990s was really that part of surgical training was to develop a thick skin and hide any sensitivity. Among trainees at that time, we knew surgery was looking for strong minded individuals who were decision makers. To say that that worked well would be to endorse the non-caring aspect, but to a degree it did. This era was about surviving stressful situations without the current understanding of how to handle stress. Hiding sensitivity became almost an art in itself, as represented by one colleague who had left an abdominal pack inside a patient. When asked whether it gave him sleepless nights he replied to me. “No that’s what you have medical defence insurance for”. That deflective approach has been endorsed in surgery unofficially until recently. We now know that for many, stress was internalised not deflected, causing not only personality change but potentially suicidal behaviour.4 There are, we now know, many factors related to the 50% burnout rate among trainees, and one of the positive developments has been identifying issues and discussing them.5 The value of discussion, particularly interactive, cannot be underestimated. More can be done, and I base this partly on my own experience, some of which is detailed below as an example, as well as recent evidence.

Having survived a terrorist attack, which threatened my future in surgery, I applied the ‘surgical principle’ related to stress; to not to internalise it and get on with life and surgery. I only realised that such an approach was totally inadequate when others remarked on apparent personality changes, anger reactions to minor provocation, the disappearance of happiness in family interactions and corruption of otherwise accurate decision-making, all now commonly recognised as manifestations of stress.5,6 At that time PTSD was not adequately explained, nor how to deal with it. Salvation in terms of the overwhelming stressful reaction was therefore serendipitous; I started writing about had happened.

One major stressor in surgery is litigation. For a young surgeon without the old reflective hide, it can be as devastating as personal trauma. Early in my surgical career I was sued over an inguinal wound infection. The exchange of lawyer’s letters suggesting I was incompetent permeated my subconscious, despite being told by my counsel that this was all part of a legal game to achieve a settlement. The nightmare finally went away. Independent expert international opinion attributed the infection to mismanagement by the microbiologist consulted. My lawyer then advised a $60,000 settlement to make the case go away. Noting my indignation, she said “up to you if you want to appear in the local newspaper and suffer the consequences to your practice then we will fight it”. I clearly didn’t fancy that despite the indignation and we settled. To survive rabid legal character assassination which such litigation would involve, I believe surgical trainees need to be given real-life scenarios; directed by colleagues and antagonistic lawyers, (although I can’t imagine any doing it pro bono, which may limit the interaction). This could be further developed with a closed password access online forum for surgeons to be able to support colleagues through their own experiences, particularly in litigation.7 Surgeons who have been through similar personal trauma, and who are at ease talking about it, could volunteer to be online mentors, notified by email when a colleague registers on the online forum. This could also extend to other specialties. One of the things that I found most helpful later in my surgical career was being able to talk to colleagues about situations that arose in surgery, and have their advice on not only how they dealt with complications, but any potential litigation.

In summary, the greater understanding that surgery is now showing around factors causing stress and burnout could be further expanded through personal support and intervention, potentially diminishing burnout even further. In addition, the availability/oversight of professional colleagues trained in dealing with stress and anxiety, monitoring and providing feedback, and where necessary advising on treatment would be desirable. To have an online forum available immediately when the trauma happens may potentially lessen the impact on trainees and young surgeons while providing another avenue for research about burnout.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Paul Anderson, Department of Nursing, Te Whare O Wananga Awanuiarangi, Whakatane.

Acknowledgements

Correspondence

Dr Paul Anderson, Department of Nursing, Te Whare O Wananga Awanuiarangi, 13 Omain Road, Whakatane 3120.\u00a0

Correspondence Email

pganderson9@gmail.com

Competing Interests

Nil.

  1. Imran A, Calopedos R, Habashy D, Rashid P. Acknowledging and addressing surgeon burnout. ANZ Journal of Surgery. 2018; 88:1100.
  2. McCray LW, Cronholm PF, Bogner HR, Gallo JJ, Neill RA. Resident physician burnout: is there hope? Family medicine. 2008; 40(9):626–632.
  3. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Annals of internal medicine. 2002 Mar 5; 136(5):358–367.
  4. Dimou F, Eckelbarger D, Ruial TS. Surgeon burnout: a systematic review. J Am Coll Surg. 2016; 222:1230–9.
  5. Barrack RL, Miller LS, Sotile WM, Sotile MO, Rubash HE. Effect of duty hour standards on burnout among orthopaedic surgery residents. Clinical orthopaedics and related research. 2006; 449:134–137.
  6. Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL. The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Annals of surgery. 2006; 243(6):864–871.
  7. Chung RS, Ahmed N. How surgical residents spend their training time: the effect of a goal-oriented work style on efficiency and work satisfaction. Archives of Surgery. 2007; 142(3):249–252.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

The recent articles and commentary on surgical stress/anxiety and burnout are to be welcomed.1–3 As a senior surgeon who has been through many stressful situations without support it is especially welcome. At the time of my training and practice in the 1990s stress was considered part and parcel of being a surgeon. There are now many research articles discussing surgical stress and its effects. There is also scope to share personal experiences, the intensity of which cannot be underestimated. The descriptions may have potential benefit for both trainee and qualified surgeons. This letter is an attempt to start a more personalised discussion, based on the academic foundation that has been now established around burnout and its causes and treatment.

A surgical mentor once told me that complications would occur, but part of being a great surgeon was not letting that get to you. The lesson back then in the late 1990s was really that part of surgical training was to develop a thick skin and hide any sensitivity. Among trainees at that time, we knew surgery was looking for strong minded individuals who were decision makers. To say that that worked well would be to endorse the non-caring aspect, but to a degree it did. This era was about surviving stressful situations without the current understanding of how to handle stress. Hiding sensitivity became almost an art in itself, as represented by one colleague who had left an abdominal pack inside a patient. When asked whether it gave him sleepless nights he replied to me. “No that’s what you have medical defence insurance for”. That deflective approach has been endorsed in surgery unofficially until recently. We now know that for many, stress was internalised not deflected, causing not only personality change but potentially suicidal behaviour.4 There are, we now know, many factors related to the 50% burnout rate among trainees, and one of the positive developments has been identifying issues and discussing them.5 The value of discussion, particularly interactive, cannot be underestimated. More can be done, and I base this partly on my own experience, some of which is detailed below as an example, as well as recent evidence.

Having survived a terrorist attack, which threatened my future in surgery, I applied the ‘surgical principle’ related to stress; to not to internalise it and get on with life and surgery. I only realised that such an approach was totally inadequate when others remarked on apparent personality changes, anger reactions to minor provocation, the disappearance of happiness in family interactions and corruption of otherwise accurate decision-making, all now commonly recognised as manifestations of stress.5,6 At that time PTSD was not adequately explained, nor how to deal with it. Salvation in terms of the overwhelming stressful reaction was therefore serendipitous; I started writing about had happened.

One major stressor in surgery is litigation. For a young surgeon without the old reflective hide, it can be as devastating as personal trauma. Early in my surgical career I was sued over an inguinal wound infection. The exchange of lawyer’s letters suggesting I was incompetent permeated my subconscious, despite being told by my counsel that this was all part of a legal game to achieve a settlement. The nightmare finally went away. Independent expert international opinion attributed the infection to mismanagement by the microbiologist consulted. My lawyer then advised a $60,000 settlement to make the case go away. Noting my indignation, she said “up to you if you want to appear in the local newspaper and suffer the consequences to your practice then we will fight it”. I clearly didn’t fancy that despite the indignation and we settled. To survive rabid legal character assassination which such litigation would involve, I believe surgical trainees need to be given real-life scenarios; directed by colleagues and antagonistic lawyers, (although I can’t imagine any doing it pro bono, which may limit the interaction). This could be further developed with a closed password access online forum for surgeons to be able to support colleagues through their own experiences, particularly in litigation.7 Surgeons who have been through similar personal trauma, and who are at ease talking about it, could volunteer to be online mentors, notified by email when a colleague registers on the online forum. This could also extend to other specialties. One of the things that I found most helpful later in my surgical career was being able to talk to colleagues about situations that arose in surgery, and have their advice on not only how they dealt with complications, but any potential litigation.

In summary, the greater understanding that surgery is now showing around factors causing stress and burnout could be further expanded through personal support and intervention, potentially diminishing burnout even further. In addition, the availability/oversight of professional colleagues trained in dealing with stress and anxiety, monitoring and providing feedback, and where necessary advising on treatment would be desirable. To have an online forum available immediately when the trauma happens may potentially lessen the impact on trainees and young surgeons while providing another avenue for research about burnout.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Paul Anderson, Department of Nursing, Te Whare O Wananga Awanuiarangi, Whakatane.

Acknowledgements

Correspondence

Dr Paul Anderson, Department of Nursing, Te Whare O Wananga Awanuiarangi, 13 Omain Road, Whakatane 3120.\u00a0

Correspondence Email

pganderson9@gmail.com

Competing Interests

Nil.

  1. Imran A, Calopedos R, Habashy D, Rashid P. Acknowledging and addressing surgeon burnout. ANZ Journal of Surgery. 2018; 88:1100.
  2. McCray LW, Cronholm PF, Bogner HR, Gallo JJ, Neill RA. Resident physician burnout: is there hope? Family medicine. 2008; 40(9):626–632.
  3. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Annals of internal medicine. 2002 Mar 5; 136(5):358–367.
  4. Dimou F, Eckelbarger D, Ruial TS. Surgeon burnout: a systematic review. J Am Coll Surg. 2016; 222:1230–9.
  5. Barrack RL, Miller LS, Sotile WM, Sotile MO, Rubash HE. Effect of duty hour standards on burnout among orthopaedic surgery residents. Clinical orthopaedics and related research. 2006; 449:134–137.
  6. Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL. The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Annals of surgery. 2006; 243(6):864–871.
  7. Chung RS, Ahmed N. How surgical residents spend their training time: the effect of a goal-oriented work style on efficiency and work satisfaction. Archives of Surgery. 2007; 142(3):249–252.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

The recent articles and commentary on surgical stress/anxiety and burnout are to be welcomed.1–3 As a senior surgeon who has been through many stressful situations without support it is especially welcome. At the time of my training and practice in the 1990s stress was considered part and parcel of being a surgeon. There are now many research articles discussing surgical stress and its effects. There is also scope to share personal experiences, the intensity of which cannot be underestimated. The descriptions may have potential benefit for both trainee and qualified surgeons. This letter is an attempt to start a more personalised discussion, based on the academic foundation that has been now established around burnout and its causes and treatment.

A surgical mentor once told me that complications would occur, but part of being a great surgeon was not letting that get to you. The lesson back then in the late 1990s was really that part of surgical training was to develop a thick skin and hide any sensitivity. Among trainees at that time, we knew surgery was looking for strong minded individuals who were decision makers. To say that that worked well would be to endorse the non-caring aspect, but to a degree it did. This era was about surviving stressful situations without the current understanding of how to handle stress. Hiding sensitivity became almost an art in itself, as represented by one colleague who had left an abdominal pack inside a patient. When asked whether it gave him sleepless nights he replied to me. “No that’s what you have medical defence insurance for”. That deflective approach has been endorsed in surgery unofficially until recently. We now know that for many, stress was internalised not deflected, causing not only personality change but potentially suicidal behaviour.4 There are, we now know, many factors related to the 50% burnout rate among trainees, and one of the positive developments has been identifying issues and discussing them.5 The value of discussion, particularly interactive, cannot be underestimated. More can be done, and I base this partly on my own experience, some of which is detailed below as an example, as well as recent evidence.

Having survived a terrorist attack, which threatened my future in surgery, I applied the ‘surgical principle’ related to stress; to not to internalise it and get on with life and surgery. I only realised that such an approach was totally inadequate when others remarked on apparent personality changes, anger reactions to minor provocation, the disappearance of happiness in family interactions and corruption of otherwise accurate decision-making, all now commonly recognised as manifestations of stress.5,6 At that time PTSD was not adequately explained, nor how to deal with it. Salvation in terms of the overwhelming stressful reaction was therefore serendipitous; I started writing about had happened.

One major stressor in surgery is litigation. For a young surgeon without the old reflective hide, it can be as devastating as personal trauma. Early in my surgical career I was sued over an inguinal wound infection. The exchange of lawyer’s letters suggesting I was incompetent permeated my subconscious, despite being told by my counsel that this was all part of a legal game to achieve a settlement. The nightmare finally went away. Independent expert international opinion attributed the infection to mismanagement by the microbiologist consulted. My lawyer then advised a $60,000 settlement to make the case go away. Noting my indignation, she said “up to you if you want to appear in the local newspaper and suffer the consequences to your practice then we will fight it”. I clearly didn’t fancy that despite the indignation and we settled. To survive rabid legal character assassination which such litigation would involve, I believe surgical trainees need to be given real-life scenarios; directed by colleagues and antagonistic lawyers, (although I can’t imagine any doing it pro bono, which may limit the interaction). This could be further developed with a closed password access online forum for surgeons to be able to support colleagues through their own experiences, particularly in litigation.7 Surgeons who have been through similar personal trauma, and who are at ease talking about it, could volunteer to be online mentors, notified by email when a colleague registers on the online forum. This could also extend to other specialties. One of the things that I found most helpful later in my surgical career was being able to talk to colleagues about situations that arose in surgery, and have their advice on not only how they dealt with complications, but any potential litigation.

In summary, the greater understanding that surgery is now showing around factors causing stress and burnout could be further expanded through personal support and intervention, potentially diminishing burnout even further. In addition, the availability/oversight of professional colleagues trained in dealing with stress and anxiety, monitoring and providing feedback, and where necessary advising on treatment would be desirable. To have an online forum available immediately when the trauma happens may potentially lessen the impact on trainees and young surgeons while providing another avenue for research about burnout.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Paul Anderson, Department of Nursing, Te Whare O Wananga Awanuiarangi, Whakatane.

Acknowledgements

Correspondence

Dr Paul Anderson, Department of Nursing, Te Whare O Wananga Awanuiarangi, 13 Omain Road, Whakatane 3120.\u00a0

Correspondence Email

pganderson9@gmail.com

Competing Interests

Nil.

  1. Imran A, Calopedos R, Habashy D, Rashid P. Acknowledging and addressing surgeon burnout. ANZ Journal of Surgery. 2018; 88:1100.
  2. McCray LW, Cronholm PF, Bogner HR, Gallo JJ, Neill RA. Resident physician burnout: is there hope? Family medicine. 2008; 40(9):626–632.
  3. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Annals of internal medicine. 2002 Mar 5; 136(5):358–367.
  4. Dimou F, Eckelbarger D, Ruial TS. Surgeon burnout: a systematic review. J Am Coll Surg. 2016; 222:1230–9.
  5. Barrack RL, Miller LS, Sotile WM, Sotile MO, Rubash HE. Effect of duty hour standards on burnout among orthopaedic surgery residents. Clinical orthopaedics and related research. 2006; 449:134–137.
  6. Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL. The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Annals of surgery. 2006; 243(6):864–871.
  7. Chung RS, Ahmed N. How surgical residents spend their training time: the effect of a goal-oriented work style on efficiency and work satisfaction. Archives of Surgery. 2007; 142(3):249–252.

Contact diana@nzma.org.nz
for the PDF of this article

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