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As a result, they are a high-risk group to reject normal checks and balances of self-care and continue to overwork especially when demands come from authoritative sources. The aim of this paper is to provide an overview of the current state of knowledge, merging various fields in order to identify areas that require action together with proposing possible solutions. 2 Work stress and expected duties - relevant proof 2.1 Occupational stress The National Institute for Occupational Safety and Health defines Occupational Stress as "the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker".[8] The concept of occupational stress is often confused with challenge, but these concepts are not the same. Challenge energizes us psychologically and physically, and it motivates us to learn new skills and master our jobs. Chronic, cumulative and incremental stress needs to be differentiated from acute temporary situations of high stress that are expected parts of the work done by physicians and nurses. Stress has a subjective experience and physiologic component. On a physiologic level, stress is characterized by activation of two major stress axes: The sympathetic nervous system which puts out higher levels of epinephrine and norepinephrine; and the hypothalamic-pituitary-adrenal (HPA) axis. The latter results in elevated levels of glucocorticoids, primarily cortisol. Frequent/constant activation of these axes has been well documented to induce health problems for the individual and will deteriorate the quality of decision ability which can result in worse decisions and sub-optimal solutions. Stress has been documented to be increasing in all full-time employed individuals by 31% from 1983 till 2009 in the U.S. using the Perceived Stress Scale.[9] Sixty-three percent of physicians surveyed in 2012 reported that they were more stressed than three years prior, and 34.3% reported that they were much more stressed than three years prior.[ 2.2 Burnout and its causes Burnout can be defined on several levels • Exhaustion: Physical and Emotional. Downward spiral, even after attempting to rest. • Depersonalization: Dysfunctional coping mechanism. Keeping your patients at a distance to not drain you more: Cynicism, sarcasm, compassion fatigue– nothing left to give. • Lack of efficacy: What is the use? What is the purpose? Work is subpar, feel like not making a difference, work has no purpose.[11] Burnout is the polar opposite of engagement, when defined by vigor, dedication and absorption in your work.[12] Stress and burnout can be related to a number of different factors. Much of this relates to individual core values, attitudes, expectations, and behaviors gained through genetic makeup and life experiences (see Table 1). Deep seated internal perspective attitudes and values related to age and generation, gender, culture and ethnicity, religious and spiritual values, and other early life experiences help shape one’s personality. A second contributing factor are the more adult experiences shaping values and attitudes influenced by medical training, debt obligations, and pressures from the current work and home environment.
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