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The psychology of medical training added to pre-existing altruistic characteristics of individuals can cause difficulty in being aware how stressed the physician actually is. Pushing oneself beyond usual human abilities is the cultural norm in pre-med, medical school, and residency. This cultural training makes individuals less likely to realize the unreasonable level of expectation that incrementally has accumulated. Drummond has outlined a number of characteristics 4 Strategic business drivers 4.1 Overview Some may ask whether there is a need for a business case to reduce Burnout. Isn’t there a moral responsibility to reduce physician burnout? The business of healthcare has evolved substantially with more individuals as investors external to the field of medicine. Even the most ethical employers and decision makers will be helped by making the business case for reducing burnout and improving healthy work environments for providers.[42] Effects of stress and burnout have significant impact on the business of healthcare. Major impact from physician burnout includes include lower job sat of physicians that predispose them to burnout with the clandestine psychology of medical training: Be a workaholic, superhero, emotion-free, Lone Ranger, perfectionist, show self-effacement (how you feel does not matter, the patient is always first), and do not ask for help.[39] 3.4 Mechanisms of impact at individual, institution, and patient interface When work demands exceed a maximal level, human functioning capability is negatively affected.[40] Plotting performance versus stress arousal, there is a range from "comfort zone" and ability to "stretch" to take on more duties. After the "hump" in an average reasonable individual, there is a degeneration of the ability to cognitively function, less compassion, irritability, less ability to listen the patients, and medical, physiologic stress-related illnesses occur as does disability and death (see Figure 2). Chronic distress and hyper-stress situations have been highly correlated to lack of control of one’s life.[41] isfaction, desire to work fewer hours, and desire to retire early or to leave the practice for another career. Addressing the impact of stress and/or burnout on providers is a business imperative that warrants attention.[43] 4.2 Financial issues Excessive workplace stress has direct effect on healthcare workers health,[44–49] has financial impact on the institution in which they work[50, 51] and the cognitive performance of the provider or staff, especially if adverse conditions persist and no clear end-point to the stressful circumstances exist. Occupational stress accumulation leads to diminished occupational performance.[51–55] Conversely, positive organiza tional environments, supportive to those doing the work at hand, lead to increase performance and financial improvements.[56, 57] High burnout is associated with a higher personal healthcare expenditure compared with low burnout physicians, per member. Stakeholders should therefore address burnout to reduce expenditure and promote health.[47] Patients of physicians with high-exhaustion and high depersonalization had significantly lower satisfaction scores, compared with patients of physicians with low-exhaustion and low-depersonalization, respectively.[58] The leading cause of short-term and long-term disability in 2005 was mental health issues, including stress.[59] Burnout is associated with increased rates of medical errors, malpractice risk, physician and staff turnover, and increased start up and ramp up costs.[48] Physicians who suffer from stress and burnout can present patient safety risks such as difficulty making decisions, communicating effectively with others, irritability and conflict which can translate into costly medical errors.
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