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Impact of Burnout on Empathy Molly Reynolds, Andrew Mccombie, Mark Jeffery, Roger Mulder, Frank Frizelle

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Impact of Burnout on Empathy Molly Reynolds, Andrew Mccombie, Mark Jeffery, Roger Mulder, Frank Frizelle ARTICLE Impact of burnout on empathy Molly Reynolds, Andrew McCombie, Mark Jeffery, Roger Mulder, Frank Frizelle ABSTRACT AIM: Burnout has a damaging effect on both the wellbeing of medical professionals and patients alike. Empathy is an important part of the therapeutic relationship and could be damaged by burnout. We aimed to describe the prevalence of burnout, assess levels of empathy and explore the relationship between burnout and empathy among senior medical officers (SMOs). We hypothesised that there would be a negative correlation between empathy and burnout. METHOD: This was a cross-sectional observational study involving SMOs from a variety of specialities. The focus is on SMOs with relatively prolonged contact times with patients. Email invitations were sent out requesting participation in an electronic survey on the QuestionPro platform. The survey comprised 42 questions enquiring about demographics, empathy (Jefferson Scale of Physician Empathy) and burnout (Copenhagen Burnout Inventory). Correlational analyses were performed. RESULTS: Three hundred and fourteen invitations were sent out and 178 responses were received (56.7% response rate). Forty-five percent of SMOs surveyed were experiencing high levels of personal burnout. There was a statistically significant negative correlation between empathy and patient- related burnout (p=0.018). CONCLUSIONS: The results show high levels of personal burnout among SMOs and suggest that empathy reduces as patient-related burnout increases. The nature of this relationship is a complex one, and other contributing variables should be considered. urnout—a syndrome that is character- factor in most definitions of empathy is that it ised by emotional exhaustion, deper- bridges the gap that exists between the self’s Bsonalisation and low sense of personal experiences and the experiences of others.4–6 accomplishment—has been associated with Empathy has been described as a way of a higher frequency of medical errors, lapses grasping another’s emotions, and thereby it in professionalism, impeded learning, prob- facilitates trust and disclosure in the patient– lematic alcohol use and suicidal ideation. doctor relationship. Many doctors agree that Burnout is important because it can damage empathy makes the practice of medicine doctors and impair patient care. Burnout more satisfying and meaningful.6 is defined as “a state of physical, emotional Our study had a particular focus on one and mental exhaustion that results from aspect of burnout: that is, its association long-term involvement in work situations with empathy. Qualitative and quantitative 1 that are emotionally demanding.” Many research around the factors that contribute variables contribute to the development of to burnout has been completed both inter- burnout, such as long hours of work, work- nationally and in New Zealand.2,7,8 The home conflicts, resourcing, managerialism objective of this study was to explore the 2,3 and interpersonal relationships. rates of, and relationship between, burnout Empathy helps with becoming a good and empathy among senior medical officers doctor. It is an extensively discussed concept (SMOs). We hypothesised that there would that plays a role in the therapeutic rela- be a negative correlation between empathy tionship, as does burnout. The common and burnout. NZMJ 19 February 2021, Vol 134 No 1530 ISSN 1175-8716 © NZMA 12 www.nzma.org.nz/journal ARTICLE Methods Variables Study design Empathy The Jefferson Scale of Physician Empathy The study population of this observational is a 20-question validated questionnaire cross-sectional study was SMOs employed created by Hojat et al at the Jefferson by the Canterbury District Health Board Medical College, Philadelphia, in 2001.9 (CDHB) who come from a variety of special- Each question is scored on a 7-item Likert- ities and have regular face-to-face contact scale, with the total sum relating to each with patients. The participants were invited participant’s level of empathy. A high level to complete an anonymous electronic survey of empathy was defined as any total score using the QuestionPro platform (Ques- greater than 1.5 standard deviations (SDs) tionPro Inc. Beaverton, OR US). The survey above the mean. This is in accordance was comprised of 42 questions enquiring with the scoring algorithm provided by the about demographics, empathy (Jefferson authors of the scale.10 Scale of Physician Empathy) and burnout (Copenhagen Burnout Inventory). Burnout Category A ethics approval was granted The survey employed the Copenhagen from the University of Otago Human Burnout Inventory (CBI), a 19-question vali- Ethics Committee (F17/017). The Ngāi Tahu dated questionnaire created in Denmark Research Committee was consulted prior to by researchers Borritz and Kristensen. the commencement of the study to ensure This questionnaire enquires about burnout acknowledgment of the needs of Ngāi in three domains: personal burnout, Tahu for Māori development. CDHB Local work-related burnout and patient-re- Authority was also granted. lated burnout.11 Each question is scored Setting on a 5-item Likert scale. A high degree of overall burnout is a score of 50 or more in The study was performed at the University each of the categories.12 In December 2017, of Otago (Christchurch campus), and CDHB Chambers et al used the CBI to quantify Local Authority was used to contact CDHB levels of burnout among New Zealand employees via their email addresses. Partici- SMOs.2 pants were recruited via email invitation and asked to complete the online survey between Data sources/measurement 15 December 2017 and 29 August 2018. The survey was established and dissem- Participants inated using QuestionPro®, an online survey platform. We collated demographic SMOs from the CDHB were invited via data, including age, gender, speciality mailing lists. Specialities were selected on and ethnicity, as well as the time since the basis of having adequate contact time the participant’s last period of annual with patients. Speciality groups included leave that was greater than one-week in those from anaesthesia, medicine, surgery duration. Scoring of each of the empathy and psychiatry. The surgery group included and burnout scales was performed in those who responded from general surgery, accordance with scoring guidelines for obstetrics and gynaecology, vascular, each of the questionnaires.10,12 The initial plastics and orthopaedics. The medicine invitation was sent on 15 December 2017 group combined those who responded from and follow-up invitations (sent to all people general medicine, respiratory, cardiology, who did not respond to the initial invi- oncology and palliative care. As mentioned, tation) were sent on 23 April 2018 and 2 we selected specialties that had a relatively August 2018. prolonged contact time with patients, and specialties that included more substantial Study size numbers of SMOs. The excluded specialties A sample size of approximately 180 partic- were dermatology, emergency medicine, ipants would provide >80% power to show endocrinology, infectious diseases, intensive an R2 of >0.05 for the association between care, neonatal medicine, neurology/neuro- empathy and burnout as statistically signif- surgery, ophthalmology, radiology and icant (2 tailed, α=0.05). pathology. NZMJ 19 February 2021, Vol 134 No 1530 ISSN 1175-8716 © NZMA 13 www.nzma.org.nz/journal ARTICLE Statistical methods SPSS version 23 was used for statistical Table 1: Participant characteristics. analyses.13 Frequencies were calculated for demographic variables, and Pearson’s Characteristic n (%) correlation coefficients were calcu- lated between the empathy and burnout Sex subscales. Missing answers were replaced Male* 115 (64.6%) using single imputation. Imputations made on the CBI involved completing missing Female 62 (34.8%) answers with the average calculated from Age answers scored in the respective subscale. Those who responded to fewer than three or >60 27 (15.2%) four questions in each subscale were clas- 51–60 57 (32%) sified as non-responders.12 Missing answers on the Jefferson Empathy Scale were 41–50 67 (37.6%) filled with the average score of completed 31–40 27 (15.2%) answers. Those who answered fewer than 16 questions out of the 20-question total Ethnicity** were classified as non-responders.10 NZ European 129 (72.5%) Results Other 49 (27.5%) Participants Time since last annual leave Three-hundred and fourteen invitations < 1 month ago 49 (27.5%) to participate were made. We received 178 responses (56.7% response rate). Table 1 1–3 months ago 72 (40.4%) shows the demographics of the 178 partic- 3–6 months ago 43 (24.2%) ipants: 64.6% were male, 72.5% were New Zealand European and the most prevalent >6 months ago 11 (6.2%) age bracket was 41–50 (37.6%). The specialty Decline to answer 3 (1.7%) with the highest response rate was medicine (43.5%). Specialty *** (invited) Main results Anaesthesia (61) 29 (16.3%) 44.9% of participants were experiencing Medicine (110) 77 (43.3%) high levels of personal burnout, 29.2% were experiencing high levels of work-re- Surgery (78) 34 (19.1%) lated burnout and 5.6% were experiencing Psychiatry (61) 23 (21.3%) high levels of patient-related burnout. Five percent of participants were experiencing High degree of burnout (CBI score >50) high levels of burnout in all three domains Personal 80 (44.9%) (personal, work-related and patient-related burnout) (Table 1). Work-related 52 (29.2%) We found a statistically significant Patient-related 10 (5.6%) negative correlation between empathy and level of patient-related burnout (Table 2). All three above 50 9 (5.1%) Other analyses *59% of Canterbury District Health Board SMOs are male. Specialties ** ‘Others’ includes ethnicities with populations < 10. Comparisons of burnout and empathy These included Māori, both Māori and Pakeha, English/ between specialties are shown in Table 3. German, Indian, South African, European, Chinese and These results show the surgery group scored unknown mixed/prefer not to answer. *** ‘Medicine’ includes: general medicine, respiratory, highest in both personal and work-related cardiology, gastroenterology, oncology and palliative burnout, with scores of 48.04 (SD 16.74) care.
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