Electronic health records and clinician burnout: A story of three eras.

OBJECTIVE: The study sought to provide physicians, informaticians, and institutional policymakers with an introductory tutorial about the history of medical documentation, sources of clinician burnout, and opportunities to improve electronic health records (EHRs). We now have unprecedented opportunities in health care, with the promise of new cures, improved equity, greater sensitivity to social and behavioral determinants of health, and data-driven precision medicine all on the horizon. EHRs have succeeded in making many aspects of care safer and more reliable. Unfortunately, current limitations in EHR usability and problems with clinician burnout distract from these successes. A complex interplay of technology, policy, and healthcare delivery has contributed to our current frustrations with EHRs. Fortunately, there are opportunities to improve the EHR and health system. A stronger emphasis on improving the clinician's experience through close collaboration by informaticians, clinicians, and vendors can combine with specific policy changes to address the causes of burnout. TARGET AUDIENCE: This tutorial is intended for clinicians, informaticians, policymakers, and regulators, who are essential participants in discussions focused on improving clinician burnout. Learners in biomedicine, regardless of clinical discipline, also may benefit from this primer and review. SCOPE: We include (1) an overview of medical documentation from a historical perspective; (2) a summary of the forces converging over the past 20 years to develop and disseminate the modern EHR; and (3) future opportunities to improve EHR structure, function, user base, and time required to collect and extract information.

Is Today's 21st Century Burnout 19th Century's Neurasthenia?

This essay addresses the relevance of the concept of "burnout" to concerns about the mental and physical health of today's physicians and those training to join the medical profession. Comparisons are made with the diagnosis of neurasthenia in the 19th century. Social contributors to and the influence of stress on the phenomena in each instance are presented.

[Alienation to burn-out. Psyche and the Universe of Technology]. / Dall'Alienazione al Burn-out. la Psiche e l'Universo della Tecnica.

The new D. Lgs. N 81, 2008 Article 28 paragraph 1 sanctions that the risk assessment must involve all the possible risks to safety and health of workers, including the work-related stress factors. Stressors at work may vary as to: quantity of work assigned, whether excessive or inadequate; lack of recognition or reward for good job performance; degree of responsibility; precariousness of work; emotional pressures exerted on workers; violence and harassment of psychological nature, poor balance between work and private life. The need man has to understand the causes of his psycho-physical and social disease are old. Only the words we use when dealing with the topic has changed over the time: once it was Alienation now it is Burn-out. The concept of alienation, which has been very important over the time, has many different aspects and has had countless interpretations (which have followed one another), the psycho-analytical, the sociological analysis and the Marxist one, Burnout is actually a syndrome characterized by three interrelated dimensions: exhaustion, cynicism and inefficacy. Therefore it is important to prevent, eliminate or reduce problems related to occupational stress. Among preventive measures, the Europe Agreement identified in the management and in the communication the information necessary to define the goals of the company and the role each employee has. Moreover information and formation are considered the necessary elements to increase awareness and understanding of the problem, its potential causes and possible ways of approading it. Our research group, has developed targeted questionnaires, biological indicators and medical instrumental examinations the occupational doctors can make use of to assess these issues.

Two sides of the same coin? On the history and phenomenology of chronic fatigue and burnout.

BACKGROUND: Burnout and chronic fatigue syndrome (CFS) are two fatigue syndromes which have developed largely independently from each other, yet whose similarities in symptoms can be a source of confusion. We aim to explore the phenomenology of burnout and CFS in a historical context as this may provide some insight into the links and relationship between these conditions. METHOD: A narrative review based on literature in the fields of history, social science and medicine. RESULTS: The origins of CFS lie within medicine, whereas burnout developed in a psychological setting. As well as symptoms, burnout and CFS also share similar themes such as an overload process triggering illness onset, the need for restoration of depleted energy, external causal attributions and the characteristics of people suffering from these illnesses. However, these themes are expressed in either psychological or medical terms according to the historical background. CONCLUSION: Despite their similarities, there have been few direct comparisons of the two concepts. Culture, illness perceptions and accountability are important issues in both conditions and could contribute to their differences. Comparing burnout and CFS within one sample frame, thus looking beyond the psychology/medicine divide, could be a useful first step towards understanding their relationship.

The Fielding H. Garrison lecture: "I am their physician": Dr. Owen J. Wister of Germantown and his too many patients.

Owen J. Wister, M.D. (1825-1896) acquired one of the busiest "outdoor" practices in nineteenth-century Philadelphia, conducted throughout the city's large northwest district. Through letters, he described events in his daily rounds to his wife, the writer Sarah Butler Wister, when she was traveling to restore her own health. Wister's practice was filled with the mundane details of any general doctor's existence but also with confrontations with sudden and overpowering disease, and sometimes the grisly deaths of friends and family. Often he worked from early morning until late evening, seeing as many as thirty or forty patients scattered over a thirty-mile range. He endured as well frequent calls at night for real or imagined emergencies and maternity cases. In 1869 he collapsed from overwork and was able to resume his career only after a three-year respite. This lecture describes Wister's practice and his emotional responses to it, as inscribed in the letters. In addition, I explore what attributes he had as a physician and as a man that accounted for his popularity and why the social environment of his practice made it virtually impossible for him to control its demands, even at the cost of his own well-being.

Intervenção profissional na Educação Física escolar: considerações sobre o trabalho docente / Intervención profesional en la Educación Física Escolar: consideraciones acerca del trabajo docente / Professional Intervention at School’s Physical Education: considerations about the teaching work

O presente ensaio aborda os principais problemas enfrentados no trabalho docente, mais especificamente dos professores de Educação Física da Educação Básica. O ambiente de trabalho nesta área tem favorecido o surgimento de doenças laborais, tais como Síndrome do Esgotamento Profissional, estresse, dependências químicas, doenças no aparelho fonador, entre outras. Deste modo, a necessidade de realização de novas investigações que abordem a qualidade de vida no trabalho e o estilo de vida dos docentes é apontada. Além disso, alerta-se para a necessidade dos problemas detectados serem considerados pelos gestores e pela comunidade escolar para favorecer a melhoria do ambiente da profissão docente.

This essay touch on the main problems faced in the teaching work. Most precisely, it deals with the professional practices of Physical Education teachers of basic education. The work’s environment of such a subject has been favorable for the appearance of working diseases, such as the burnout syndrome, stress, chemical addiction, phonetic system infirmities, and so on. Thus, it is noticeable the necessity of new investigations about quality of life in the work, and life style of those teachers. In addition, this essay warms managers and the schooling community about the necessity of awareness on the detected problems in order to facilitate the improvement of the teacher’s professional environment.

El presente ensayo plantea los principias problemas enfrentados en el trabajo docente, tratándose especialmente de los profesores de Educación Física Básica. El ambiente de trabajo en esta área ha contribuido para el surgimiento de enfermedades laborales, tales como el síndrome del agotamiento profesional, estrés, dependencias químicas, enfermedades en el aparato fonador, entre otras. La necesidad de la realización de nuevas investigaciones que traten de la calidad de vida en el trabajo y el estilo de vida de los docentes es sobresaliente. Además, se alerta para la necesidad de especial atención por parte de los gestores y comunidad escolar con los problemas detectados, pues esto puede contribuir para la mejoría del ambiente de la profesión docente.

A review of the history of traumatic stress studies in Japan: from traumatic neurosis to PTSD.

Based on available literature, this review article investigates traumatic stress studies in Japan from the late 19th century to the present for English speaking audiences. First, traumatic neuroses of war victims, A-bomb survivors, and victims of work-related accidents are discussed. Second, traumatic stress studies of victims of other manmade disasters, such as the sarin gas attacks in Tokyo, domestic violence, and burn injuries. Third, psychological outcomes of natural disaster studies are discussed in relation to social support and help-seeking tendencies of Japan disaster victims.

Estresse ocupacional e Síndrome de Burnout no exercício profissional da psicologia / Ocupational stress and Burnout Syndrome in the profissional practice of the psychology

Esta revisão teórica busca analisar os aspectos vinculados ao estresse ocupacional de burnout, bem como relacioná-los com a prática profissional dos psicólogos. Essas síndromes podem afetar o psicólogo pois, nas suas relações de trabalho, ele se encontra muito próximo de pessoas em sofrimento, podendo identificar-se e vincular-se afetivamente às mesmas. São discutidos aspectos conceituais e causais das síndromes, das relações de trabalho em saúde mental e, especificamente, do exercício profissional em Psicologia, considerando a realidade do Brasil e de outros países.(AU)

Reflections on the history of occupational stress in hospice/palliative care.

The concept of hospice and palliative care emerged a quarter of a century ago out of recognition of the unmet needs of dying persons and the social issues of the 1960s and 1970s. The issues of the day included the sexual revolution; a questioning of social values; an increased awareness of death resulting from the murder of the Kennedy brothers and Martin Luther King and daily television exposure to deaths in the Vietnam War, feminism, consumerism, reclaiming a more humanized role in the birth process, and hence in the process of death. The history of the hospice movement and the stress experienced by staff is traced from the early developmental days through to the present. Initially there was sometimes a struggle to integrate the concepts of relief of physical symptoms with meeting the psychosocial and emotional needs of patients and families, caregivers were expected to sacrifice much of their personal life for work, emotional intensity was high and supports were developed to ease some of the stress experienced by caregivers. From the early days team stress and burnout have been issues of concern. In the 1980s issues involved establishing funding sources, dealing with the new crisis of AIDS, and dealing with the gap between the ideal and the real. In the 1990s the economic climate has escalated some of the tensions that have always existed as hospice attempts to position itself within mainstream care with diminishing fiscal resources. These are issues that confront us as we move into the next century.