Burnout among physicians.

Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to cognitive-behavioral and patient-centered therapy have been found to be of utmost significance when it comes to preventing and treating burnout. However, evidence is insufficient to support that stress management programs can help reducing job-related stress beyond the intervention period, and similarly mindfulness-based stress reduction interventions efficiently reduce psychological distress and negative vibes, and encourage empathy while significantly enhancing physicians' quality of life. On the other hand, a few small studies have suggested that Balint sessions can have a promising positive effect in preventing burnout; moreover exercises can reduce anxiety levels and exhaustion symptoms while improving the mental and physical well-being of healthcare workers. Occupational interventions in the work settings can also improve the emotional and work-induced exhaustion. Combining both individual and organizational interventions can have a good impact in reducing burnout scores among physicians; therefore, multidisciplinary actions that include changes in the work environmental factors along with stress management programs that teach people how to cope better with stressful events showed promising solutions to manage burnout. However, until now there have been no rigorous studies to prove this. More interventional research targeting medical students, residents, and practicing physicians are needed in order to improve psychological well-being, professional careers, as well as the quality of care provided to patients.

Education may improve the underutilization of genetic services by Middle Eastern primary care practitioners.

AIM: This study assesses Arab Middle Eastern primary care practitioners' (PCPs) use of and referral to clinical genetic testing and counseling, as well as the effect of education on their willingness to utilize or refer to these services. METHODS: A total of 128 PCPs were surveyed. Data about their demographics, academic background, perceptions about their role in genetic testing and counseling, as well as their use of genetic testing and counseling services were collected. Another survey was distributed to participants who attended a genetics symposium and inquired about their willingness to include these services in their practice. RESULTS: Most of the PCPs rarely or never request genetic testing (64.8%), and 42 (33.6%) have never requested a genetic test. Similarly, 30% have never performed genetic counseling and 34.7% rarely perform genetic counseling. Lack of knowledge and expertise were considered major barriers. After attending the genetics symposium, many PCPs expressed their willingness to start doing genetic testing or referring to genetic testing, and many more answered that they will start counseling or referring to counseling. CONCLUSION: This study shows that genetic testing and counseling services are underutilized by Arab PCPs in the Middle East. Education may improve their use of and referral to these services.

Prevalence of burnout syndrome among medical residents: experience of a developing country.

BACKGROUND: It has been well established that burnout, defined as emotional exhaustion (EE), de-personalisation (DP), and a 'decreased sense of personal accomplishment (PA) due to work related stress', is prevalent to a great extent among medical residents. This has been implicated in the delivery of suboptimal patient care. Residents in developing countries work under difficult working and social conditions and therefore examining burnout is important when addressing quality of care and working conditions. OBJECTIVES: The objectives of the study were to assess the point prevalence of burnout among residents in Lebanon and investigate some of the work and non-work related factors associated with burnout. METHODS: A cross sectional study of all medical residents was carried out in two major hospitals in the capital city. A total of 155 residents responded, representing all specialities. Maslach Burnout Inventory for Health Services Workers (MBI-HSS) was used. Burnout in three domains was dichotomised into high versus not high burnout. RESULTS: The prevalence of burnout was high in all the domains with the highest in the domain of emotional exhaustion (67.7%). 80% of the sample had a high level of burnout in at least one domain. Being female, experiencing a major stress, working for more than 80 h per week, and having more than eight calls per month increased the odds of burnout in at least one domain. CONCLUSIONS: The high burnout level calls for action. This could be addressed by re-examining workload and other working conditions of residents as well as attending to their psychological wellbeing. The limitations of the study are also discussed.

Communication skills in a Lebanese medical school: from movie theaters to medical classrooms.

BACKGROUND: Communication skills are widely taught in US medical schools, but in Lebanon, such teaching is in its infancy. METHODS: At the American University of Beirut, we piloted a communication skills teaching package using video scenarios in Arabic. A total of 150 second-year medical students addressed eight communication issues in a 3-hour multi-method workshop that included watching and discussing video clips and role-playing. RESULTS: Students evaluated the sessions positively for relevancy, quality of video clips, teaching methods, and usefulness for future practice. CONCLUSIONS: This interactive, role-playing workshop proved highly acceptable to Arab students and has been permanently incorporated into the curriculum.

Neuroleptic malignant syndrome with olanzapine associated with severe hypernatremia.

A 30-year-old white man with schizophrenia developed anorexia and nausea, and was admitted to hospital for confusion and delirium. He was on olanzapine, 10 days prior to admission. On admission, typical neuroleptic malignant syndrome (NMS) developed with elevated body temperature (39.7 degrees C), obtundation, tremor, rigidity, diaphoresis, fluctuating pupillary diameter, tachycardia, labile hypertension, elevated serum creatine kinase and severe hypernatremia (190 meq/l). Olanzepine was stopped few days after admission to the hospital and the NMS manifestations resolved by hospital day 12. The patient had all of the major manifestations of NMS. There was no other likely explanation for his illness. This is the first case reported in which NMS was associated with olanzapine and extremely elevated levels of serum sodium. Copyright 2001 John Wiley & Sons, Ltd.