Like Pregnancy

Learning Objectives:

After reading this case, students will be able to:
• Identify at least two symptoms of burnout that often affect healthcare professionals.
• Describe how burnout can lead to patient harm.
• Identify at least three ways to prevent burnout among health care professionals.

Description:

Preeti is a second-year resident in a demanding internal medicine residency program. She is generally regarded as one of the most talented residents and has just been elected to the chief resident position for the next year. For several months, however, she has been feeling a significant amount of burnout. Preeti’s mood has become low, her energy level has dropped, and she is having difficulty getting out of bed in the morning. She is in the middle of a very demanding ICU (Intensive Care Unit) rotation, during which she is on call every third night, so at first she thinks that it might just be sleep deprivation causing the problem. But she continues to feel increasingly unwell both physically and emotionally. To make matters worse, Preeti’s mother was recently diagnosed with breast cancer…
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The Case:

Preeti is a second-year resident in a demanding internal medicine residency program. She is generally regarded as one of the most talented residents and has just been elected to the chief resident position for the next year. For several months, however, she has been feeling a significant amount of burnout. Preeti’s mood has become low, her energy level has dropped and she is having difficulty getting out of bed in the morning. She is in the middle of a very demanding ICU (Intensive Care Unit) rotation, during which she is on call every third night, so at first she thinks that it might just be sleep deprivation causing the problem. But she continues to feel increasingly unwell both physically and emotionally.

To make matters worse, Preeti’s mother was recently diagnosed with breast cancer. Her mother lives over a thousand miles away, and it’s impossible to visit her, since Preeti only has one day per week off from work. Her mother reassures her, saying, “Don’t worry about me – keep working.” Nevertheless, Ana can’t stop thinking about her mother and is having a hard time focusing on medicine. She has to force herself to complete tasks and she stops doing the extra reading on medical cases that she usually enjoys. She is feeling overwhelmed and increasingly hopeless about life and, in spite of her many past successes, she is starting to regard herself as a complete failure.

Preeti also feels that she is not able to care for her patients as well as she used to in previous rotations. The other day when a patient was admitted with recurrent fainting episodes, she took a brief history from the patient and did not do a thorough job asking about family history, missing the fact that both the patient and other family members had histories of blood clots. As a result, she did not think to work the patient up for a pulmonary embolus (blood clots to the lungs) even though he had had some shortness of breath on admission, which is a common presenting symptom of this dangerous condition. If a colleague had not thought about this possibility and suggested the requisite testing, the patient’s life might have been in danger. Preeti feels that she did not spend enough time talking to the patient; she also feels that if she were doing her usual amount of reading of the medical literature, she would have been better prepared.

Preeti is worried because she was briefly diagnosed with clinical depression as a teenager, and her symptoms are beginning to resemble what she felt back then. She knows, however, that she cannot drop out of rotation; there is no one who can take her place in her ICU, and her not being there would force the other residents to be on call every other night, giving them an intolerable work load. Even if it were possible to find a substitute for the rotation, she does not have any vacation time left and she can’t progress to the third year if she takes off any more time.

Preeti is afraid to tell anyone how she feels because she knows that people in the program will start to regard her as a “weak” resident if she complains. Besides, all the other residents are working just as hard and don’t seem to be having any problem. She will not even discuss the situation with her family at home because she does not want to disappoint them. She is feeling completely trapped and wonders why she went into the medical field in the first place; she would do anything at this point to escape it.

TASK : Breast Cancer

DATE : 12may 2016