The impact of stress and burnout on physician satisfaction and behaviors.

Dr. Sour is a 50-year physician who practices in a busy multispecialty group practice in a large metropolitan community. In years past he was passionate, energetic and proud of his role as a health care provider. He enjoyed participating in a number of different hospital committees and clinical projects and was happy to help out when and wherever needed. Recently he has been noted by staff to be more angry and irritable and not the same old jovial person he used to be. He lost his smile. The staff also noted that he was showing up late, appeared stressed and fatigued, and didn’t seem to take the time to interact or be as focused as he usually was, often letting things fall through the cracks. When the staff tried to approach him he usually shied away or mumbled something like medicine isn’t what it used to be. When pushed he would say that he didn’t appreciate people telling him what he could and couldn’t do and getting paid less for doing it. Even the patients appeared ungrateful. Being a physician isn’t what it used to be. One day during surgery he started yelling and screaming at the OR staff complaining about schedule changes, poor equipment, and nurse competency. One nurse in particular was so upset by the disrespectful berating behavior that she left the room in tears. Later on that day when he was called about a change in a patient’s condition he became extremely agitated and acted in a condescending manner to the nurse questioning her competency and how she ever got her license. It got to the point that he became so intimidating, that no one wanted to interact with him. There were several issues raised about communication responsiveness and coordination of care, but no one seemed to want to say anything to him directly as there was a general reluctance to intervene. In the weeks following, Sour became more and more isolated. He stopped showing up at the committee meetings and rarely mingled with his peers. Friends and family didn’t seem able to help. He appeared to be getting more and more depressed. A question was raised about whether or not there was an underlying problem with substance abuse. After a series of minor disruptive events there was an incident where a nurse called Sour with a concern about a patient’s condition and he appeared to be in such a distressed state that concerns were raised about patient safety. At that time the executive medical staff intervened and the physician was called in to discuss these issues.