Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Palliat Med. 2009 Sep;12(9):773-7. doi: 10.1089/jpm.2009.0050.
Hospice and palliative medicine (HPM) is now an American Board of Medical Specialties-recognized subspecialty, and many physicians are choosing it as a career. There is little written about recognition and prevention of burnout or physician self-care in this challenging and ever-evolving field.
We conducted a qualitative online survey of 40 HPM physicians practicing in the United States and asked them to comment on their strategies for avoiding burnout and finding fulfillment in palliative medicine. Responses were coded into thematic classes by commonalities.
Thirty of 40 HPM physicians (19 males, 11 females) surveyed responded in full. Each listed between 1 to 7 strategies (median 4 per respondent) they felt to be important in preventing burnout that were placed in 1 of 13 thematic classes. Physical well-being was the most common strategy reported (60%), followed by professional relationships (57%), taking a transcendental perspective (43%), talking with others (43%), hobbies (40%), clinical variety (37%), personal relationships (37%), and personal boundaries (37%). "Time away" from work (27%), passion for one's work (20%), realistic expectations and use of humor and laughter (13% each), and remembering patients (10%) were cited less frequently.
HPM physicians report using a variety of strategies to promote their personal well-being suggesting a diversified portfolio of wellness strategies is needed to deal with the challenges of palliative care medicine. Additional studies are needed to help HPM recognize burnout in their practices and among their colleagues, and to determine how to help future HPM physicians develop individualized strategies to promote personal wellness and resilience.
缓和医疗和姑息医学（HPM）现在是美国医学专业委员会认可的亚专科，许多医生选择将其作为职业。在这个充满挑战且不断发展的领域，关于倦怠的识别和预防以及医生的自我保健，相关文献很少。
我们对在美国从事 HPM 的 40 名医生进行了一项定性的在线调查，要求他们对自己在姑息医学中避免倦怠和获得满足感的策略发表意见。通过共同特征将回复编码为主题类别。
接受调查的 40 名 HPM 医生中有 30 名（19 名男性，11 名女性）做出了完整回复。每位医生列出了 1 到 7 种（每位受访者中位数为 4 种）他们认为对预防倦怠很重要的策略，并将这些策略归入 13 个主题类别之一。报告的最常见策略是身体健康（60%），其次是专业关系（57%）、采取超然视角（43%）、与他人交谈（43%）、爱好（40%）、临床多样性（37%）、人际关系（37%）和个人界限（37%）。较少提到“远离工作”（27%）、对工作的热情（20%）、现实的期望以及使用幽默和笑声（各 13%）和记住患者（10%）。
HPM 医生报告使用了多种策略来促进个人幸福感，这表明需要采用多样化的健康策略组合来应对姑息治疗医学的挑战。需要进一步研究来帮助 HPM 在实践中以及在同事中识别倦怠，并确定如何帮助未来的 HPM 医生制定个性化策略来促进个人健康和适应能力。
