Yoon John D, Hunt Natalie B, Ravella Krishna C, Jun Christine S, Curlin Farr A
1 Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA.
2 The MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA.
Am J Hosp Palliat Care. 2017 Dec;34(10):931-937. doi: 10.1177/1049909116661817. Epub 2016 Jul 27.
Physician burnout raises concerns over what sustains physicians' career motivations. We assess whether physicians in end-of-life specialties had higher rates of burnout and/or calling to care for the dying. We also examined whether the patient centeredness of the clinical environment was associated with burnout.
In 2010 to 2011, we conducted a national survey of US physicians from multiple specialties. Primary outcomes were a validated single-item measure of burnout or sense of calling to end-of-life care. Primary predictors of burnout (or calling) included clinical specialty, frequency of encounters with dying patients, and patient centeredness of the clinical environments ("My clinical environment prioritizes the need of the patient over maximizing revenue").
Adjusted response rate among eligible respondents was 62% (1156 of 1878). Nearly a quarter of physicians (23%) experienced burnout, and rates were similar across all specialties. Half of the responding physicians (52%) agreed that they felt called to take care of patients who are dying. Burned-out physicians were more likely to report working in profit-centered clinical environments (multivariate odds ratio [OR] of 1.9; confidence interval [CI]: 1.3-2.8) or experiencing emotional exhaustion when caring for the dying (multivariate OR of 2.1; CI: 1.4-3.0). Physicians who identified their work as a calling were more likely to work in end-of-life specialties, to feel emotionally energized when caring for the dying, and to be religious.
Physicians from end-of-life specialties not only did not have increased rates of burnout but they were also more likely to report a sense of calling in caring for the dying.
医生职业倦怠引发了人们对维持医生职业动力因素的关注。我们评估临终关怀专业的医生是否有更高的职业倦怠率和/或照顾临终患者的使命感。我们还研究了临床环境以患者为中心是否与职业倦怠有关。
2010年至2011年，我们对美国多个专业的医生进行了全国性调查。主要结果是一项经过验证的单一项目的职业倦怠或临终关怀使命感测量指标。职业倦怠（或使命感）的主要预测因素包括临床专业、与临终患者接触的频率以及临床环境以患者为中心的程度（“我的临床环境将患者的需求置于收益最大化之上”）。
符合条件的受访者的调整后回复率为62%（1878人中的1156人）。近四分之一的医生（23%）经历过职业倦怠，所有专业的倦怠率相似。一半的受访医生（52%）同意他们感到自己被召唤去照顾临终患者。职业倦怠的医生更有可能报告在以盈利为中心的临床环境中工作（多变量优势比[OR]为1.9；置信区间[CI]：1.3 - 2.8）或在照顾临终患者时经历情感耗竭（多变量OR为2.1；CI：1.4 - 3.0）。将自己的工作视为使命的医生更有可能从事临终关怀专业，在照顾临终患者时感到精力充沛，并且更虔诚。
临终关怀专业的医生不仅职业倦怠率没有增加，而且他们更有可能报告在照顾临终患者时有使命感。
