Who Is Sicker: Patients—or Residents? Residents' Distress and the Care of Patients

• Internship and residency
• Burnout, professional
• Quality of health care
• Depersonalization
• Physician role

Is burnout in residents a malignant disease? Do exhaustion, cynicism, and ineffectiveness start small, then grow, spread, and harm? Do they extend to students, other residents, patients, career, family? If so, what is the pathogenesis? What is the treatment? Can we prevent, cure, or heal this? Should anyone care?

Starting with the last question, there is growing evidence that, despite generations of denial, physicians' feelings matter. Grol and colleagues (1) have shown that frustrations, tensions, and annoyance with time pressures are linked to giving patients short shrift: Physicians may write a plethora of prescriptions yet give a paucity of time to listening and explaining (1). Conversely, physician satisfaction is associated with patient adherence to medical regimens (2) and patient satisfaction (3, 4). It is obvious that patients should care if residents—and older physicians, nurses, and other health professionals, for that matter—are depleted and discouraged. Physicians and their families should also care because professional experiences and attitudes can affect home life (5). Policymakers should care because the health of our society depends in part on the health and effectiveness of health professionals. Medical educators should worry: The problem is happening on their watch.

Maslach and others (5, 6) have demonstrated that burnout in many walks of life happens because of work. Workers are not the culprits; rather, work load, practices, conflicts, and environment are. Tensions may rise for some physicians (and others) as work pressures combine with home pressures, such as having child-care responsibilities (7) or having a spouse who frequently works overtime (8). The bulk of discouragement and alienation, however, stems from work, as shown by studies elsewhere in the health care arena: Excessive work demands in hospital nursing units have been linked to nurses' distress (9), a high mortality rate in intensive care units …