“Good Morning Dr Aggarwal. I am back again”, said Mr C with an innocent smile on his face. “Yeah, long time no see”, I said, just to humor the situation. “What brings you back again so soon?”, I asked. “I continue to get the fatigue and pains all over”, he said. This is after we have ruled out most of the organic disorders including thyroid issues, sleep apnea, electrolyte imbalances,lyme disease vitamin deficiencies and many others. I saw him strongly and said,”seems like you are stressed or depressed, are you?’. The wife immediately jumps from her chair and said, ‘He is always thinking about something. He does not sleep well because of that. All day long, he just sits and thinks”.
This is a very common situation in Primary care office. Patients are afraid to admit their true symptoms and continue feeling that they have something major going on. It is very hard to treat patients with such attitudes, which unfortunately are the majority of our patient population. People do not want to digest the fact that they could be stressed or depressed. It is still a taboo for many to be labelled as depressed being. Struggle to find what is wrong leads to ‘Patient Burnout’.
We all have heard of doctors being overwhelmed with their work because of long hours, stress related to performance and administrative hassles leading to ‘Burnout’. But I feel, what goes un-noticed most of the time is patient burnout.
Burnout leads to patients being frustrated even more. They keep visiting multiple doctors to get the answers they want which does not exist. Adding frustrations and elaborate testing leads to ‘Patient Burnout’. Not that it is something that is easily fixable, but definitely needs more attention.
Factors leading to Patient Burnout
- Repeated visits to Healthcare providers
- Multiple tests
- No clinical evidence of any particular disease after extensive testing
- Difficult family situation
- Difficult work situation
- Living alone
- Stomach upset
It gets overwhelming for physicians to keep doing a zillion dollar workup and find no strong evidence of any particular disease at the end. The fix to the problem is not easy. But one thing that providers can do it to engage the patients in a dialogue. Have them analyze what exactly is going on in their psychosocial arena that could be contributing to this. Encouraging patients to get into healthy habits including diet control, exercising, yoga and meditation are some of the magical things that they can teach the patients. Getting to the bottom of the problem is must.
- Have patient summarize their thoughts on the problem
- Have them identify their psychological makeup
- Reassure them
- Encourage them
- Recommend Lifestyle Modifications
- See them periodically to assess their progress
- Provide self-education and stress management materials
- Offer support
Identifying and Managing certain psychological issues are challenges for most physicians. But a streamlined thought process to catch these problems help patients avoid the burnout.