Burned Out at the Bedside: Patient Perceptions of Physician Burnout in an Internal Medicine Resident Continuity Clinic.
BACKGROUND
Burnout is high among resident physicians and may be associated with suboptimal patient care and reduced empathy.


OBJECTIVE
To investigate the relationship between patient perceptions of empathy and enablement and physician burnout in internal medicine residents.


METHODS
Cross-sectional, survey-based observational study between December 2012 and March 2013 in a resident continuity clinic located within a large urban academic primary care practice in Baltimore, Maryland.


METHODS
Study participants were 44 PGY1-3 residents and a convenience sample of their English-speaking adult primary care patients (N = 244).


METHODS
Patients rated their resident physicians using the Consultation and Relational Empathy Measure (CARE) and the Patient Enablement Instrument (PEI). Residents completed the Maslach Burnout Inventory (MBI). We tested for associations between resident burnout and patients' perceptions of resident empathy (CARE) and enablement (PEI) using multilevel regression analysis.


RESULTS
Multilevel regression analyses indicated significant positive associations between physician depersonalization scores on the MBI and patient ratings of empathy (B = 0.28, SE = 0.17, p < 0.001) and enablement (B = 0.11, SE = 0.11, p = 0.02). Emotional exhaustion scores on the MBI were not significantly related to either patient outcome.


CONCLUSIONS
Patients perceived residents who reported higher levels of depersonalization as more empathic and enabling during their patient care encounters. The relationship between physician distress and patient perceptions of care has important implications for medical education and requires further study.
Division of General Internal Medicine, Department of Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, USA.|Department of Medicine, Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, MD, USA.
Justin P
JP
Lafreniere
Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Rebeca
R
Rios
Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Hillary
H
Packer
Department of Pediatrics, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Sharon
S
Ghazarian
Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Scott M
SM
Wright
Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA. rlevine@jhmi.edu.
Rachel B
RB
Levine
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002055:Burnout, Professional / Q000175:diagnosis / Q000523:psychology*; D003430:Cross-Sectional Studies; D003861:Depersonalization / Q000523:psychology; D004645:Empathy; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D008396:Maryland; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D011594:Psychometrics
burnout; empathy; enablement; graduate medical education; patient outcomes