Julika Zwack

If Every Fifth Physician Is Affected by Burnout, What About the Other Four? Resilience Strategies of Experienced Physicians

Purpose To identify health-promoting strategies employed by experienced physicians in order to define prototypical resilience processes and key aspects of resilience-fostering preventive actions. Method From January 2010 to March 2011, the authors conducted 200 semistructured interviews with physicians of different ages, disciplines, and hierarchical status from across Germany. The interview transcripts were analyzed according to the Content Analysis method. Results Analysis revealed 30 subcodes in three dimensions: (1) job-related gratifications derived from treatment interactions, (2) practices, such as leisure-time activities, self-demarcation, limitation of working hours, and continuous professional development, and (3) attitudes, such as acceptance of professional and personal boundaries, a focus on positive aspects of work, and personal reflexivity. Conclusions The reported strategies and attitudes helped to develop mental, physical, and social resource pools that fostered effective decision making. Successful coping, in turn, encouraged the maintenance of resilience-promoting abilities. In relation to Conservation of Resources Theory, physician resilience emerged as the ability to invest personal resources in a way that initiates positive resource spirals in spite of stressful working conditions. Enriching traditional stress management approaches with the dynamic of positive as well as negative resource spirals would thus appear to be a promising approach.

Resilienz im Arztberuf – salutogenetische Praktiken und Einstellungsmuster erfahrener Ärzte

What enables physicians to cope efficiently with their every day stressors? Which strategies and attitudes contribute to long term job satisfaction and biopsychosocial health throughout their career? In order to work out the resiliency processes and coping strategies of residents and senior physicians we conducted 200 qualtitative expert interviews. The analysis revealed 30 main categories, referring to 5 subsystems: relating to patients and colleagues, dealing with structural restrictions, maintaining private relations and fields of interests and developing self-awareness. Based on the empirical salutogenetic practices and attitudes we draw conclusions for prevention.

Navigieren im Dilemma

Das Durchleben und Durchleiden berufsbezogener Dilemmata gehort zum Alltag vieler Fuhrungskrafte. Unvorbereitet mundet die Konfrontation mit ihnen haufig in Zynismus, Schuldgefuhle, Lahmung oder Frustration. Mit dilemmatischen Situationen zu rechnen, sich mit der Struktur von Dilemmata zu beschaftigen und Navigationsstrategien zu entwickeln, kann helfen, auch in dilemmatischen Situationen das Gefuhl von Handlungsfahigkeit und Selbstwirksamkeit aufrechtzuerhalten. Solche Navigationsstrategien werden anhand von Erfahrungen aus individuellen Fuhrungskraftecoachings und aus einem Praxisforschungsprojekt der Autoren mit Gruppen mittlerer Fuhrungskrafte in zwei Produktionsbetrieben beschrieben.

Pathogenetic and Salutogenetic Aspects of Physicians' Health

OBJECTIVE To analyse pathogenetic and salutogenetic processes of physicians suffering from depression, burnout and drug addiction. METHODS Qualitative follow-up interviews with 32 former physician patients from the Oberbergkliniken hospital group. RESULTS Long working hours, bureaucratic restrictions and double burdens of combining family life and professional demands are major pathogenetic strains. They interact with biographic performance scripts. Major salutogenetic factors are the expansion of self care with regard to physical, spiritual and social needs and the reconstruction of resources outside the job. CONCLUSIONS Prevention programmes for health care professionals should focus on the reflection of biographic performance scripts, on maintaining multifaceted sources of gratification and the buildup of extra-professional resources.

[Working with a family systems therapy approach as part of the routine treatment on acute psychiatric wards: sustained effects on team members' workload].

OBJECTIVE Assessing long-term effects of a family systems therapy approach (systems therapy methods in acute psychiatry, SYMPA) on occupational stress and interdisciplinary cooperation of team members in three German psychiatric hospitals. METHODS Pre-post-follow-up survey using the Maslach Burnout Inventory (MBI) and Team Climate Inventory (TCI) questionnaires complemented by semi-structured in-depth interviews (N = 56). RESULTS Three years after implementing a family systems therapy approach, experienced work load and staff burnout remain significantly lower than before. Interdisciplinary cooperation was intensified and nursing staff status increased. Following systemic case conceptualisations and interventions the therapeutic alliance moved towards a need-adapted treatment approach. CONCLUSIONS Seven years after implementation, the family systems therapy approach still included significantly lower workload burden, an intensified interdisciplinary cooperation, and a need-adapted treatment orientation that strengthens the alliance between staff and client system.

Grundlagen der systemischen Therapie

Die systemische Therapie ist in den Jahren 1970–1980 aus der Familientherapie hervorgegangen. Seither hat sie uber die Familientherapi e hinaus auch in vielen anderen psychotherapeutischen Settings Einzug gehalten.