Bias and Burnout: Evil Twins

Carol Peckham

Disclosures

January 12, 2016

In This Article

Bias and Burnout: Is There a Connection?

In this survey, physicians who reported burnout were more likely to also report bias. Forty-three percent of physicians who expressed burnout reported that they also experienced bias; in contrast, just over one third (36%) of non–burned-out physicians reported bias (Figure 9).

If one aspect of burnout is depersonalization, then one would expect there to be a particular risk for the burned-out physician to be biased toward the emotional or difficult patient.

Figure 9.

Is Burnout Related to Bias?

The Medscape survey, however, showed only a slight relationship between burnout and bias toward "emotional" patients, with 27% of burned-out physicians citing these patients as a bias trigger compared with 22% of non–burned-out physicians (Figure 10).

Nevertheless, difficult patients have been found to increase the chance of not only bias but also burnout. Emergency medicine physicians may be at particular risk. In the Medscape survey, the highest percentage of physicians admitting bias was seen among emergency medicine physicians, who were also in the top three of burned-out specialists. One survey found that a high percentage of emergency medicine physicians were burned out from treating patients who repeatedly used the emergency department inappropriately—for primary care or prescriptions, or as social centers. Three quarters of emergency medicine physicians expressed bias against these patients, and 59% had less empathy.[30]

An article in Family Practice Management[31] on the difficult patient discussed burnout as a possible factor in exacerbating a negative response to not only these patients but to any patient. "Physicians who are burned out, stressed and generally frustrated over near-term crises or long-term concerns are more likely to react negatively to patients, not just those with characteristics that may contribute to a difficult encounter. Recognizing our own trigger issues and knowing what personal baggage we bring into the exam room can be valuable."[31]

Figure 10. Burned-out Physicians With Bias Toward Patients With Emotional Problems

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