Physician burnout

The impact of patients' anxiety states on the specialist's emotional background

Constant contact with pronounced anxiety requires significant resources from the physician. Excessive anxiety in a patient may be a cry for help and the result of multiple factors: a reaction to an extraordinary situation, worsening somatic status, a panic attack, depression, or the onset of acute psychosis. Management varies depending on the clinical picture:

• In neuroses. Anxiety is chronic or periodic in nature. Simple reassurance does not work because, due to psychological defense mechanisms, the true cause remains hidden, even though the patient realizes the groundlessness of their fears. The main management method is systematic psychotherapy (referral to a specialist). Tranquilizers are used exclusively in cases of sharp decompensation (panic attacks), as they provide only a short-term effect.
• In depression. The condition is accompanied by akathisia, sighing, and a specific facial expression (especially in the elderly). There is an extremely high risk of suicide, requiring careful supervision and the involvement of a psychiatrist. Pharmacotherapy utilizes drugs with pronounced sedative effects: antidepressants (mianserin, mirtazapine), antipsychotics (levomepromazine, quetiapine, chlorprothixene), and tranquilizers (diazepam).
• In early dementia. Anxiety is associated with confusion, particularly at the onset of Alzheimer's disease. Due to memory problems, the environment seems frightening, and the patient may ask to go home even while being there. Hospitalization sharply worsens disorientation (the patient cannot find their bed or the toilet). Tranquilizers are not recommended in such cases due to the risk of weakness and coordination impairment. Small doses of antipsychotics are the drugs of choice (quetiapine, chlorprothixene, haloperidol drops). The physician must constantly explain what is happening in simple phrases ("I am your doctor", "Lunch will be soon").
• In acute psychoses. Restlessness may herald delirium, oneiroid syndrome, or acute paranoid states in a somatic hospital setting. These conditions can be triggered by medications (antiparkinsonian, antihypertensive, antituberculosis drugs, antiarrhythmics, hormones, weight-loss products), substance use disorders (alcoholism, drug addiction), or act as an acute attack of an endogenous process (schizophrenia).

Tactics in malingering, aggravation, and dissimulation

Attempts by patients to deceive the specialist are a frequent cause of conflict and stress. Malingering and aggravation are motivated by the search for specific benefits: allowances, draft exemption, or obtaining a plea of insanity.

The main mistake when exposing deception is a direct accusation. In response to an allegation of deceit, the patient activates psychological defenses, begins to file complaints, and seeks "proof" of being right, forcing the physician to justify themselves to management. Refusing treatment through a medical commission or announcing conclusions in front of relatives are also incorrect actions.

Optimal strategy:

1. Inform the patient about the lack of need for further treatment without direct accusations.
2. Give the patient an opportunity to "save face" and self-respect.
3. Express joy that there is no severe or dangerous disease.
4. Offer an outpatient solution for any remaining issues.

This approach allows the patient to realize that their ruse has been exposed and to accept the proposed exit without conflict. It is also important to remember that dissimulation (concealment of an existing illness) is always rooted in fear, rather than aggression or depression.

Communication psychology in complex situations

For effective contact and to reduce their own emotional tension, the physician needs to respond correctly to the patient's emotions. The main rule is to name the feelings experienced by the patient in words. Demonstrating detachment or mirroring emotions with facial expressions are considered incorrect tactics.

The following situations require a specific approach:

• Treatment of VIP patients. Managing high-ranking individuals involves heightened demands. It is necessary to organize additional consultations, show signs of attention, make concessions, and constantly report on the course of treatment to management.
• Medical professional in the role of a patient. It is important to realize that a colleague-patient is rarely objective in assessing their health. They cannot flawlessly diagnose themselves and do not differ significantly in optimism or pessimism compared to people without a medical background.

During the interaction, it is helpful to show the patient a good treatment outlook, and in some tense dialogues it may be appropriate to answer a question with a question. The foundation of trusting communication remains the principles of sincerity and gradual progression.

Class and exam questions

What else to study on this topic

• Mechanisms of forming a sense of self-fulfillment among medical professionals.
• The physician's unconscious needs when choosing a profession.
• Principles of sincerity and gradual progression in building a trusting contact.
• Phases of analysis in psychotherapeutic and clinical practice.

Other topics in the section "Chapter 31. Psychologically Complex Situations in Medicine"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.