Abstract: the authors investigated the burnout situation at family physicians divided in two different groups, one with Balint training and other without Balint training. Thus it is confirmed once again the protective role of Balint practice during the medical activity for escape from the burnout problems.
Key words: family physicians, burnout, Balint training.
Introduction
Freudenberger described the burnout syndrome (BS) in 1974. Initial this syndrome was described at the volunteers who activated for humanitarian organisation (1).
In 1983 Maslach define BS like a "syndrome of emotional exhaustion, depersonalisation and reduced personal accomplishment that can occur among individuals who do ‘people work’ of some kind” (2).
In 1994 Pines and Aaronson spread the application of BS to others workers and Karazman in 1998 utilised BS on the medical activities.
The aim of research
By this research we tried to find the influence of Balint group about the medical activity of family physicians.
Method and materials
For this research we used a questionnaire with 48 items linked in 12 themes. Every set by 4 questions corresponds of one problem that can appear in the medical activity: powerlessness, no information, conflict poor team work, overload, boredom, poor feed back, punishment, alienation, ambiguity, unrewarding and value conflict. Every item could be noted from 1 to 9 corresponding to frequency of appearing during the medical activity (1 – seldom and 9 – constant). By adding all the notes we obtained a score and by this we could identified the level of SB: 48 – 148 low level, 149 – 312 moderate level and 313 – 432 high level (3).
We applied this questionnaire to 2 groups: one made by 10 family physicians from Harghita County (which participated at Balint training) and 58 family physicians from Bihor County selected at random. We considered the second group as reference group because they didn’t participated at Balint training.
The composition of the Balint group was:
- 10% men and 90% women;
- 70% from village and 30% from city;
- 10% single, 10% divorced and 80% married;
- average age – 38 years;
- average length of service – 12 years;
- average number of patients – 1650.
Affirmative the length of service from Monday to Friday as 8 hours/day and 5 hours/week-end.
The composition of reference group was:
- 26% men and 74% women;
- 48% from village and 52% from city;
- 1,8% single, 10,3% divorced, 3,4 widower and 84,4% married;
- average age – 47 years;
- average length of service – 20 years;
- average number of patients – 1734.
Affirmative the length of service from Monday to Friday as 9 hours/day and 5 hours/week-end.
Results
The reference group had these scores: 13,8% low BS, 74,1% moderate BS and 12,1% high BS. The average score as 214.
For the Balint group scores was: 60% low BS, 40% moderate BS and the average score were 137.
In the reference group the highest notes was attributed to overload (average note 26,7), ambiguity (average note 21,3) and conflict (average note 20,3). The lowest notes were: value conflict (average note 14,7), poor teamwork (average note 15,4) and no information (average note 15,6).
In Balint group the highest notes was attributed to ambiguity (average note 17,7), overload (average note 16,3) and unrewarding (average note 16,3). The lowest notes were: no information (average note 9,1), poor teamwork (average note 10,8) and value conflict (average note 11,6).
According to the gender of physicians by the comparison of the average score we obtained the next results:
|
Reference group |
Balint group |
% difference |
|
|
M |
209 |
126 |
39,7% |
|
F |
222 |
138 |
37,8% |
Making a comparison between the average score according the place of office we obtained:
|
Reference group |
Balint group |
% difference |
|
|
Village |
196 |
169 |
13,8% |
|
City |
243 |
162 |
33.3% |
For analyze of score according to the age of physicians we divided the groups in 3 subgroups: under 35 years, between 35 – 50 years and over 50 years. Thus we obtained:
|
Reference group |
Balint group |
% difference |
|
|
< 35 years |
206 |
162 |
16,5% |
|
35 – 50 years |
217 |
162 |
25,3% |
|
> 50 years |
227 |
112 |
50,7% |
According by the civil status the comparison of the average score we obtained:
|
Reference group |
Balint group |
% difference |
|
Married |
226 |
175 |
22,5% |
|
Single |
222 |
127 |
42,8% |
|
Divorced |
182 |
112 |
38,5% |
|
Widower |
194 |
- |
- |
Discussions
The physicians from Balint group have scores of BS obvious better than the reference group made by physicians without Balint training. The difference between two groups vary between 13,8% and 50,7%, the average of difference was 32,1%. The average score of reference group was 214 comparison with 137 of Balint group (the percentage difference is 36,4%).
The teamwork and value conflict themes show a better approach of them who use the Balint method for patient – physician relation. At every categories of questionnaire (gender, civil status, place of office, age) the average scores shown a better value of physicians from Balint group than the reference group.
We can note that the problems shown at the reference group (overload, ambiguity and conflict) were spotlighted by other Romanian authors (4,5). These evidence confirmed the validity of reference group.
Conclusions
This research confirmed again, if there was necessary, the validity of observations others authors made by others groups. It’s obvious that the Balint training offer to the participants another mood of thinking in their activity and this special kind of approach save the mind and the spirit from the fail to sand bar of occupational and emotional exhaustion.
BIBLIOGRAPHY:
BURNOUT QUESTIONARRY
Powerlessness
1. I can't solve the problems assigned to me.
2. I am trapped in my job with no options.
3. I am unable to influence decisions that affect me.
4. I may be laid off and these is nothing I can do.
No Information
5. I am unclear about the responsibilities of my job.
6. I don't have information I need to perform well.
7. People I work with don't understand my role.
8. I don't understand the purpose of my work.
Conflict
9. I am caught in the middle.
10. I must satisfy conflicting demands.
11. I disagree with people at work.
12. I must violate procedures to get my job done.
Poor Team Work
13. Co-workers undermine me.
14. Management displays favoritism.
15. Office politics interfere with my doing my job.
16. People compete instead of cooperate.
Overload
17. My job interferes with my personal life.
18. I have too much to do into little time.
19. I must work on my own time.
20. My workload is overwhelming.
Boredom
21. I have too little to do.
22. I am overqualified for the work I actually do.
23. My work is not challenging.
24. The majority of my time is spent on routine tasks.
Poor Feedback
25. I don't know what I’m doing right or wrong.
26. My supervisor doesn’t give feedback on my work.
27. I get information too late to act on it.
28. I don’t see the results of my work.
Punishment
29. My supervisor is critical.
30. Someone else gets credit for my work.
31. My work is unappreciated.
32. I get blamed for others' mistakes.
Alienation
33. I am isolated form others.
34. I am just a cog in the organizational wheel.
35. I have little in common with people I work with.
36. I avoid telling people where I work or what I do.
Ambiguity
37. The rules are constantly changing.
38. I don’t know what is expected of me.
39. There is no relationship between performance and success.
40. Priorities I must meet are unclear.
Unrewarding
41. My work is not satisfying.
42. I have few real successes.
43. My career progress is not what I'd hoped.
44. I don't get respect.
Values Conflict
45. I must compromise my values.
46. People disapprove of what I do.
47. I don't believe in the company.
48. My heart is not in my work.
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