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Stress is necessary as a force that motivates. When excess stress becomes detrimental, it is more appropriately called distress. Much like Starling's law, each individual has his or her own curve with a point beyond which further stress causes less, rather than more, output.

As the stress syndrome progresses, providers attempt to decrease their contact with patients and staff, tend to become less respectful listeners, and order more tests and referrals. They may behave rudely and be quick to anger, argue, and blame.

Burnout is a state of physical, emotional, and mental exhaustion that occurs as a result of intense involvement with people over long periods in emotionally demanding situations. Physicians suffering from burnout often refer to a sense of lack of accomplishment in their work. Burnout within a department or organization usually is experienced as increased turnover, absenteeism, poor morale, and patient dissatisfaction.

Burnout symptoms in their extreme form are characterized by physical depletion and chronic fatigue, feelings of helplessness and hopelessness, and the development of negative attitudes toward self, work, life, and others. Among physicians, symptoms of burnout are thought to be potential precursors of more severe manifestations of impairment.

1. Hughes PH, Brandenburg N: Prevalence of substance use among US physicians. JAMA 267:2333, 1992.

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