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This paper explores how coping styles relate to physicians' feelings of emotional exhaustion, a key dimension of burnout. We also explore whether four coping styles are more or less effective depending on certain dispositional and/or situational factors. We analyze survey data from 1,110 physicians in Western Canada. Denial is significantly related to physicians' emotional exhaustion, but it increases rather than decreases it. Physicians use denial when they experience work overload and difficult patient interactions. Furthermore, it is used by those with high negative affectivity. A highly positive outlook, however, appears to neutralize the harmful relationship between denial and emotional exhaustion. The harmful experiences related to stressful patient interactions are weakened for doctors who disengage or take a time out from the situation. We conclude that certain coping strategies are more effective depending on personality type and the type of stress encountered. KEYWORDS: burnout, job stress, denial, personality, professionals This paper examines how different coping styles that physicians use relate to emotional exhaustion, the key defining dimension of burnout. Specifically, we examine the extent to which they use active problem solving techniques, seek support, disengage from the situation or use denial as a coping strategy. In addition, we also explore whether the coping styles are more or less effective depending on certain dispositional and/or situational factors. Two individual predispositions are examined in this study in terms of positive and negative affectivity, as optimism and pessimism are stable personality traits that have implications for how individuals view situations and respond to them. Four different sources of physician work stress are examined to reflect the situational factors: work overload, patient interactions, average weekly work hours at work, and average weekly work hours at home. We analyze survey data from 1,110 practising physicians in a single health region in Western Canada. The overall pattern of results suggests that physicians' individual dispositions are relevant to understanding the coping styles that they adopt. Physicians appear to use denial as a coping strategy when they experience work overload and difficult patient interactions. Furthermore, it is used by those with high negative affectivity. However, having a highly positive outlook appears to neutralize the harmful relationship between denial and emotional exhaustion. This supports the literature that argues that the effects of different coping styles may depend on the personality traits of who uses them. In addition, the harmful experiences related to stressful patient interactions are weakened for doctors who disengage or take a time out from the situation. This supports the literature that suggests that certain coping strategies may be more effective depending on the situation or type/source of stressor. Our findings suggest that certain coping strategies may be more effective depending on personality type and the type or source of stress encountered. KEYWORDS: burnout, job stress, denial, personality, professionals Cet article examine comment differents modes d'adaptation utilises par les medecins sont relies a l'epuisement emotif, la dimension-cle de l'epuisement professionnel. Plus particulirement, nous examinons dans quelle mesure ils ou elles font appel a une forme active de resolution de problme, cherchent a obtenir du support, se dissocient de la situation ou utilisent le deni comme strategies d'adaptation. De plus nous explorons egalement dans quelle mesure les modes d'adaptation sont plus ou moins efficaces selon certains facteurs situationnels ou lies aux predispositions des personnes. Deux predispositions personnelles sont examinees dans cette etude en termes d'affectivite positive ou negative, etant donne que l'optimisme et le pessimisme sont des traits de personnalite stables qui ont des implications sur la manire dont les personnes percoivent les situations et y repondent. Quatre sources differentes de stress chez les medecins sont examinees afin de refleter les facteurs situationnels : des situations de surcharge de travail, les interactions avec les patients, le nombre hebdomadaire moyen d'heures passees au travail et le nombre hebdomadaire moyen d'heures passees a la maison. Nous analysons les donnees d'une enquete menee auprs de 1,110 medecins pratiquant dans une meme region de l'Ouest canadien. Une vue d'ensemble des resultats suggrent que les predispositions personnelles des medecins sont pertinentes dans la comprehension des modes d'adaptation auxquels ils recourent. Les medecins semblent recourir au deni comme strategie lorsqu'ils sont en situation de surcharge de travail et lors d'interactions difficiles avec des patients, particulirement chez ceux et celles qui affichent une affectivite negative. Toutefois, le fait d'afficher une affectivite positive semble neutraliser les relations pernicieuses entre le deni et l'epuisement emotif. Cela vient en appui a la litterature suggerant que les effets des divers modes d'adaptation dependent des traits de personnalite de ceux qui y ont recourt. De plus les experiences douloureuses liees aux interactions stressantes avec des patients sont moins presentes chez les medecins qui s'en dissocient ou qui prennent un temps d'arret face a la situation. Cela vient aussi en appui a la litterature suggerant que certaines strategies d'adaptation peuvent s'averer plus efficaces selon la situation ou le type des facteurs de stress ou leur source. Nos resultats suggrent donc que certaines strategies d'adaptation sont plus efficaces selon le type de personnalite et selon le type de facteurs de stress rencontres ou leur source. MOTS-CLES : epuisement professionnel, stress lie a l'emploi, personnalite, professionnels Este articulo examina como los diferentes estilos de afrontar el estres que usan los medicos son asociados al agotamiento emocional, dimension clave de la definicion del surmenaje. En concreto, se analiza en que medida los medicos utilizan de manera activa ciertas tecnicas de resolucion de problemas, buscan a obtener apoyo, se retiran de la situacion o usan la negacion como estrategia de afrontamiento. Exploramos tambien si los estilos de afrontamiento son mas o menos eficaces en funcion de ciertos factores situacionales o vinculados a predisposiciones personales. En este estudio se examinan dos predisposiciones individuales en terminos de afectividad positiva o negativa, dado que el optimismo y el pesimismo son rasgos estables de la personalidad que tienen implicaciones en la manera como las personas perciben las situaciones y como las enfrentan. A fin de reflejar los factores situacionales, se examinan cuatro diferentes fuentes de estres en el trabajo medico: sobrecarga de trabajo, interacciones con los pacientes, promedio semanal de horas de trabajo, y promedio semanal de horas de trabajo en casa. Los datos analizados provienen de una encuesta con 1110 medicos que ejercen en una region sanitaria del Oeste Canadiense. El patron general de los resultados sugiere que las caracteristicas temperamentales individuales de los medicos son pertinentes para comprender los estilos de afrontamiento que ellos adoptan. Los medicos parecen utilizar la negacion como estrategia de afrontamiento cuando experimentan sobrecarga de trabajo e interacciones dificiles con el paciente. Mas aun, esto es utilizado sobre todo por las personas con alta afectividad negativa. Sin embargo, tener una actitud muy positiva parece neutralizar la relacion perjudicial entre la negacion y el agotamiento emocional. Esto apoya la literatura que sostiene que los efectos de los diferentes estilos de afrontamiento pueden depender de las caracteristicas de personalidad de quienes los usan. Ademas, las experiencias perjudiciales asociadas a las interacciones estresantes con el paciente son menos presentes en los medicos que se desvinculan o se alejan temporalmente de la situacion. Esto apoya la literatura que sugiere que ciertas estrategias de afrontamiento pueden ser mas eficaces en funcion de la situacion o el tipo/fuente de estres. Nuestros resultados sugieren que ciertas estrategias pueden ser mas eficaces en funcion del tipo de personalidad y del tipo o fuente de estres encontrado. PALABRAS CLAVES: surmenaje; estres ocupacional; negacion; personalidad; profesionales, Introduction While 'people work' can be extremely rewarding and gratifying most of the time for many workers, it can also be a stressful line of work for countless health care [...]

Background: Working within the landscape of death and dying, professionals in palliative and hospice care provide insight into the nature of mortality that may be of benefit to individuals facing the end of life. Much less is known about how these professionals incorporate these experiences into their personal lives and clinical practices. Methods: This ethnographic inquiry used semi-structured interviews and participant observation to elicit an in-depth understanding of the impact of death and dying on the personal lives of national key leaders (n = 6) and frontline clinicians (n = 24) involved in end-of-life care in Canada. Analysis of findings occurred in the field through constant comparative method and member checking, with more formal levels of analysis occurring after the data-collection phase. Results: Eleven specific themes, organized under three overarching categories (past, present and future), were discovered. Early life experiences with death were a common and prominent feature, serving as a major motivator in participants' career path of end-of-life care. Clinical exposure to death and dying taught participants to live in the present, cultivate a spiritual life, reflect on their own mortality and reflect deeply on the continuity of life. Interpretation: Participants reported that their work provided a unique opportunity for them to discover meaning in life through the lessons of their patients, and an opportunity to incorporate these teachings in their own lives. Although Western society has been described as a 'death-denying' culture, the participants felt that their frequent exposure to death and dying was largely positive, fostering meaning in the present and curiosity about the continuity of life., Although preserving life is a central goal of medicine, in the end, death is an unavoidable outcome. Professionals in palliative and hospice care, working within the landscape of death and [...]

The CMAJ is to be applauded for featuring the research by Sinclair (1) examining the impact on physicians of dealing with death and dying. Although it has important implications for [...]