Resident physicians are in the most stressful stage of their medical career. Normal stress may increase to the point where it becomes abnormal stress, which is thought to achieve a critical level at some point. This abnormal stress level can then lead to burnout; burnout can lead to impairment. Both professional and personal stresses make huge demands on the resident's time. Unfortunately, there are only 24 hours in a day, and as a resident physician that day includes very little, or no, free time. Learning medicine at this level requires a greater level of involvement in patient care and responsibility.

The daily actions of ordering medication, following outcomes of tests and communicating with patients and their families all fall upon the resident. The resident is still supervised by the attending physician. As during medical school, residents must learn to manage enormous amounts of information, new research, treatment protocols and processes of medical practice. This requires a great deal of study-time, as well as time in lecture, discussion groups, and journal clubs in order to learn their specialties.

An additional demand occurs in residency. Residents become teachers

"Burnout is a cumulative process leading to emotional exhaustion and withdraw," says John-Henry Pfifferling, Ph.D., director of the Center for Professional Well-Being in Durham, N.C. The symptoms of burnout are as varied as the sufferers. Some people become angry, blowing up or growling at anyone who crosses their path, including other physicians. When asked to relate the most stressful position he had been in, one resident physician at University Hospital stated, "One time on call, there was a resident who was so tired and fed up with his pager going off, that he flushed the pager down the toilet. He then turned around and went back to sleep." Some resort to blaming any annoyance, large or small, on external factors. Some become quiet, introverted and isolated, which can indicate the start of a serious depression. Others manifest burnout by under- or overeating or abusing alcohol or other mood-altering substances. My experience with physicians using mood-altering substances would be this last Halloween. I went to a resident physician's Halloween party and when I walked in, the majority of physicians were smoking marijuana. I couldn't help but notice the irony.

less time with patients, exhibiting tardiness and absenteeism, medication errors, poor record keeping, impersonal or stereotyped communications, sarcasm, and cynicism. The physician often searches for relocation, is ineffective with patient care, misses deadlines and procrastinates, avoids interactions at home and work, and has frequent tearful or emotional outbursts. Physical symptoms of burnout include a rapid pulse, insomnia, fatigue, reduced resistance to infection, weakness and dizziness, memory problems, weight changes, hypertension, and head, back or muscle aches. Spiritual symptoms of burnout include doubt concerning one's value system or beliefs; drawing conclusions that a major change is necessary such as divorce, a new job, or relocation, and becoming angry or bitter at God and withdrawing from fellowship.

Managing their personal lives bec

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