Physician Distress and Burnout: The Neurobiological Perspective.
Physician Distress and Burnout: The Neurobiological Perspective.
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医生的痛苦和倦怠：神经生物学的观点。
DOI：
10.1016/j.mayocp.2020.12.027
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发表时间：
2021-03
影响因子：
8.9
通讯作者：
Shanafelt T
中科院分区：
文献类型：
--
作者：
Arnsten AFT;Shanafelt T
医生职业倦怠及其他形式的职业困扰是现代医学中的一个重大问题，在新冠疫情期间尤其如此，然而很少有医生熟悉导致这些问题的神经生物学原理。职业倦怠与一些变化有关，这些变化会降低医生对自身执业的掌控感，破坏与患者和同事的关系，干扰工作与生活的平衡，并导致无法控制的压力。大脑研究表明，不可控的压力（而非可控的压力）会损害前额叶皮质的功能，前额叶皮质是一个新近进化的大脑区域，对思维、行动和情绪进行自上而下的调节。前额叶皮质控制着许多对医生至关重要的认知操作，包括抽象推理、高阶决策、洞察力以及克服挑战的能力。然而，前额叶皮质非常依赖唤醒状态，在疲劳和/或不可控压力条件下，当唤醒调节剂（如去甲肾上腺素、多巴胺、乙酰胆碱）水平不足或过高时，其功能会受到损害。随着慢性压力的暴露，前额叶灰质连接会丧失，但可通过缓解压力得以恢复。前额叶皮质自我调节能力的降低或许可以解释与医生职业倦怠相关的一些挑战，包括动力下降、不专业行为以及与患者沟通欠佳等。了解这种神经生物学原理可能有助于医生以更明智的视角来缓解或预防职业倦怠症状，也可能有助于行政领导优化工作环境，打造更高效的组织。努力恢复医生的掌控感可能尤其有益。
Physician burnout and other forms of occupational distress are a significant problem in modern medicine, especially during the COVID19 pandemic, yet few doctors are familiar with the neurobiology that contributes to these problems. Burnout has been linked to changes that reduce a physician’s sense of control over their own practice, undermine connections with patients and colleagues, interfere with work–life integration, and result in uncontrolled stress. Brain research has demonstrated that uncontrollable stress, but not controllable stress, impairs the functioning of the prefrontal cortex, a recently evolved brain region that provides top-down regulation over thought, action and emotion. The prefrontal cortex governs many cognitive operations essential to physicians, including abstract reasoning, higher order decision-making, insight, and the ability to persevere through challenges. However, the prefrontal cortex is remarkably reliant on arousal state, and is impaired under conditions of fatigue and/or uncontrollable stress when there are inadequate or excessive levels of the arousal modulators (e.g. norepinephrine, dopamine, acetylcholine). With chronic stress exposure, prefrontal gray matter connections are lost, but can be restored by stress relief. Reduced PFC self-regulation may explain several challenges associated with burnout in physicians including reduced motivation, unprofessional behavior, and suboptimal communication with patients. Understanding this neurobiology may help physicians have a more informed perspective to help relieve or prevent symptoms of burnout, and may help administrative leaders to optimize the work environment to create more effective organizations. Efforts to restore a sense of control to physicians may be particularly helpful.
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影响因子：
34.7
作者：
Arnsten, Amy F. T.
通讯作者：
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影响因子：
10.6
作者：
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影响因子：
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作者：
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通讯作者：
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DOI：
10.1073/pnas.0908563106
发表时间：
2009-10-20
影响因子：
11.1
作者：
Hains, Avis Brennan;Vu, Mai Anh T.;Arnsten, Amy F. T.
通讯作者：
Arnsten, Amy F. T.
DOI：
10.2478/s13382-013-0093-3
发表时间：
2013-01-01
影响因子：
2
作者：
Kakiashvili, Tamar;Leszek, Jerzy;Rutkowski, Krzysztof
通讯作者：
Rutkowski, Krzysztof