This is a condition born of good intentions. Doctors who fall prey to it are, for the most part, individuals who have striven for perfection in their careers. It grows from unrealistic goal setting. Burnout is fostered by common personality characteristics of those that choose and succeed in emergency medicine. Near-compulsive overachievement, denial of one's limits, a low level of trust, distant interpersonal relationships, and independent self-sufficiency are common. An effect is that the processing of deep feelings is repressed. Instead of addressing their own symptoms of personal stress, physicians tend to project feelings of irritability, anger, and frustration on others: patients, nurses, and their families.

The ability to dissociate feelings from one's work is an adaptive coping mechanism for working with contagious disease and dangerous situations, but it can also help physicians ignore their own vulnerabilities. They may not recognize the toll that a lifestyle of little sleep, poor diet, and little time for recreation or reflection may be having on themselves and their families. Dissociation becomes deadly when the "it can't happen to me" philosophy is used to justify increasing alcohol and drug consumption or other self-destructive behaviors.

Fear of incompetence is nearly universal among physicians and is the source of many of the stressors related to medical decision making. When dealing with other people's lives, mistakes can have life-threatening ramifications. If one cannot accept his or her limits and the possibility of making a mistake, one must (at least hope to) be perfect and all-knowing, a situation that promotes arrogance and a strong need to defend against perceived criticism. Even symbolic challenges, perhaps by someone asking a question about care or interjecting a different opinion, can strike deep at defense mechanisms, frequently resulting in inappropriate physician behavior.

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