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Commentary on the paper by Bennett et al (see page 1112)
In the last few years a series of child abuse tragedies and fiercely contested murder trials has put paediatricians under the spotlight as never before. There is a growing reluctance among consultants and trainees to get involved in child protection. The attempt by Bennett and colleagues1 to measure and analyse the stress and burnout among child protection professionals in Canada is, therefore, very timely—but inevitably it also poses a number of further questions. Can slippery concepts like stress and burnout be reliably defined in operational terms? Is child protection different from other healthcare tasks and if so, does it affect different disciplines in different ways? Are there differences between countries and if so, do these relate to their cultural attitudes or child protection systems? Do stress and burnout affect people in other walks of life? And, most important, what are the risk factors for burnout and what might be done to reduce the risks of these (presumably) negative consequences of such work?
DEFINING THE TERMS2
The literature uses various terms with related but sometimes poorly defined meanings: stress, burnout, compassion fatigue, secondary traumatic stress reactions (STS) or vicarious traumatisation (VT), and traumatic countertransference (a psycho-analytic term).
Stress can be defined as “demands (internal or external) that are judged by an individual to tax or exceed their resources” and coping is defined as “behaviours, thoughts, and feelings adopted to protect against stress”. Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of mental and physical exhaustion, indifference and cynicism, and a sense of failure as a professional and as a person. The warning signs of impending burnout include anger, hostility, and reduced productivity …
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