LAUSR

DOI:10.1097/ACO.0000000000000597 Anaesthesiologists work in high stakes, demanding environments. Surgical patients are getting sicker and older, increasing stress on clinicians. Although new technologies have much to offer in improving patient safety (in my career, oximetry and capnography, simulation, and advanced airway management come to mind), they also allow surgeons and proceduralists to ‘push the limits’ in performing interventions on increasing numbers of patients with more and more comorbidities. External economic pressures, such as the Affordable Care Act and practice consolidation in the United States and threats to the National Health System in Great Britain, also affect clinicians’ work environments. We are often asked to do more with less, and faster! In many cases, this can result in maladaptive behaviours both in clinical environment (bullying, disruptive and passive/aggressive behaviours that weaken team performance), and at home (work life conflict, sleep deprivation, pharmacologic coping). Multiple surveys attest to increasing levels of burnout in physicians in general, and anaesthesiologists specifically. Substance abuse disorder, suicide, depression, disability and early retirement threaten to then further reduce the numbers and effectiveness (’presenteeism’) of the clinical workforce. We have assembled in this volume an international group of experts to examine these issues. Dr van der Wal et al. (pp. 351–356) from Radboud University Nijmegen Medical Center in the Netherlands examine the relationships between personality types and the subsequent development of burnout. In particular, they identify neuroticism as a precursor to burnout. However, it is not clear that identifying physicians at a higher risk of subsequent burnout based on personality type should guide trainee selection for entry into the field. In a separate article, Drs Saadat (Quinnipiac University) and Kain (University of California, Irvine, California, USA) (pp. 375–381) examine the physiologic effects of stress and highlight individual differences in physiologic response. In the operating room, we find a number of contributors to stress and burnout. While technology and electronic medical records have been touted as solutions to clinical inefficiency and information