Being a #physician is a stressful job. There are intense demands on your time and often there is a shortage of resources. When we are put to the grind day after day and don't have a chance to recover, we become vulnerable to burn out.
We may be aware of the problem, but where are the solutions? Let's take a look at what options are available to you and start a conversation about where you want to go.
Three Stages of Burnout
According to Nicola Payne (2001) of the University of Hertfordshire in the UK, burnout consists of three stages. First, the job's chronic demands lead the physician to feeling emotionally exhausted. To be able to continue performing on the job despite this low energy, physicians become cynical. What this means is they stop seeing their patients in an empathic way. They begin to see them as just another appointment during their busy and stressful day. This is considered a coping mechanism. In other words, by not engaging too much emotionally, we are reserving our energy. But this comes at a cost. Low energy coupled with cynicism lead to a feeling that you're not accomplishing as much as you'd like. When we feel a lack of personal accomplishment, we lose our sense of meaning.
So imagine going to work day in and day out, feeling tired, feeling like you're just going through the motions, and feeling like you're not getting any meaning from your work. This is what #burnout feels like.
Effects of Burnout
We know burnout is caused by chronic #stress, which in this case is the high job demands coupled with low resources. The obvious solution to burnout would be to target the organization and decrease those demands while increasing the resources available to physicians. But that is not as easily accomplished. If you feel like your job is leading you to burnout and you can't change the system, let's focus on what YOU can do to help yourself.
It is well known that one in two physicians are burned out. This indicates the severity of the problem at hand. Surely, the unrealistic expectations we place on physicians largely contributes to this problem. But what are doctors doing to recover from work?
Many doctors suffer from #depression. This is not surprising given that they have lost their sense of meaning for their work. But why do we see double the suicide rates for physicians that we see for the general population? Perhaps it is because doctors aren't getting the help they need.
There has always been a stigma around mental health and sadly, in 2018, as I write this, there is still some stigma in existence around therapy.
Why is Therapy Important?
Depression can take many forms, but typically what we see is low mood and/or a change in your general interest level. You may find that activities which you typically enjoyed are no longer pleasurable. You feel numb or down for most of the day, nearly every day, and this lasts weeks or months. During this period, you experience other changes. If you lose your appetite and can't sleep, the two main forms for energy recovery are no longer there to help you between work shifts.
As a physician, you probably know all of this. Many of your patients might come to you when they are depressed because there is less stigma in seeing a medical doctor than in seeing a psychiatrist to get that prescription for anti-depressants. But when it's YOU that's depressed, who do you see? Do you ask for help? Are you taking steps to help yourself recover or are you isolating, pushing yourself too hard, and feeling ashamed for not being able to "get over it" yourself?
These are important questions. What it comes down to is #compassion. As a Psychologist, I can't write prescriptions for my clients, but I often tell them that if I had a prescription pad, what I would prescribe them is to use more self-compassion. Be kinder to yourself. Perhaps, reconnect to WHY you wanted to be a doctor. Chances are you wanted to serve others. You wanted to help other people feel better and be healthier. Well, what if you are the one that needs to feel better and be healthier? How can you bring yourself to get the proper care that you need? Not only will it benefit you, but it will allow you to enjoy your work more, which is kind of the point! Why go through all this if you can't get any joy or purpose from your job?
There are solutions that you can implement. We have to match the solutions to the symptoms of burnout symptoms. In order of importance, if you are feeling depressed or suicidal, the focus has to be on getting back to baseline. That means working to improve your mood and any other depression related symptoms. To overcome depression, it is recommended you work with a therapist. Some people opt for medications alongside therapy, but medications alone are insufficient. There are perhaps some coping skills therapy can address. If you suffer from #compassionfatigue, seek out trauma-related therapy.
If you're not depressed, but just stressed, there are two main points of focus. The first is around managing stress on the job. The second is around creating a wellness routine.
Managing Stress On The Job
What are the main stressors at work? Is it the number of appointments you have each day? Is it the administrative work you have to do between patients? Is it dealing with difficult personalities? Identify the main issue for you so you can start to outline solutions. The skills that are helpful on the job to help combat stress include effective communication skills, taking breaks, being organized, and staying positive.
Creating a Wellness Routine
The main reasons we don't focus on our own wellness when we are stressed is because we lack time and energy. Some people don't know what to do or feel #overwhelmed with all the other demands on their resources that they are out of steam when it comes to their wellness.
It's important to create a routine, a consistent set of behaviors you engage in daily, to ensure that you are taking care of yourself and have a chance to recover from stress. Here are my recommendations for professionals who don't have much time and want to increase their energy:
Wake up and drink a tall glass of water. This will help rehydrate your body and prepare it for digestion once you have your breakfast.
Spend 2 minutes stretching. You've spent all night in one position. Let your body wake up this way. It will help you feel more in tune with how you feel physically.
Spend 10 minutes meditating. If you've never meditated or find it hard to do so, start with a guided meditation or start with 5 minutes and build up to 10. Sit up tall on the ground, on a pillow, or if in a chair - ensure your feet touch the floor. Close your eyes and breathe. Notice, as you scan your body, where you feel tension or pain. Breathe into that area. Slow down your mind with your deep and slow breaths. It is recommended you use a timer and to keep yourself #accountable, keep count of your streak. The app Insight Timer, for example, does that for you.
Spend 5 minutes strengthening your upper and mid-body. For upper body, I recommend the a series of movements called Vinyasa or Chaturanga that are used in yoga, but you can also do a simple set of push ups. For your mid-body, work to build up to 100 sit ups. By working your core you'll protect your lower back from the effects of stress.
During the Day:
Continue to hydrate with water throughout the day. Many people drink coffee to get a boost of energy, but this only dehydrates the body.
Take mini-breaks throughout the day to stretch, step outside to breathe some fresh air, or to listen to soothing music.
Eat a healthy lunch and take time with this longer break to recover from the first half of your day. If possible, bring your lunch from home.
One of the biggest overlooked issues with regards to recovery from work stress is the transition between work and home. Find what works for you, but ensure that when you leave work, you engage in a ritual to help you decompress. This can include taking a long walk. If you have a long commute, it might be a good time to listen to relaxing music or a book on audio. You can take 10 minutes out when you arrive at home to sit quietly. Perhaps change out of your work clothes and into more comfortable house clothes.
It is tempting to continue working at home to catch up with the never-ending to do list. If that's something you can't avoid, ensure that you still have #boundaries about when you STOP to work. Don't let work take over your entire personal time.
Ensure that you are getting 7-9 hours of sleep each night. If you have a hard time falling asleep because your mind is racing, then take 10 minutes before bed to meditate, listen to relaxing music, or visualize a calming and relaxed you. Then get into bed. Keep a notebook by your bedside in case you have any thoughts you don't want to forget. Write them down and try to shut down your mind.
Weekly and Beyond
In addition to the daily routine above, it is recommended you find time throughout your week to exercise. This takes care of the lower part of your body which isn't addressed in the morning and incorporates aerobic movement for your heart.
Find time to reflect on what you're spending your time and energy on. Of the items you're focusing on, which do you want to keep and which do you want to get rid of? Are there items you'd like to incorporate that you haven't had time for? How can you rearrange your priorities to be more in line with what brings you joy?
Taking a vacation gives you multiple days away from work to hit the "refresh" button. Make sure you take vacations regularly and that you disconnect from work when you're on vacation so you can use the time to your benefit. Yes, work might pile up while you're gone, but taking this time for yourself is not an option. It's got to happen to prevent burnout.
If you are a physician working in North America, chances are that you are either burned out or on your way to feeling burned out. While it is essential for organizations to change their expectations, lower the demands on physicians, and increase their resources, those changes are harder for any physician alone to make.
To ensure you are recovering from the chronic stress of your job, create a wellness routine you can implement each day. Focus on what aspects of your life on and off the job are most stressful or the ones you like the least and think about how to shift what you spend your time on. By incorporating more self-care, managing stress, and reprioritizing your time, you can minimize the effects of burnout or maybe even avoid it altogether.