Physician burnout is a syndrome of emotional exhaustion, depersonalization and a sensation of low personal accomplishment. It is a culmination of unresolved frustration, a sense of being overwhelmed with no way out, often leading to feelings of numbness, exhaustion, lack of interest, low self-esteem and even depression or suicide in the extreme cases. It can bring even the most concerned and compassionate physicians to a state of uncaring irritability. It is unhealthy at best and dangerous at its worst for both the physician and the patient.
The underlying causes of burnout are complex, but usually contain the elements of a once dedicated professional, who prides himself on his work, somewhat of a perfectionist - detail-oriented and wanting sincerely to do a good job - who is faced with a constant, unending barrage of an overwhelming workload that goes on day after day after day with no stop-date and no obvious or easy way to get out of it. There is a tremendous internal conflict between personal expectations of perfection (or at least meeting certain personal standards) and the external forces making perfection an impossibility. Even when a much needed vacation comes up, there is a greater amount of work to do before the first day off and for the first several days after coming back, so that a vacation is not something to look forward to, but only something that is going to increase the workload. Within minutes after returning to work, the same symptoms of frustration and resentment return immediately.
Most of us can deal with this for a while, but at some point, ultimately, the burnout sets in. What were once personal and professional challenges and opportunities become unending chores and burdens. Caring about patients gives way to numbness because there is no way that you can do a good job for that person in front of you because you don’t have the time. So you just go through the motions, becoming detached from your patients, not really listening to them, just trying to get through the day. You know that’s not really the right thing to do and that patients don’t like it, but there doesn’t seem to be any alternative. You become aware of mistakes that are occurring, which just increases your anxiety, and lowers your self esteem that much more. Because we are professionals, some of us try to put on a good show and hide the misery, but some of us are unable to do this, unfortunately, allowing our resentment and irritability to find their way to the front. Bedside manner suffers, but even worse, patients don’t get good care.
I would wager that most, if not all, physicians and other health professionals have experienced burnout at one time or another. Nor is burnout unique to the health professions, although it is often discussed in relationship to them. Health professionals tend to lend themselves to this problem because they basically, ironically, really do care or they wouldn't have gone into this profession to begin with. They tend to be detail-oriented perfectionists, a little obsessive-compulsive and expecting themselves to perform to a high level of standards. When they are not able to perform the way they expect themselves to perform, which is at times unrealistic under the circumstances, then the professionalism falls apart and gives way to not caring, which serves as a defense against the extreme frustration.
So how can we prevent this problem of burnout, guard against it, or get ourselves out of it when it inevitably occurs?
An article in JAMA, Vol.302. No. 12, Sept.,23/30, 2009, entitled "Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians", by Michael Krasner, et al reported a study showing that a program of mindfulness meditation, narratives, interviews and discussions about meaningful clinical experiences seemed to help reduce burnout and improve empathy and mood in the 70 primary care physicians studied - both in the short term and the long term (15 months). Comments by other physicians about the article suggest that although this may be helpful for some, this intervention only attacks the internal portion of the problem. The external factors remain, which if unresolved, will likely lead to the recurrence of symptoms eventually.
Nonetheless, those internal factors are important, and meditation, self-awareness and reflection should become a part of our daily lives. Try to include a few minutes of this several times a day as much as possible. You can do this while driving to work or at mealtimes. If nothing else, escape to the bathroom for a few minutes and take some deep breaths while trying to remember why you are doing what you’re doing.
Go to conferences. Try to rekindle your interest in the scientific aspect of medicine. Try to recapture what you enjoyed about the study of medicine in the first place. Go back to work with a renewed interest in taking care of your patients using the knowledge you’ve acquired at the meeting.
Exercise regularly. Eat right and try to take care of yourself. Physical deterioration only adds to the burden of the daily grind and makes it worse than it needs to be. See a doctor yourself. Stay healthy. DON’T use alcohol or other drugs as an escape.
Do something for fun outside of medicine. Take up a hobby or sport. This helps you to realize that there is another world out there for you to enjoy.
Socialize with other physicians who are going through the same thing but avoid those who are constantly negative.
Write poems or essays mostly for yourself that may help you understand yourself, your role and position in this universe, what you mean to others. Keep a private journal containing short narratives about clinical experiences that have been meaningful or that have helped you grow as a person and as a professional.
Try to keep things in perspective. Maintain balance between your work and your lifestyle. Don’t allow yourself to be consumed by one or the other. If you have too many bills that force you to remain in a work environment that you can’t tolerate, sell your house or trade in your car so that you don’t have to work so hard to maintain these things.
Religious and spiritual involvement may help you find more meaning in life and in what you do for others.
Remember that there are always options. Sometimes, we feel like we’re trapped in situations that we can’t get out of, but if you sit down and think about it, you can usually find a workable solution. Sometimes, it may involve a move or a job change, both of which can be pretty daunting, but the reward of getting back to a more enjoyable work environment may be well worth it.
If you feel stuck, don’t let the situation get so bad that you become chronically bitter or depressed. Seek help from a counselor or psychiatrist. Talk about the situation with family members. Don’t resign yourself to an unhappy professional career. Make the changes that you need to make so that you can get back to providing good patient care because that, in the end, is what you are all about, that is what you do best and that is why you are here.
This page was last updated on August 16, 2015.
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