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I think if any of these symptoms are showing up you might be saying, “Jill, should I start paying attention?” Yeah, I think so. I think it’s time to pay attention. It doesn’t mean you need to panic. It’s just– let’s pay a little attention to this and see if there are some ways that we can turn the direction of our ship so to speak.
Hello, and welcome to DocWorking: The Whole Physician Podcast. I’m Jill Farmer, one of the lead coaches at docworking.com. I am so glad you decided to join us today, because today we’re going to be talking about burnout. Now, as a physician, I know you have heard a lot about burnout. It’s been a very popular topic for the past few years as concerns have been increasing about the number of physicians who have experienced burnout, the number of physicians that even have left the profession because of burnout. So, it’s not uncommon for doctors to tell me, “I’m kind of burned out” talking about burnout. Still, I think, what’s missing often in the conversation about burnout is, it feels a little depressing because we’re not given anything to do about it. So, today’s conversation that I’m having with you, and the information that I want to share with you is designed to give you some tools to empower you, to identify burnout in yourself, or in colleagues, or in staffers, and to understand some ways that you can pivot, or move through burnout, or move back to where you were before you got to burnout with some tangible practical ideas. Okay?
This is not just another depressing conversation about how everybody’s burning out because they’re working so hard and all of these things. We’re going to be looking at some things that are researched and have certainly, I have seen in my own clients now, coaching physicians for more than a decade, who have been able to help themselves and often help those around them by understanding a little bit more about how burnout works. So, I’ll start with a story about a physician client. I’ll call her Stacy. She came to me and she said, “I’m exhausted no matter how much I sleep, I’m feeling frustrated and negative about everyone and everything at work,” and to top it all off recently, her supervisor had told her that her work wasn’t really up to par. I immediately said, “Ah, Stacy, you’re burned out.” She said, “How do you know that?” I said, “That was a classic case, literally, you just laid out the three most common symptoms of burnout here,” and I’m going to tell you a little bit more about those in just a couple of minutes.
We know that it was really in the summer of 2019, when the World Health Organization made it official, called burnout a bona fide syndrome, that it started gaining some more attention, not just around physicians, but across the board in business, and the dollar figure of $322 billion a year was given to the cost of burnout. Well, the cost of burnout to business is important. I’m not diminishing that. I’m more concerned about the cost that it takes on individual people. Losing their zest for life, their passion for doing work that matters, their ability to be in meaningful relationship, both in work and outside of work, and so, I think I want to focus a little bit more on that second part today, which is the individual costs of burnout and ways that we can mitigate that if you will and make it better.
I talked about Stacy and one of the first symptoms that she expressed was just being tired all the time, which is recognized as one of the common symptoms of burnout. I’m not talking about things like, “Well, I haven’t slept for four nights in a row. So, I’m tired because the baby’s been up or other circumstances that have created higher than normal levels of exertion.” When we’re talking about burnout exhaustion, it’s just a sense of– even when you’re getting the amount of sleep that you’re used to getting and doing the amount of work you’re used to doing, there’s zero energy and just kind of a general feeling of depletion or exhaustion. That’s another way that I would describe that.
The second symptom that we talk about a lot of times is negativity, which I know can be really nebulous and overly broad in a lot of cases. But specifically, when we’re talking about burnout, it’s things like being perpetually, right? Not just one time, not just circumstance, not just even for a few days, but more perpetually frustrated, feeling hopeless, passively aggressively cynical, perhaps have a hard time caring, cranky, irritable, critical of yourself and others even when you experience a success, and that’s extremely common in that situation. That’s what we’re talking about when we’re talking about negativity. Even beyond that, a lot of people will describe it as a hyperactivity or hyperactive stress response, the inability to shut down, or to set things aside, or an overreaction to triggers. So, something that didn’t used to bother you or would annoy you a little suddenly enrages you, right?
Another physician client I call Ron had a story about losing an entire night of sleep because of a perceived slight of a colleague. He said even a year before, something like that would have happened, and I would have taken a run, blown it off, and moved on. So, we’ve got– the symptoms are exhaustion, that kind of negativity which creates a hyperactive stress response that we described in a little more detail and then the third thing that we really look for is performance. Workplace efficacy is decreased as it’s described for those who are kind of professionals on the lookout for burnout. What do we mean by decreased workplace efficiency?
I don’t mean that you’re not perfect all the time. You’re not supposed to be. Perfectionism can be another contributing cause to burnout. But we’re talking more about spending a lot more time blaming, or shaming yourself, or other people, withdrawing from responsibilities, taking much longer to get things done, experiencing a lot of what productivity experts might call contaminated time where, when you’re at work, you’re thinking and distracted about things that have to do with home or things outside of work. Then when you’re home, you’re constantly thinking about things that are having to do with work. So, you are kind of contaminating the separation of those two things.
I think one of the experts that I have turned to in relation to this burnout, said it so beautifully, “That we can summarize burnout as exhaustion and fatigue paired with overreacting and under caring.” I think if any of these symptoms are showing up you might be saying, “Jill, should I start paying attention?” Yeah, I think so. I think it’s time to pay attention. It doesn’t mean you need to panic. It’s just– let’s pay a little attention to this and see if there are some ways that we can turn the direction of our ship so to speak. A lot of things have been written about it in the last few years about the causes of burnout, what is burning us out?
In general, one of the things that gets pointed to most often is that, when we are in high pressure, low control situations, when there is no break in pressure, or generalized a lack of autonomy, and in situations where we just feel like we’re busy all the time, and we cannot step off that hamster wheel. So, we know that high pressure, low agency circumstances are common in medicine. Particularly, when you are working in highly scheduled environments, depending on your discipline, the number of procedures and number of people that you’re seeing, patients that you’re seeing every day are often completely out of your control. So, you’re like, “Well, great. That’s just part and parcel. It’s a condition of my work that’s going to be required. So, am I destined for burnout?”
No, the thing that I think is important to remember here is even though that high pressure low agency situation can be a big cause of burnout, the other thing that we do have agency over and that often I see that physicians forget is when they get outside of those work hours, they subconsciously put themselves in situations where they have high pressure and low agency. So, they will say yes to all kinds of additional projects in academic medicine. “Yes, I’ll write that paper, yes, I’ll give that talk, yes, I’ll come do this, yes, I’ll join this board, yes, I’ll do this to volunteer here.” So, they end up inadvertently or subconsciously creating in that time outside of work situations where they have, again, other people’s deadlines, other people’s priorities, other people’s emergencies become theirs as opposed to leaving some open space in that time outside of work to have some agency in order to counterbalance what we know is a cause.
Of course, the number one cause of burnout is stress. I think when you’re like, “Great, yes. Well, what am I supposed to do about that, Jill?” Stress is part and parcel to this work. I think, it’s important for us to recognize, and this is one of the things physicians that I’ve worked with have come back and said was most helpful to them, is we talk about stress, but we then forget to really differentiate the difference between stressors and stress, which by that we mean an activated stress state. When we do that, then we forget to discern the difference between stressors that are within our control and stressors that are outside of our control. When we forget to make that discernment, we feel like everything’s bearing down on us. We have no control, we have no agency, we’re not in the driver’s seat of our own life.
When we take a little bit of time and say, “Oh, wait, here’s the stressors that are out of my control.” Things like there is a world pandemic going on or that according to the description of this job, I need to see x number of patients per day. But the other stressors in our life that we do have some control over, it’s important for us to identify those and reduce the amount of stress we let them create for us when we can. It’s also important that we reduce our stress to be able to, when we don’t have a control over a stressor like the weather, when we spend time and energy being frustrated, and complaining, and wailing, and gnashing our teeth against that stressor that we have no control over, we’re actually using a lot of mental and sometimes physical energy in that.
If you’re hyper focusing on the stressors and saying things like, if only that person would stop blank, which you have no control over. If only there wasn’t tax season, right? Can you imagine if we could just say that because of the stress of paying taxes? So, instead we need to think about how to better process our stress to get out of that vicious cycle where when we get stressed we’re likely to find everyday occurrences even more frustrating. When we’re in an activated state of stress, sometimes we falsely believe that that’s good, and that’s when we get things done, but we know that the research tells us it’s really not. The slightest bit of adrenaline can get us moving, but being in an activated stress state for long periods of time is not good for us and you already know that. So, I’m not going to belabor that.
The way to look at this that I have just really liked, probably better than anybody else’s process on this, is from a book by two authors, they’re sisters, Emily and Amelia Nagoski. And it’s called Burnout: The Secret to Unlocking the Stress Cycle. Because what they identify in this book, again, is to me a very practical, tactical perspective on burnout, which is one of the most effective things we can do to better manage or process our stress. They call it completing the stress cycle. Again, other people talking about burnout, treating burnout on the forefront of burnout, we’ll call it better processing your stress. You’re like, “Okay, yeah, everybody keeps saying to process my stress.” How do we do that? Very back to basics ways to complete that stress cycle have been identified to have a really meaningful impact on burnout. That includes exercise, which of course, burns or metabolizes the stress hormones. I don’t care what you do. Walk, dance, box, get an app on your phone that gives you a full body workout in seven to 10 minutes that you can take along with you and take breaks.
Secondly, we know that another way that we can complete that stress cycle and process stress better, which we know will reduce our likelihood of burning out over time, is mindfulness. Check out some really good podcasts on mindfulness and meditation that we have in this very collection of podcasts at DocWorking: The Whole Physician Podcast for some really good ideas on how to make mindfulness and meditation a part of your life no matter how busy you are as a physician. We know it’s important for burnout and for processing stress. We also know that community connection, paying attention to ways that we can be in community is important as well. It’s really common for me to hear from physicians who say, “Yep, I’m in the hospital, I’m around patients all day, I’m literally with people all the time, but I still feel lonely,” because of old imprints and the whole process of being competitive against colleagues that’s in place from undergrad to med school to residency, that can create this sensation of competing against colleagues as opposed to connecting to them in meaningful relationships or in harmonious ways, and that can lead to sensations of loneliness.
So, it’s often surprising to people that it takes some attention and intention to cultivate meaningful relationships when they’re around people all day. But it’s important. It’s important for the way that you metabolize stress for completing that stress cycle to have support, connections with other human beings that are beyond just kind of the normal work environment running into each other relationships or reporting to each other relationships. That does not mean you have to go make best friends with everybody you work with. That’s not your jam or they’re not your people, that’s fine. You just need to be intentional about cultivating relationships with people somewhere. It doesn’t mean more is better than that if you have hundreds of people in your circle. You just need some trusted thinking partners, support systems, people that you can have fun with. It just turns out it’s really good for people who are burned out to have meaningful relationships with other people. It helps a lot.
Then one of the most powerful, probably the most powerful, when I’ve worked with physicians who are burnt out, the most powerful antidote for treating burnout and I am not a physician, so, I’m using that incorrectly, I apologize. But one of the best ways to improve the symptoms of burnout that people have been experiencing, in my experience of working with folks as a coach, is to help them reconnect with and reidentify why their work matters, right? So, I had a client, I call him, Frank, leading physician, really in the country– one of the leading physicians in the country in his field, very, very, very, very well respected. And I could tell in our conversations and he could tell that he was experiencing some burnout. When I asked him, why did his work matter to him? It took him a really long time to answer the question and he hemmed and hawed, and he
I was like, “I don’t know, and I said, “Well, you’re saving lives.” He said, “Yes, and that does matter.” It’s not that that has stopped mattering, I’ve stopped caring about the people that I’m helping to treat and to– in many cases save lives or at least greatly improve the quality of their lives. But that had lost its spark to fire his engine, if you will, in the same way that had burned out literally that spark.
When we started talking about what really did matter to him, it was mentoring young physicians and leadership and different ways of making a difference beyond just “Yeah, I’m saving lives.” When he could re-identify more clearly for himself, he just kind of forgot to stop and think about it. So, if you’re feeling burnout in addition to doing a better job potentially of burning off stress with exercise, and mindfulness, and meditation, and being in community, and doing the things that we know work to complete that stress cycle, it’s also really important that you take the time to turn inward a little bit. And remember why this work matters to you. Not why it’s supposed to matter to the world or why somebody told you it should matter, but why it actually matters to you. Because that is going to be a powerful re-ignition switch for you in order to get that spark or that light burning in you again, if you feel like it’s been snuffed out or that it has burned out in a way that doesn’t feel good to you anymore. If you’re having a hard time defining for yourself why that work matters to you, that’s a good time for you to partner up with a trusted thinking partner. Of course, I’m biased but I think coaching is a really, really, really effective way to help that happen. It can be mentors. If you have the right mentor that is very caring and honest, and you have a really trusted relationship with them. It can be friends and partners as well.
But it’s finding somebody that you can really honestly go inside yourself with as a trusted thinking partner to help you identify for yourself why this work matters to you, because it’s going to be one of the most important ways you can either prevent burnout to shift gears if you’re starting to have some symptoms of burnout, or even to begin to treat burnout if you find that you’re really in that burned out mode.
I love talking about this stuff. I would love to hear from you as well. I hope you’ll reach out to me via any of our social media channels on Instagram or Facebook. Of course, docworking.com podcast has a whole library of wonderful conversation topics designed to really give you good information, to help you be the best physician you can be in your work and in your life. Until next time, this is Jill Farmer for DocWorking: The Whole Physician Podcast, and I look forward to seeing you again.
Amanda: Hello, and thank you for listening. This is Amanda Taran. I’m the producer of the DocWorking Podcast. If you enjoyed our podcast, please like and subscribe. We would also love it if you check out our website which is docworking.com. You can also find us on YouTube, Facebook, Twitter and on Instagram. On Instagram, we are @docworking1 and that is with the number one. When you check us out on social, please let us know what you would like to hear on the podcast. Your feedback really means a lot to us. If you’re a physician with a story you’d like to tell please reach out to me at [email protected] to apply to be on the podcast. Thank you, again, and we look forward to talking with you on the next episode of DocWorking: The Whole Physician Podcast.