The worst thing I remember from being burnt out wasn’t losing my practice or my health, it was missing out on celebrating our daughter’s birthday. Lacking the energy to haul myself out of bed, let alone get dressed, I could only listen to the happy sounds of the party at the other end of the house while feeling horribly guilty and ashamed.
While it’s great to wear the superhero’s cape, saving the world and its occupants from the ravages of illness and disease, doctors need to keep sight that we are human, with the same physiological and psychological needs as everyone else.
Having the smarts to get into medicine doesn’t provide superpowers to go beyond the limit of normal human endurance, regardless our high personal standards of professionalism and perfectionism.
It’s time to stop justifying and accepting overwork and chronic fatigue as “business as usual”.
First described by the psychiatrist Freudenberger in 1975, burnout is now classified as an “occupational phenomena occurring as the result of unmanaged stress”, not infrequently accompanied by anxiety, panic attacks and/or depression.
Medscape reported 42% of American physicians are burnt out, with Australian practitioners experiencing similar levels of emotional exhaustion and psychological distress. Burnout is like a fire out of control.
As a high achiever and hard worker, dedicated to your work and passionate about what you do, it can be hard to acknowledge that the fire’s gone out of your belly, that you’re feeling irritated and emotionally distanced from your patients, and just so wretchedly tired. Denial can be very seductive as a firebreak.
But ignoring those signals of distress, the growing sense of frustration and chronic fatigue wears us down to the point that something gives, which is when it can all get awfully messy.
Why don’t we speak up?
As doctors, admitting that we’re not coping, are emotionally exhausted and feeling terrible remains clouded in stigma. This is due to denial, fear of being judged as weak, or worse, incompetent, fear of losing our ability to practise medicine, our job and future opportunities with self-sacrifice being culturally seen as a sign of commitment and dedication. There is also a lack of support from the system and reluctance and embarrassment at being a patient
Self-care is an important start but does not always sit comfortably, or get done. It smacks of self-indulgence, takes time and extra commitment, which when you’re so tired can be hard to find the motivation for. We need change at a systemic level.
The lead up to Christmas can be especially wearing. The last quarter of the year can feel like the last lap of a very long race uphill. Hanging out for a few days or weeks of respite over the festive season seems great, but is insufficient to allow you to fully restore and recover. Tips for reducing risk are in the table.
Burnout is such a waste. It’s time to turn the tide and look at better ways to stay safe and deliver great work, making a positive difference to the health and wellbeing of our patients.
Reducing the risk
- Start with the basics. Yes, it matters to get some regular exercise, take a proper lunch break and get enough good quality sleep.
- Consider mindfulness meditation or self-compassion training to act as a buffer against stress
- Commit to non-work activities you find rewarding or give you joy. Volunteering and charity work take us out of our normal sphere of always working, helps to lower stress and elevates mood
- Check in regularly with yourself. Are you undertaking those decisions you made to avoid overwork and adhering to taking regular time off; that quarterly long weekend and annual vacation?
- Make wellbeing a practice priority for everyone
- Review workplace practices including the handling of clerical work and appointments. What can be eliminated, improved on or reduced?
- Regular practice meetings and social events provide an opportunity to make talking about wellbeing and mental health issues the norm. It’s easier to find the courage to share how things are going, when you enjoy a higher level of camaraderie and trust with your colleagues. Sharing stories is also a great way to help you reconnect to your purpose and meaning.
References available on request.
Questions? Contact the editor.
Author competing interests: the author works for a group providing imaging.
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