Physician Burnout: Breaking the Cycle
As the pace of the healthcare world increases annually, the risk of physician burnout increases with it. In the preceding articles in this series, we discussed the characteristics of physician burnout, its symptoms, and its causes. Though it can look similar to stress, burnout is a much more serious psychological issue with lasting effects on not only the physician but his or her family and medical community. Therefore, the healthcare profession at large must learn to not just detect, but prevent physician burnout, rather than simply treating it after it has become an issue.
There are three strategies to preventing physician burnout, and when utilized simultaneously, they can have a significant impact on the mental, emotional and physical health of care providers: treating the whole person, distinguishing between stress and burnout, and increasing awareness about the source of burnout.
To successfully combat physician burnout, the medical community must learn to treat the whole person rather than individual symptoms and causes. The state of impairment can result from a combination of several factors that affect the mind, body and emotional well-being of a person. These include physical components, such as nutrition, exercise, and sleep; emotional and mental components like self-awareness, self-image and self-reliance; and spiritual components such as meaningful work and meaningful relationships. All of these aspects of life are part of the psycho-stressors involved in stress and burnout. Treating the whole person means not restricting restorative life changes to the work environment, but also promoting a strong support system of family and friends. Encouraging the development of deep, strong connections with others is crucial to minimizing stress and the risk of burnout in physicians. The medical culture should also cultivate the ability to resolve conflict constructively and in a healthy way, as well as the ability to manage one’s own personality — both the positive and negative tendencies — effectively. These holistic prevention and maintenance tactics are not often thought to be necessary parts of practicing medicine and therefore are not taught or developed early on in a physician’s career. But they are the key to eliminating the need for intervention and alleviating conditions that otherwise may have led to physician impairment.
As previously mentioned in preceding articles, stress and burnout are not one and the same. Don’t confuse one for the other. Stress primarily manifests physiologically, while burnout is a psychological injury. Stress can often be assuaged by rest, proper nutrition and exercise, and life coaching. Burnout is a more devastating blow to one’s life, developed over an extended period of time. It can lead to complete physical and emotional collapse. So while detecting signs of stress and burnout can be similar, the diagnostic definition of the condition, and therefore its treatment, is very different.
Finally, it’s important to increase awareness within the medical community and specifically your organization concerning the causes of burnout. Often, the triggers of stress and burnout are confused with the actual underlying cause. Details like long hours, increasing regulatory compliance requirements, practice management problems, financial issues, increasing complexity of technology, poor or absent leadership, and poor relationships are often identified as the source of stress and cause of burnout. These factors do influence a physician’s life, but someone who has a strong sense of self, a consistent state of general well-being and a practiced resilience will not be as strongly affected by day-to-day complications as someone who does not. In cases of burnout, these everyday life stressors are simply the triggers for increasingly dysfunctional responses. Practical changes can be made to schedules, requirements, timelines and leadership, but these temporary fixes cannot be cobbled together as lasting remedy for burnout. A healthy view of self and others is, therefore, crucial to preventing this severe condition. Creating resilience, strengthening internal well-being and developing an appropriate view of life are the only ways to establish a firm personal foundation on which to stand when the stressors come and avoid burnout. Ideally, this training would begin educationally in medical school and continue through residency. It must be a part of physician leadership development across the board and an ongoing part of career training as well as peer-to-peer dialogue surrounding wellness.
Minimizing and preventing physician burnout is not an overnight fix. It will require a full shift in the culture of medicine. Providers should not be viewed as the omnipotent, omniscient, invulnerable super-humans often alluded to by the public, media, healthcare industry and even patients themselves. When culture at large can shed the stereotypes and understand physicians as real people — gifted, called and highly skilled, but living life like everyone else — we will equip our community and our physicians with the ability to provide even better care for patients as well as themselves.
Mother Theresa said of doctors, “How full of love your heart must be, because the sick, the lonely, the disabled come to you with hope, and that is why they must be able to receive from you that tender love, that compassion.”* But healers must first have hope and compassion for themselves, otherwise, how can they have it for others?
*The Joy in Living: A Guide to Daily Living, Penguin Compass, p.344