Burn-Out

Posted: January 7, 2007 by Doc in Endings, Medical, Medical career, Medicine

It starts with a rumor, whispered in hushed tones among classmates and co-workers, as if  some misfortune had befallen or as a cautionary tale. “Did you hear about so-and-so? He/ she was in the prime of her career when BAM!, up and quits his/ her practice, moved out of town.  Couldn’t handle it. What a shame, what a waste.” And we all shake our heads, secretly wondering whether we might be next.

It happened to one of my best friends.  She was a superb physician, giving 200% to her cancer patients.  But the demands of family and career proved to be too much and she quit her practice and decided to stay home with her kids.  She is happy, and her family is happy.  But she has to continuously keep justifying her decision to friends, her parents, and colleagues.  It was the right decision for her, because this is what she had to do for her own sanity.  She would not have been of much use to her patients or her family if she persisted in a career that was making her miserable.  I do not believe her training and education were wasted because she helped many many people while she was practicing and the experience made her a wiser, better person and parent.  Furthermore, she had the courage, which most of us lack, to recognize and admit that she was miserable and to make a very painful change.

The medical culture does not encourage admitting to vulnerability or weakness, in fact in the lingo of residency training, trainees who do not perform up to standards are called “weak” and are stigmatized.  We are taught to “soldier on”, similar to the reports about war veterans with Post-Traumatic Stress Syndrome who feel ashamed for admitting that they have a problem and need help. 

In a study on medical career burn-out conducted by Vanderbilt University, it is characterized by “emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment”.

The study goes on to conclude that: 

“Preventing burnout-a responsibility of all physicians and of the healthcare organizations in which they work-entails the explicit promotion of physician well-being.  Physicians must be guided from the earliest years of training to cultivate methods of personal renewal, emotional self-awareness, connection with social support systems, and a sense of mastery and meaning in their work.  Maintaining these values is the work of a lifetime.  It is not incidental to medicine, but is at the core of the deepest values of the profession:  ‘First, do no harm.’ 

Harmlessness begins with oneself.  If physicians hope to heal the distresses of the 21st century and lead their patients to enjoy healthy, sustainable lives, they must show that this is possible by their own lives of sustainable service that emanates from the depths of spirits that are continuously renewed.”(italics mine)

So, whether you’re in medical school, residency, or in practice for years,  you have to take care of yourself before you can care for others. One thing we can change is to talk about it more openly without the stigmatization. As with all things, awareness and prevention are key.

So, here are some other useful links for dealing with/ preventing burn-out:

Emergiblog

BMJ Career Focus, “Will you burn out?”

MomMD, “Physicians giving it all up?”

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Comments
  1. idcrossroads says:

    This is a real problem among all the physicians I know. I was in the same burned out boat 2 years ago. Then I realized that I wasn’t getting enough mental stimulation at my job. I had to make some major changes in my life. I figured I spent most of my waking hours doing my job, so I had better like it!

  2. tom says:

    Who cares for the care giver? Frequently, no one. Over time this can lead to what I call the Maple Tree Syndrome. Tapped for its sap (knowledge,service, caring) every day, with no time for renewal, the tree will eventually be unable to produce and become labeled unproductive, in physicians this sometimes labeled “difficult”. Once thus labeled, the chainsaw replaces the “tap” and the once productive Maple is off to the woodpile.

  3. docwhisperer says:

    But we’re thinking, feeling beings. There has to be a way to keep doing what we love and what we’re good at without giving up our personal lives and our sanity.

  4. tom says:

    Yes, and the first step begins with self-I need to do this( renewal) for ME. Recreation=re-creation. Schedule time for yourself-do things for personal enjoyment-don’t consider such actions as being selfish-they are not. Establish, implement and stick to, practice rules on how and when you work. Share these rules and the reasons for them in writing with your patients. I would share them with your family too. Want a specific suggestion? With your monthly haircut (you still have hair right?), schedule a steam and a massage and afterwards meet your spouse for a glass of wine and perhaps an early dinner and a movie-NO pager No phone

  5. burnedMD says:

    Interesting that you mention PTSD. It seems to me that one possible devolutionary progression of burn-out (aka compassion fatigue, etc.) is in fact a subtype of PTSD, what I would label atypical complex caregiver PTSD. Atypical compared to the general population, somewhat less atypical when compared to physicians in general, & especially some high burn-out prone specialties such as EM & Anesth. Complex – in that it’s not the DSM-IV lock-step typical progression; it’s more of a cumulative effect. Dr. Judith Herman MD {Psych @ Harvard) wrote an interesting book along the lines of 1 on 1 trauma {a male who abuses females etc.}, & how the cumulative effect produces a subtype of PTSD not adequately explained by DSM-IV criteria. Aside from PTSD in physicians and abused women, I have also seen this atypical complex variety among ex-members of ‘high demand’ religious groups, aka sects or even, in a non-pejorative sense, cults, whether religious, political, psychoterapy oriented, etc. So, when one encounters a female physician, specialty EM, with an abusive husband, who is still in or has recently existed from an ARM {alternative religious movement, euphemism for cult}, this is one sick pupppy in need of major support.

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