I can guarantee that you would immediately recognize a STEMI patient and activated your cath lab and that you would quickly recognize and treat the classic signs of appendicitis in a patient. Would you be able to recognize the signs and symptoms of burnout in yourself or a colleague? Maybe, but would you know what to do or how to manage it? Chances are probably not. We go through training learning how to fix others and recognize illness in others but we often do not recognize symptoms that scream we are not well.
According to an article published in the 2015 Mayo Clinic Proceedings, over 70% of EM doctors, 65% of FM doctors and just over 60% of IM doctors report feeling burned out. The average of rate of physician burnout is 54%. Across most specialties there was a 10% increased in burnout when compared to data from 2011. The reasons are varied. A lot of them are secondary to systemic problems. There are a lot of organizations compromised of a combination of different letters that dictate the way we practice medicine. Some our practices are held hostage to hospital administrations preferring unvalidated clipboard metrics over front line provider needs, experiences and suggestions leading to stress.
Abraham Maslow published a hierarchy of human needs in his 1943 paper entitled “A Theory of Human Motivation”. In his pyramid are the following needs: physiologic, safety, love/belonging, esteem and self-actualization. His pyramid has undergone some adjusting and some criticism regarding the order and hierarchal ranking of the different needs. My take on it is you need all of them in order to maintain balance and it is not a step-by-step process. When you are lacking in these needs, you feel stress.
The stress response is physiologic and necessary as it is responsible for learning and influencing long-term memory. It is all directed through the hypothalamic-pituitary axis and in a normal physiologic state, it acts as a negative feedback loop as circulating catecholamines act as an off switch to the process. Unfortunately in the setting of chronic stress, the continuous elevations in catecholamines have a deleterious physiologic effect on the body. Neurologically, people can develop insomnia and difficulty learning. Neuronal loss is demonstrated in rats. GI symptoms such as anorexia, irritable bowel syndrome and gastritis develop. The immune system can suffer secondary to adrenal suppression. Cardiovascular effects are well documented. Takotsubo syndrome’s very pathophysiology is secondary to the chronic circulation of catecholamines. Stress also leads to more stress, depression, irritability and a rash of other negative feelings.
You may be thinking “That’s all well and fine but my patient care is still spot on.” It is highly likely that you are mistaken. A 2002 paper from Annals of Internal Medicine demonstrated that resident experiencing burnout inappropriately discharged patients, did not fully discuss treatment options, made medical errors, paid little attention to the emotional needs of patients and felt little emotional response to the death of a patient on a weekly basis…a WEEKLY basis.
In order to beat or avoid burnout, one must take an inventory of her needs because the solution is very individual. What works for me, may not work for you. Exercise, healthy eating and sleep are standard for most individuals. Meditation is widely used in Eastern medicine and making it’s way to Western medicine. However, healthy ways of relaxing is very individual. Items that replenish each us are very different.
Before you let your zen imagination run wild, take 10 minutes to account for your time. There are 168 hours in a week. Account for yours. Calculate your average weekly hours for work and sleep. Then figure out what you do with the rest of the time. This includes everything, ie, running errands, home care, pet care, child related, commute times, time on the toilet or in the shower, etc…everything. Stop reading this until you have done that.
I wonder how many of you actually stopped. Now that you have your list of where your time goes, create a list of your energy boosters and replenishers. What fills your tank? Once that is done, look at your weekly hours list. Are any of those replenishers on it? If not, there should be. You must dedicate at least 1 hour for yourself each week. You are a giver. You give your time, your compassion, your knowledge, your love but you must always give to yourself first. If your tank is empty, you have nothing to offer to others. If your tank is always empty, you are heading down a path that is ablaze.
There are systematic conditions that we cannot change as individuals. If you want a big change in terms of the system, get involved in an organization that has the weight to make to changes. If you are not interested in going that big, it’s ok. Go little. Start with the little changes you can make within your own life. We are very go-big-or-go-home-people. There is an amazing Japanese theory called the Kaizen effect. This practice involves making a series of small manageable changes in your life that cumulatively have a profound effect on the whole. If you don’t exercise right now, don’t join a gym. Go walk for 5 minutes a week. It’s more than you are doing now and eventually you can add to it over time. You must prioritize yourself and make time for your needs. It is not being selfish. It is nothing that should cause guilt. Your health, your livelihood and continued ability to give are dependent on it. You ARE your life.
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