Burned Out? How Doctors Recover Their Spark

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s. fuchs dc

Burned

Out? How Doctors Recover Their Spark

M. Reese

Posted: 07/28/2011

Introduction

When

Steve Hyman, MD, from Nashville,

Tennessee, looks back, he doesn't

like the person he used to be.

" I

was a lot meaner then, " says Hyman, an anesthesiologist. " I was a lot

less tolerant. I had a chronic depression and I didn't know what the problem

was. " Attributing his malaise to his workplace, he switched practices. It

didn't help.

It wasn't until Dr. Hyman cut back his work schedule to

3 days a week and started using his newfound spare time to indulge a forgotten

passion for piano that he was able to pinpoint the root of his problem:

burnout.

Today Dr. Hyman happily splits his time between medicine and music. Three days

a week he is in the operating room. The rest of the time he is a concert

pianist performing recitals and playing with regional orchestras.

Dr. Hyman wasn't able to avoid burnout, but he was fortunate to find a way out

of the abyss. It's something that other doctors can do as well.

Burnout:

" A Loss of Ideals and Hope "

Stress

and burnout are often lumped together, but they are distinct processes. Unlike

stress, which is associated with overengagement, burnout is characterized by

disengagement, blunted emotions, depression, exhaustion that affects motivation

and drive, and demoralization. Stress produces

a sense of urgency and hyperactivity.

Burnout produces a sense of helplessness and hopelessness.

Archibald

Hart, PhD, psychologist, author, and Dean Emeritus of the Fuller Theological

Seminary School of Psychology in Pasadena,

California, noted that

" Burnout can best be understood as a loss of ideals and hope. "

Stress is

omnipresent. Underwater mortgages, the economy, job losses, and the mundane

stressors of daily living affect many people. Every industry has its own cache

of challenges. Doctors may have to contend with healthcare reform, EMRs,

reduced rates, medical school loans, and pressure to see more patients.

What puts

physicians at greater risk for burnout isn't necessarily the work-a-day

stresses they face but the nature of their role as caregivers, says Neelum Aggarwal, MD, a Chicago neurologist who

frequently lectures on stress and burnout. " We have to interact with many

people many times a day, " she says, " and the element of having to

provide care for someone -- the personal responsibility for someone else's

health -- that's an unconscious element that feeds into everything. "

It's a

role that many physicians -- unlike professionals in most other fields --

internalize, notes -Henry Pfifferling, PhD, director of the Center for

Professional Well-Being in Durham,

North Carolina. " The

greatest risk for burnout comes when the doctor identifies being a doctor as

who they are. "

" Delayed

Gratification " Puts Doctors at Risk

Part of

the problem, Dr. Aggarwal says, is that doctors are in constant motion. They're

also very purposeful and, thanks to their protracted medical training, masters

when it comes to delayed gratification. Those qualities, especially if they're

mixed with characteristics such as perfectionism, conscientiousness, a need to

be in control, and difficulty relaxing, can put physicians at risk, she says.

" When

you are always doing, you can't step back and see the big picture, " she

says. " Often people know something is wrong. They sense it. But the way

they try to work through it is, 'Maybe I'm not productive enough or efficient

enough' and they go back and try to do more. Figuring out what's wrong really

requires stepping back. "

The

workplace often exacerbates the problem. It's not just long work hours,

demanding postcall schedules, and administrative demands, notes Pfifferling.

Physicians aren't taught how to work in teams and support each other, and

there's a stigma associated with reaching out for help.

What's

more, although they're very good about preaching self-care to their patients,

they often don't internalize those messages.

" When

I talk about burnout I used to start with the medical aspects -- diet and

exercise -- for preventing it, " says Dr. Aggarwal. " But I realized

that just put them back into 'doing' mode. Now I start with, 'You have to learn

to sit and be at peace with yourself.' That hits home with people because most

doctors can't just sit quietly. "

Dr.

Aggarwal herself spends an hour in quiet each morning. Quiet sitting might

involve meditation, inspirational reading, listening to relaxing music, or just

doing nothing, she says, and it's a skill that doctors need to master before

they can move on to more active tactics for combating burnout, such as

breathing exercises, walking, improving their diet and -- most important --

adding joyful pursuits back into their lives.

The

Importance of Meaningful Pursuits

In

February 2008 LocumTenens.com asked 1200 physicians how they avoid burnout. The

answer: They aren't couch potatoes. Respondents listed participating in sports,

travel, and outdoor activities as their top 3 burnout busters . Many mentioned

volunteer and humanitarian commitments as well.

A recent

posting on the Medscape discussion board posed the same question.

" Exercise every day, " advised one physician. " I'm not a gym rat

or fitness freak. I'm just talking about a 20-minute walk. Leave the cell phone

at home. " Another advised, " Buy a small vacation house in Sarasota and go there for

5 days every 4-6 weeks. I did, starting 4 years ago before I sold my practice,

and I came back refreshed and recharged. "

Diet,

exercise, and rest are important components to health, but wellness is a

holistic pursuit with physical, emotional, psychological, and spiritual

components.

Physicians

need to remember -- or discover -- what brings them joy and fulfillment. It

might be making dinner with family or friends, listening to music, bowling,

traveling, volunteering, or participating in spiritual or religious activities.

Whatever pastime they find fulfilling, Dr. Aggarwal says, doctors need to

purposefully reintroduce it into their lives.

As easy

as it sounds, it can be very difficult to break out of the cycle of perpetual

motion, Dr. Hyman says.

" When

you have a really strong work ethic and take time off for yourself, you feel

guilty about the free time. It takes you a while to get over that, " he

says. It was only when he brought music back into his life that he was able to

accept and embrace the difference between " what I want to be doing and

what I do for a living. "

Although

it definitely falls in the " doing " category, finding a long-term way

to deal with burnout means addressing workplace issues as well, says a

Cora, MD, a psychiatrist and author of Leading

Under Pressure: Strategies to Avoid Burnout, Increase Energy, and Improve Your

Well-Being. That means finding a way to take control over your

environment and workload and learning to say " no. "

" Don't

just look at yourself, " she advises, " Look at your practice. Is your

nurse practitioner or your office manager stressed out? Look at your turnover.

What's the mood? Burnout often happens when there is a lack of processes but

also a lack of lifestyle balance. You need a combination of organizational skills

and lifestyle strategy to tackle it. "

The

Cost of Stoicism

Finally,

Dr. Hyman says, doctors need to understand that in ignoring the symptoms of

burnout, they aren't being stoic; rather, they are doing a disservice to

themselves, to the people around them, and to their patients.

" In

the field of medicine, particularly for people who trained 20 or 30 years ago,

the mindset was that you really needed to forego everything to practice

medicine. But when you feel so bad about yourself and your workplace, to go there

and be cheerful and give 100% is very difficult, " he says.

Fortunately,

he says, that's not a problem for him anymore.

" Now

when I go to work I'm ready to be there. I like my work and I do a really good

job. I don't think the fact that I have other interests and that I don't love my work makes me a bad physician.

It doesn't make me less empathetic to my patients. You have to take care of

yourself. "

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