BLOG: Tame the demon of burnout

ByJohn D. Kelly IV, MD

Data are clear. Burnout remains on the rise with estimates approaching 50% prevalence for subsets of health care workers. Increased intrusion of third parties, the electronic medical record, loss of autonomy and omnipresent legal stress are only some of the challenges facing surgeons today.

There is hope. Some simple decisions we can make can have a material difference on the quality of our lives and our ability to minister to others.

Name it before you can tame it

Burnout manifests in three principle forms and each relates to specific ineffective coping strategies:

Overload. Characterized by one who works toward success until exhaustion. Venting of emotions as a coping strategy is associated with this subset of burnout. These individuals complain about the organizational hierarchy at work, expressing feelings of helplessness and frustration. This strategy only compounds stress and often leads to a desire to quit.

Lack of personal development. If work is not stimulating or challenging, these workers tend to manage stress by distancing themselves from work. Detachment from others and “avoidance strategy” leads to cynicism and depersonalization — both predictors for burn out.

Neglect. Stems from a coping strategy based on giving up in the face of adversity. These individuals lack the motivation and dedication to plow through barriers to materialize goals.

It seems most of us can relate best to the first subtype, and there are means to mitigate the demon of burnout regardless of the dysfunctional coping strategy. Author Sasha Van Hoven offers the following tips:

Say no

The more we say “yes” to something, we are saying “no” to other potentially more meaningful activities, like time with family and service work. Recognize that most of us have a little bit of “approval addiction” and we do not like disappointing others.

While you may be pleasing others with your “yes,” you may be disappointing your loved ones and not holding true to your dreams.

Give up on forcing motivation

Negative emotions can certainly make accomplishing meaningful work harder; but, do not try to stamp these out. Accept negative thoughts and do not fight them; that will give them more energy. Van Hoven suggests creating “distance” from these thoughts and act beside these thoughts. Take a deep breath, create a little space between you and the negativity, and act anyway. To wait until you are psyched to do something is pointless and may backfire. Just get going and act on your values. Some of the greatest accomplishments in medicine were realized by those who plowed through negative feelings and acted with purpose anyway.

Treat the disease, not just symptoms

Usually there is a deeper and real cause for the onset of burnout. Without blaming the system or yourself ask yourself about potential triggers: Was it the last tough case, recent insurance hassle or “spat” with the charge nurse? What part of my routine is not sustainable?

Next, proactively choose a better approach to your life. Resolve to pause and breathe before booking a potentially overly challenging case. Become determined to be a peacemaker rather than conflict mongerer at work. Promise yourself to practice the “slow yes” and hard “no” when asked to serve on a committee or assume a new project. Consider reformatting the number of patients you see in a day.

Van Hoven suggests reviewing the past 24 hours each day to discern “slip ups” and deviations from intended behaviors. This habit is not to be used for self-reproach; review of behavior will give you regular feedback about attaining your goal of resilience.

Make downtime a daily ritual

We all need to rest our brains from the continual din of stimulation. Naps, mediation, walks and even hour-long “techno breaks” will allow our nervous system to re-boot and purge our brains of deleterious clutter. Creativity and inspiration occur during downtime and this must become a sacred place for all of us.

Create a ritual for unplugging, whether a personal Sabbath day or evening when at home. Institute “no fly Wi-Fi” zones in your day, and your nervous system will thank you. Continual adrenaline surges that result from “reactionary workflow” are injurious to our cardiovascular system and have been linked to heart disease and hypertension. For many, recognizing where deep sources of anxiety originate and getting counseling to address these fears will bring lasting relief from the need for continual electronic connection.

Drop kick perfectionism

I have written on the demon of perfectionism and how it can syphon energy from our lives. It is critical to set limits and boundaries for work and stick to these. Does the paper need five revisions? Is a 60-minute knee scope necessary?

Perfectionism arises from a fear of failure. Embrace the notion that we are wonderfully made and that no achievement will add to our intrinsic worth. Thoughts of perfection do not arise from our source. These thoughts are conceived from our fearful, egoic darker self which is never satisfied. Validation and self-worth are attained when we recognize our inner beauty and value. Harnessing perfection to ensure adequate downtime is essential for a lasting, productive career.

Keep track of goals

Track your progress of the important objectives of your life and gauge progress. Negative feedback is more important than abject failure. If you need to devote a few more minutes to the book chapter to complete it on time, then do it. It is far more satisfying and energizing to attain a goal on time then to be disappointed by a little self-critique.

The avoidance of information about progress toward your goals is called the “ostrich phenomenon” and is based on fear. Realistic progress checks have been associated with a higher likelihood of achieving goals, even though our progress may not be as good as we may hope.

Change location regularly

Performing tasks at different venues makes work more manageable and increases efficiency. Instead of suffering at the same workstation all day, list what needs to be done today into segments and perform portions of the day’s demands at different locales. For example, the paper can be completed at your office, the lecture at the workstation at the library and the book you have been putting off at the café with great Wi-Fi.

Do not overload downtime

Make vacations flexible and not another “must do” obligation. For vacations to be restorative, these must allow some room for choice and offer multiple options. A rigid, agenda-laden vacation itinerary can be nearly as stressful as a trying, overcrowded office-hour session.

Treat yourself to fan email

Van Hoven suggests we imagine a goal fulfilled and write an email about it to ourselves. This tactic, created by Seth Godin, is the ultimate in affirmation. For example, write out a description of the rave review you expect your upcoming lecture to receive and send it to yourself. Resist the temptation to fall into false humility and relish the opportunity to celebrate your future successes.

Break down tasks

The threat of a deadline for an enormous undertaking can be imposing. Break down the challenge into smaller and more manageable portions, each with separate deadlines, and you will be less likely to feel exasperated. Concrete tasks are more manageable than abstract ones. Furthermore, with completion of each hurdle, confidence accrues and momentum is gained.

These suggestions will help decompress anyone’s schedule, but any regime to combat burnout must include elimination of activities that hold less meaning with substitution of more purposeful pursuits.

It is time we reclaim our joy and bliss. Good luck.

References:

Dyrbye, LN, et al. Acad Med. 2014;doi:10.1097/ACM.0000000000000134.

Montero-Marin J, et al. PLoS ONE. 2014;doi:10.1371/journal.pone.0089090.

Van Holden S. Eleven Ways to Avoid Burnout. http://99u.com/articles/24201/11-ways-to-avoid-burnout.