I walked into my office and checked my schedule. As I had done for several years, I counted the number of people I had to see before I could go home. Not wanting to admit to myself that I was unhappy, I continued to treat patients, run my office, and tried to think of ways to reclaim the passion for phlebology I used to feel.
I was burned out.
What I didn’t realize at the time was that I had lots of company. Physician burnout is now at epidemic proportions – 55% of American physicians admitted to suffering from symptoms of burnout in a 2014 Mayo Clinic study. But walk into a doctors’ lounge, attend a medical meeting, or read the increasing number of articles on burnout in our journals, and we know the prevalence is even higher.
The symptoms of physician burnout
We are all aware of many forces currently conspiring to make us feel the three classic symptoms of burnout: a sense of depersonalization, that our patients are problems and not people; that we aren’t making a difference; and a feeling of emotional exhaustion at the end of our day. We often feel torn between competing demands.
One common complaint among physicians is a lack of control over our schedules. With inadequate time to see those patients who are sick or require more time, we are encouraged to shorten our interactions. This erodes our relationship with patients and our confidence that we are caring, competent doctors who formed the cornerstone of our personal and professional satisfaction.
Alternatively, we can run late, resulting in poor patient satisfaction scores, reprimands from medical group leadership, and decreased remuneration. The emphasis on patient satisfaction scores traps us between our ethical desire to provide proper care and utilize medical resources responsibly and our fear of angering patients if we don’t meet every demand.
In addition, physicians used to be respected as the leaders of the medical team, the people whose knowledge and experience were the foundation of care. Now, we are just another generic “provider” whose decision-making has been usurped by administrators and insurance company protocols and who are considered easily replaceable. As a result, many physicians feel a lack of autonomy, respect, and sense of purpose and meaning in their work.
As a physician development coach, I work primarily with physicians who are burned out, and I can happily report that most of them recover and go on to a more fulfilling career – still practicing medicine. Their road to recovery and beyond is as individual as they are. Yet, there are some common and simple tools they find useful as they make their way from feeling hopeless to inspired.
Be mindful, not critical
Let’s start with mindfulness – a common buzzword these days. But what does that have to do with physician burnout? If we pay attention to our thoughts during the day, we’ll realize that we are achievement-oriented. We perfectionist physicians often spend a lot of time berating ourselves, being angered by those we feel aren’t pulling their weight, or worrying about our competence or decisions. “I should have handled that situation better,” “I can’t believe I didn’t see that before,” “Why can’t the nurse get that right?” We spend our day listening to a never-ending stream of critical commentary.
Mindfulness allows us to let those thoughts go so we can focus on the reality of the present moment without such negative distractions. But when mindfulness is suggested, people often decline, explaining they tried meditation but “couldn’t stop thinking.” In fact, we never stop thinking! It’s the repeated exercise of letting go of thoughts that arise during meditation that trains our minds to become aware of the negative thoughts and turn our attention away from them.
I was recently contacted by a frustrated family physician, besieged by angry thoughts as she tried, unsuccessfully, to fit into a new medical group. After two weeks of meditation, she found herself sleeping better and feeling a greater sense of calm and well-being at work, enhancing her ability to deal more effectively with stressful experiences.
Mindfulness-based stress reduction programs, based on Jon-Kabat Zinn’s Full Catastrophe Living, provide a structured way of learning and engaging in a meditation practice. Apps such as Insight Timer, recordings of guided meditations, and local as well as internet-based classes, are all effective in supporting you in integrating meditation into your own life.
Reevaluate your expectations
A second tool is to examine our expectations. Most of us were trained when we had leisurely appointments and could spend time building rapport and getting to know our patients well -- when computers and EHRs didn’t intrude on our space or time. But times have changed, and we must, too.
In a 10-20 minute appointment, time must be managed efficiently and some of the aspects of our patient interactions need to be rationed. A seasoned OBGYN hospitalist explained the anxiety that caused abdominal pain and insomnia for two days before she had to spend a day in clinic, knowing she would see 40 patients, none of whom she knew, and leave feeling like a failure. “What are your expectations of yourself?” I asked.
She thought for a moment and then said, “I expect to go into every room, develop rapport with the patient, get a clear history and do an exam so I can decide what the patient has, and explain to her what she needs to do. And I want her to like me so she’ll trust me and do what I suggest.”
At that point, we both began to laugh. I doubt that anyone could satisfy her expectation that she could do that every 10-15 minutes for an entire day. She considered the dilemma and decided that her most important role was to decide what the patient’s problem was, and she agreed to consider herself successful if she did that one thing. She continued to do all the things she felt were important in patient care, but she began to walk out of clinic with a sense of success rather than failure. It completely changed her experience.
What expectations do you have that keep you feeling bad about your abilities, competence or effectiveness? Are those feelings truly serving to motivate you, or are they simply interfering with your sense of well-being? Maybe you feel a sense of dread when you look at the pile of unread journals, unreturned messages, or your calendar, chock-full of committee meetings or conferences.
Maintaining these unrealistic expectations sets you up to feel unhappy. Spending some time to reconcile your expectations with the reality of your life can relieve you of unnecessary feelings of inadequacy. Decide what you can really expect and then trim your expectations and responsibilities so they are more appropriate. Just like my client, you will likely feel an immediate sense of relief.
Get back in touch with happiness
Another source of our unhappiness is that we frequently fill our schedules with activities that we don’t enjoy. In fact, many of us have lost touch with, and have even forgotten, what does bring us joy. When I ask clients, “What do you want?” I’m usually met by silence, followed by the exclamation, “That’s a great question!” If you’re like most people, it’s been a while since anyone asked, “What do you want?”
Early in medical school, already inundated by the volume of information we had to absorb, a classmate asked me, “What do you like to do?” Without thinking, I responded, “I used to like to cook and I used to like to read and I used to like to run.” Too often, what we feel we HAVE to do crowds out what we feel we LOVE to do. Fortunately, it’s easy to reconnect with the things we love.
Think back to times in your life when everything felt perfect – an event or a moment when you thought, “This is what life should be about!” What was happening? What made it enjoyable? It’s likely that some of your core values, those principles or activities that you find fulfilling, were part of the experience. Another way of uncovering your values is to look at what makes you angry. We generally become upset when a core value is being trampled. One of my core values is kindness, so it’s no wonder that mean people make me angry.
And a third way of finding your values is to notice what does bring you joy. Being with family? The adventure of skiing down double black diamonds? Spending time in the beauty and solitude of nature? Once you understand what your core values are, begin to intentionally schedule time in your calendar when you engage in the things that inspire, fulfill, and delight you, and see how much more balanced your life feels and how the experience of your life shifts. Ironically, busy people often think that balance means doing less. But that is not always true.
“The wise Rabbi Hillel once said, “If I am not for myself, who will be for me?” If we are feeling burned out or less than satisfied with our career, it’s our responsibility to notice we are unhappy and take steps to change that. No one will do it for us.”
A client once complained about the drudgery of her academic position. She couldn’t imagine spending another 10 years seeing five full days of patients every week. Then, she realized she had a true passion for teaching communication. She worked with her department to develop a curriculum for teaching communication skills to residents and found that this addition to her workload provided the sense of adventure and contribution she was missing.
Make the change
The wise Rabbi Hillel once said, “If I am not for myself, who will be for me?” If we are feeling burned out or less than satisfied with our career, it’s our responsibility to notice we are unhappy and take steps to change that. No one will do it for us. Fortunately, this is one place in our lives in which we have ultimate power!
One simple exercise that can help to nurture our own sense of competence is to let the last question we ask ourselves each night be, “What did I do well today?” This will balance our learned tendency to always ask what we could have done better. While this encourages continual improvement, it leaves us feeling as if we’re never good enough.
Rabbi Hillel went on to ask, “If we are only for ourselves, who are we?” If we look, we’ll see many colleagues who are suffering with burnout. Sometimes, mentioning that they seem to have changed and don’t seem as happy is enough to let them know they aren’t alone and that someone cares.
Referring colleagues to a wellness committee or a professional who can work with them to restore their zest for medicine and life can be lifesaving, as we lose 300-400 physicians to suicide each year. Acknowledging something you admire or appreciate about a colleague can help to balance his or her feelings of inadequacy as we all struggle to regain our balance in this period of continuous change.
Rabbi Hillel finished his query with, “If not now, when?” We are living through uncertain times in medicine that test our confidence in our ability to make the difference we want to make. If we are to thrive individually and as a profession and provide the best care for our patients, we need to prioritize our own mental and emotional health. As we are told on every airplane, we need to put our own oxygen mask on first before placing one on anyone else.
If we all become more mindful, insist on reasonable expectations for ourselves, make time for the things that bring us joy, and care and look out for our colleagues, we can change the experience of being a doctor and create a culture in medicine where we feel valued and fulfilled. That’s the kind of culture I want to work in. How about you?