I was recently at a medical conference in Fiji. As many of you know Fiji is not considered a place associated with stress. Burnout? No chance. The nearest you will get to burnout in Fiji is when you walk from the pool area to your room in the sun.
So, it felt strange to listen to a presenter who was giving a talk to doctors who were mostly in colourful T-shirts and shorts in a conference room in Fiji on what to look out for in patients and themselves who may be suffering from burnout.
But the talk resonated with me because not many of you know this, but I suffered burnout in the late nineties. I know you may not comprehend me ever working hard with my constant blogging of how I work 3 days a week with 16-week annual leave, but you need to remember I was young once (a long time ago) and I was also chased a career too (also a long time ago).
There were times when working a 70-hour week was said with pride. We competed on who did more hours. There was one time I went to work on a Thursday and returned home the following Tuesday. These were not normal times, yet for us workaholics, trying to prove themselves it was.
But I also know that doctors work long hours and that is one of the starting points when it comes to burnout. I talk to many doctors, and they all tell me that would like to work less. Many whilst in Fiji got emails regarding work even when their bosses knew they were on leave. The constant pressure in healthcare does not seem to stop.
Burnout is a defined condition. It has been around for some years. We were told on the talk that it related to the drug trade with users considered burnt out from excessive use.
Slightly ironic when you now consider that doctors who dish out drugs are now those at probably the highest risk of burnout.
If you’re exhausted, feeling negative and your performance has dropped at work, you may well be suffering from burnout but as a doctor working hard you may simply dismiss it as nothing more than tiredness.
I know most doctors will say they are used to it. But it is a dangerous place to be because you are not doing your team any favours. You are not doing your practice or employers any favours either and you could be at risk for failing the ultimate commandment of healthcare. ‘Thou will do no harm to patients’
But if you think you may be burnt out, how can you get back on track?
Firstly, understand what burn out is. Many think it is a mental health condition. And in many ways that is why you as a medical professional may dismiss it. Mental health affects every category of people except doctors. I know many of my medical professional clients have a mental health issue. Many may privately accept it but rarely tell their peer group. There is a real stigma if you are a doctor and admit you have a mental health issue. And that is because it can become a regulatory issue.
We were told on the talk that burn out has nothing to do with mental health. The World Health Organisation defines burnout as “a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed”.
It is a workplace issue that is not being managed. Nothing else. So, relax. If you think you have burnout you can talk about it. AHPRA is not going to get involved.
The three main symptoms of burnout are:
• Exhaustion
• Feelings of negativity or cynicism towards your occupation
• Reduced professional efficacy including difficulty processing information or making decisions
Burnout is the trifecta of stress, disliking the job and yourself.
Dr Seema, burnout specialist told us: “You feel more exhausted and lack energy as time goes on. It becomes an everyday experience. You are very tired and constantly under stress.
You feel disillusioned about your job and lose your motivation and engagement with your patients, the team and all you interact with. There’s a sense of detachment from your commitments to your role.
And you might notice you’re not as sharp mentally and it’s harder to process information or make decisions. It takes longer than usual. You might work less effectively which means you work longer hours to do effectively the same thing.’’
Stages of burnout:
The typical employee profiles are:
• Those who are engaged
• Those with burnout
• Those who are experiencing one of the three symptoms who may be on the road to burnout
In 2021, the American Psychological Association found 26 per cent of workers had a lack of motivation, 32 per cent emotional exhaustion and 44 per cent physical fatigue. And it has consequences; according to Mental Health UK’s Burnout Report, 20 per cent of workers in the UK had to take time off work in 2023 due to occupational stress.
And if people are off, then that means there is more for others to do which may increase their chances of burnout. It can become a vicious cycle.
In Australia, 62% of medical professionals believe that they are expected to undertake too many bureaucratic tasks leading to burn out. The same survey suggested 41% believe the hours worked is causing burnout.
So how do we recover from burnout?
Unfortunately, it’s not as simple as writing up a self-care list.
While there are steps the individual can take, workplace stressors need to be sorted too. If you are employed your employer also has responsibilities but if you happen to be a contractor doctor you are the employer. So, in effect you must manage, well, you.
The first step to recovering from burnout is acknowledging it. But that can be easier said than done when we are hard-wired to keep going.
I remember my time. I refused to accept anything was wrong. In the end, my employers basically cancelled my entry card to the building and told me to go home. And that is exactly what I did. And then for two weeks I just slept.
They say the average recovery time from burn out is 3 months. I never said it was going to be easy or short. But it is a process that must happen.
There are usually some early warning signs like short-temperedness, irritation with colleagues or frustration with small tasks. As a doctor, you may feel emotionally detached from patients too.
Try to identify your workplace stressors and for that you may need help from your colleagues.
Recognise there is a problem and something needs to change, assess what is possible to change and change the easy ones first. Some things are just ingrained and cannot be changed.
The stressor may not be the job per se. Look for things such as:
• Increased workload
• Lack of control
• Inadequate reward systems
• A toxic community
• Lack of fairness
• Opposing values
Work constructively with colleagues and management in addressing these. How do you make this better?’ Can you make suggestions and be constructive?
Put some boundaries at work. What days will you work, when you start, when you finish. These boundaries help your brain understand when it is time to start and stop. Yes, they will be days that it all goes belly up so long as it does not happen daily.
Email is considered a real stressor. I know many medical professionals that have hundreds of unopened emails. I have one client doctor that has over a thousand unopened emails.
That creates so much stress just looking at the number of unopened emails. I make it a priority to clear out inboxes daily. Unsubscribe from crap stuff and delete the spam. Take control.
You may have to have some hard conversations with your employer or practice about what is achievable. If you are a contractor doctor you may have to have those conversations with yourself.
Medical professionals are great at looking after their patients. When it comes to them? Not so good.
And that is because they rarely focus on themselves. I have a saying in the office to my team. You are no good to my clients if you are no good to yourself.
So, focus on looking after yourself:
• Eat healthily and stay hydrated
• Try cardiovascular exercise and yoga
• Switch off screens
These things you all know and tell your patients about – but do you practice what you preach?
There are coping strategies out there: meditating, mindfulness, doing exercise, getting eight hours of sleep, and being healthier. You know this too. You must do it.
These won’t necessarily change the stressors at work, but it will help you be more rested.
In terms of exercise, a study in 2015 showed that cardiovascular training was better than resistance training at reducing psychological distress, while the latter (including yoga and Pilates) boosted positive feelings.
But having gone through burnout I can tell you this. It is horrible. And at the time I did not realise what I needed to do. It required some people who loved and cared about me to put me in my place. So, listen to those beautiful people, even if you are not in the mood to listen.
If I could go back in a time machine, I know what I would do now:
1. Talk to my employer or tell myself – that the consequences of not doing something to alleviate the stress is far worse than making changes now.
2. It is going to take time to recover – accept that.
3. Reduce the hours I work. And that may mean less money, an ego that gets busted and even a reduction of responsibility. But in later life you will realise that these are not so bad and may even shape the life you lead for the better. It certainly did that for me.
But this is what I do know. The value in living a life is contentment and joy. It is not stress. It is not pain. And it certainly is not an early death. So, if it means less money, less responsibility but a longer life it is a sacrifice I would be willing to make. And I am guessing it is one you would be willing to make too.
Working less is step 1, 2 & 3 of our 9 steps to working less, earning more and generating wealth. If you would like to know more contact Hitesh at hitesh@medisuccess.com.au or call 07 3161 9548.
