Read an Excerpt
CHAPTER 1
Burnout: A Knotty Process
Burnout is going to impact different care providers in different ways. Let's start by taking a look at Sonia, a highly regarded kidney specialist who prides herself on her passion for her work. In her 24 years as a physician, her patients and their families have always been quick to point out her compassionate care and attention to detail. She not only puts in extra time tending to patients as they come in, but also in following up with them after discharge. Her colleagues love her, too, and she's well respected by nurses, other physicians, and administrative staff at her Arizona hospital.
On the outside, the 53-year-old is a shining example of the perfect medical specialist. But what her patients and colleagues — and even Sonia herself — don't realize is that she's falling apart.
For many years, Sonia looked forward to work. As she woke up each morning and got ready for the day, her interactions with patients were a powerful fuel that drove her dedication and ambition. But lately, Sonia has found herself gripped by a terrible feeling of dread. It starts on Sunday nights as she anticipates going to work. The feeling blooms into anxiety and overwhelm by Monday morning. She's able to grit her teeth and knuckle her way through the week, but as the hours of each day progress, she begins to exhibit physical manifestations of her inner stress. Within moments of interacting with her patients, she's suddenly battling an upset stomach, her throat dries up, and she's surprised by the urge to slip out the doors of the hospital into the parking lot.
Connecting with patients — which used to come naturally — has become exasperating. Sonia's interactions at work, and then later at home, leave her feeling drained. Even the act of making minor, insignificant decisions is distressing, and she criticizes herself for losing her edge.
Every afternoon, Sonia is struck by a profound feeling of restlessness. For a woman who's been driven by passion and purpose since she was a child, this new state creates a lot of guilt. She's never been in a situation where she's felt this inadequate. The guilt compounds, adding to her stress.
And when it's time to leave the hospital each evening, there's no relief. Throughout the year, Sonia has ended her work days as a physician and transitioned into an equally intense role: a caregiver to her elderly mother, whose condition continues to decline. Sonia can see there's no real down time to recharge and nurture herself, but what can she do? Her patients need her. Her mother needs her, too.
Late at night, despite trying to briefly unwind at home after the day's long list of tasks has been tended to, Sonia struggles with insomnia that leaves her dragging during daylight hours. As months pass like this, Sonia begins gaining weight and even losing some of her hair. Tired and demoralized, she first writes off her symptoms as menopause or aging, but then she begins to wonder if something else is wrong. She even makes an appointment with a therapist, who prescribes an anti-depressant. Sonia dutifully takes the pills each morning for a few months, but they don't offer the relief she's looking for.
Sonia begins reflecting on her situation in earnest. She knows something has to change, but she isn't sure what. She doesn't know it just yet, but she's in the throes of burnout.
* * *
Burnout is a knotty process. It happens slowly, slowly, slowly — and then suddenly, it's upon you. It isn't exactly that burnout accelerates, but that we often ignore or misunderstand the signs and symptoms until they coalesce dramatically into hopelessness. What's especially tricky is that many of burnout's markers are easily masked because they mimic so many other psychological maladies. This is a key reason why the healthcare workplace is in a burnout epidemic.
In the United states, more than 42% of physicians report they're currently experiencing or have recently experienced burnout, according to Medscape's 2018 Physician Burnout and Depression Report, which interviewed 15,543 physicians across 29 specialties. And this isn't limited to the United States. Around the globe, countries such as Germany, Hungary, the United Kingdom, Portugal, and likely many more are seeing increases in burnout across a wide range of healthcare specialties as well.
In 2008, the European General Practice Research Network (EGPRN) Burnout Study Group, which interviewed nearly 1,400 family doctors in 12 countries, found numbers similar to the United States: 43% of participating physicians showed an elevated degree of emotional exhaustion, 35% exhibited high levels of depersonalization, and 32% demonstrated a sense of low personal and professional achievement.
Burnout isn't only plaguing end-stage-career physicians, either. The highest concentration of those reporting burnout in the U.S. were ages 45 to 54 — healthcare providers who were still right in the middle of their careers. It turns out burnout also brings along some other unsavory friends. Of respondents in the Medscape report, 70% were also experiencing depression. In worst-case scenarios, untreated burnout has even been shown to drive physicians to suicide.
Nurse burnout is on the rise too — one study found as many as 43% of nurses and other caregivers were experiencing the emotional exhaustion indicative of burnout. Many other kinds of care providers, including social workers, medical assistants, and even those who act as caregivers to ailing family members or a child with a disability can easily fall victim to burnout.
Beyond the impact burnout carries on a healthcare professional's well-being, the financial losses related to burnout are staggering for medical institutions as a whole. A 2017 Stanford report estimated that physician burnout costs the United States anywhere from $2.9 to $5 billion every year due to the expense of replacing physicians who are leaving their jobs earlier in their careers. Adding to this figure is the reality that burned-out doctors often contribute substandard patient care. At best, this leaves patients dissatisfied or outraged, and the organization's bottom line suffers. At worst, the consequences for patients can be life altering.
Of course, burnout isn't limited to healthcare — it impacts individuals in industries from teaching to finance. While a majority of the practical steps here could be applied no matter what an individual does for a living, the scope of this book addresses burnout in the healthcare field, specifically.
CHAPTER 2
Recognizing Burnout
Carol, a pediatric nurse who's been working for a large Midwest hospital for more than two decades, is accustomed to receiving kudos for being highly organized, compassionate, and competent. "Call Carol" is a go-to phrase the other nurses use when things on the floor are overwhelming. At 45 years old and the mother of 12-year-old twins, she's beloved by her young patients, and their happy faces are one of the great rewards of her work.
But over time she's noticed she has difficulty prioritizing tasks and keeping track of simple information. She gets distracted easily and forgets where she's supposed to be going next. She finds herself avoiding colleagues she normally loves to chat with and rushing through appointments instead. She pursues a medical work up, but when it comes back clean, Carol is at a loss. It takes her several months to realize she isn't losing her mind — she's burned out.
For others, the signs of burnout can be less obvious. Jack, a 58-year-old Boston-based psychiatrist who's been practicing for close to 30 years, treats numerous patients with various mental illnesses while working for a big medical system — he believes he's already well versed in the signs of burnout. Yet he doesn't think too much of his own growing urge to have a drink or three after arriving home for the day, or his slowly building irritability with minor details at work. He shrugs off his wife's concern that he seems more tired and cranky than usual.
It isn't until he notices how averse he's become to going to work morning after morning that Jack allows himself to consider something might be wrong. "I've been quick to interrupt my patients," he admits to me. "I have an all-around impatience — I've even snapped at my staff a few times." Coupled with what feels like an utter loss of his sense of humor, Jack can sense that something isn't right, but he isn't sure where to start.
When he blows up at an administrative assistant over a minor error in an uncharacteristic moment of rage, he realizes, "After helping others with burnout for years, I finally see I'm experiencing it myself."
Hiding Behind the Smoke Screen
One reason burnout can be so insidious is that even many medical professionals don't recognize the signs or ask for help until they're at the point where they need to quit their career altogether. In the Medscape National Physician Burnout & Depression Report for 2018, only about 9% of the physicians interviewed reported seeking professional help when facing symptoms of burnout. Even then, psychiatric assessment may not always be the right kind of help. Here's why: psychiatric evaluation may not reveal the problem. A psychiatrist is likely to speak with a patient for a few minutes and may prescribe counseling, an antidepressant, or other psychotropic medication based on a description of prominent burnout symptoms, which only masks the problem.
Adding to the complication, burnout manifests in plenty of different ways. While it may present as depression or anxiety, it can also exacerbate any number of other underlying psychiatric illnesses, such as bipolar disorder or borderline personality disorder. Despite this, burnout alone doesn't fit in any diagnostic criteria for established mental illnesses. In fact, there's not yet specific diagnostic criteria for burnout in DSM-5 (the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders), which represents the most comprehensive and widely used information currently available for clinical diagnosis of mental disorders.
What Burnout Really Feels Like
Recognizing early warning signs of burnout is difficult, but the end result is the same in all cases: You become what we'll call DEF. When in burnout, you experience Depersonalization, Emotional exhaustion, and decreased Function at work. Another way to look at this is that you become cynical, exhausted, and perform poorly.
For healthcare professionals, burnout may translate to a day-today experience of feeling like you're rushing from one patient or procedure to the next without any sense of fulfillment. For caregivers, it may feel more like you're trapped in a cycle of all work, no satisfaction.
In order to determine if you're suffering from burnout, here are two simple steps to help you make that call.
Step 1: Answer this question:
Do you often feel like "I can't do this anymore," even after an initial period of adaptation to your job?
If you answered yes, go on to the next step.
Step 2: Look out for the following symptoms:
1. You have less patience with others than you used to.
2. You feel physically exhausted right at the beginning of your workday.
3. You habitually feel like you're making errors of judgement despite adequate training.
If you answered yes to these three questions, you're likely burned out.
The above feelings may culminate in a host of symptoms, including sleepless nights, mindless preoccupations, becoming socially withdrawn, nervousness, irritability, avoidance of exercise and social interaction, and craving junk food.
If you did answer yes to those questions, you aren't alone. Understanding you're experiencing burnout means you can take actionable steps toward solutions.
Am I Stressed Out or Burned Out?
Burnout is an individual, subjective experience that happens in the space between your ears. To determine if you're experiencing burnout, it's important to distinguish between regular job-associated stress and actual burnout.
When reality doesn't match our expectations, we experience stress. Workplace stress is not uncommon for physicians and other healthcare workers. It can come from many directions and may be the result of too many expectations, mounting pressures, or external factors, like too little staffing.
While stress is often destructive, we can't ignore its ability to push us to optimal alertness and performance. The existence of stress hormones is an incredible biological adaptation that provides us with the ability to deal with high-intensity situations — imbuing us with the power of resiliency and helping us adapt to whatever our jobs (or lives) may throw our way.
While small amounts of stress can propel us forward, as a constant condition, chronic stress becomes harmful. To manage it, one of the most helpful things we can do is identify specific problem areas and take concrete steps to address the source. While some types of stress may be difficult to manage, in most cases, stress is easy to recognize.
Burnout is a different animal. It's the great imitator, so we may not recognize it for what it is. For instance, you may be a high-performing leader or a well-loved team player, doing all the things that count as being "successful" and yet, after many years of following your passion, you may suddenly feel that nothing you do is meaningful anymore. You may feel unmotivated, unchallenged, or bored at a job you were once very enthusiastic about. You don't want to quit the job you spent years training for, but at the same time you dread (or feel restless) going to work day after day. Waiting to see if this feeling will pass only seems to make it worse.
It's important to remember these feelings aren't occurring because you're less competent or capable or that you're lacking in some way. You're still the right person for the job, but your energy and enthusiasm are tapped out because they haven't been nurtured and balanced.
It's not uncommon to experience stress if you're early in your career, where it may take time to adjust to new responsibilities, a new workplace culture, and the demands of working full time. In this case, initial jitters typically melt away with experience and adaptation.
If you find that a set of new job responsibilities doesn't match your core competencies — what you like to do and what you're good at — you may experience dissatisfaction and stress, but that's not necessarily burnout. For example, I'm at my best in an acute and intense environment. You'll see me thriving when I'm running between hospital floors handling cardiac events and other critical care crises. Acute care is my core competency; I become bored and restless in a more routine patient care setting. Another per- son, however, might feel better working in a clinic where patients come to them by way of a predetermined schedule — such as an endocrinologist or a rheumatologist. This person would become stressed doing my job, and I'd stress out doing theirs. If you find that your job is causing you stress, you may want to explore other roles within your field that are a better match.
For example, take the case of 23-year-old Erika, fresh out of nursing school, who's recently started her career as an Emergency Department (ED) nurse at a hospital in Florida. She quickly realizes the pace and acuity of the ED is too much for her. She's stressed out, anxious, and tired, and she's beginning to dread her shifts. She still loves nursing and wouldn't dream of leaving her career, but she sees the ED isn't a good fit. An older colleague suggests she speak with nurses from different specialties to see if another unit might be better aligned with her skills.
After looking into nursing duties across different departments, Erika decides to try the psychiatric unit. She finds the pace and demands are just right for her strengths and personality. She's able to transfer there, and she fits right in. Her stress levels dramatically reduce, and it's easy for her to recover from an intense shift or two over the weekend.
Fast-forward 15 years. If Erika finds she can't handle her job or her stress levels are higher than usual, that could be the beginning of burnout. When your beloved profession seems more like a burden than a calling, burnout might be to blame.
Here's some good news: Studies suggest that early career burnout doesn't seem to lead to any significant, negative, long-term consequences as long as it's handled. Burnout occurring later in a career might have more serious long-term effects — especially if it's left to linger without being addressed.
* * *
So, you might ask, if medical providers are so burned out, why do we keep pushing? Great question
(Continues…)
Excerpted from "Burnout in Healthcare"
by .
Copyright © 2019 Rajeev Kurapati.
Excerpted by permission of Sajjana Publishing.
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