What is Burnout?
Burnout is an interesting concept. I find it much like mindfulness: it is fairly easy to reference as a common buzzword in modern medicine, but it is equally difficult to tangibly define. What is burnout exactly? If you asked me to concisely define it, I doubt my attempt would do it justice. At the end of the day, burnout is really an experience. It is a feeling that arises when the fulfillment of a pursuit is outweighed by its pitfalls and stressors. This feeling, this experience of burnout is something better described than defined. It is something we should all strive to avoid but will inevitably experience in some capacity during our careers in medicine.
Because it is so common and can be so physically and emotionally damaging, burnout is something that warrants true discussion. The Med School Insiders team has realized this and is pioneering the #SaveOurDoctors movement. This initiative is an effort to raise awareness about medical student and physician burnout while stimulating ideas, strategies, and plans to combat it.
Given the fluid nature of burnout and the difficulty with constraining it to a single definition, I find it more useful to describe our experiences with burnout. By discussing tangible experiences, we can further the awareness of burnout and what precipitates it. At the same time we can begin to think about ways to prevent burnout and deal with its effects when it does arise.
My Experience with Burnout
This topic is of particular relevance to me at the moment. For the first time in residency, I feel myself truly experiencing symptoms of burnout. I am a third year internal medicine resident, which means I am in the last year of my residency training. Perhaps I had been fortunate to avoid true burnout thus far, or perhaps I did not notice subtle symptoms of burnout that I had previously experienced along the way. During my last month of work, though, I found myself feeling exhaustion, frustration, and irritability to a level which I had not previously experienced.
I just completed back-to-back inpatient wards months. This means that I was working on the general medicine service in the hospital as the senior resident, running a team which cares for patients admitted to the hospital for a multitude of medical issues. After completing the first month, I was certainly tired and sleep-deprived, as is not unusual during residency. Despite this, I began the second month maintaining my normal level of positivity, hoping for a smooth rotation.
Unfortunately, the second month ended up being brutal. There is no other way to describe it. I have never had such a busy month on the medicine wards. The number of admissions and discharges to and from the hospital was the most I have ever seen. My attending (the supervising doctor on the team) jokingly commented that we set the record for most patients he had ever cared for in a 2 week span. Simultaneously, we had more sick patients than usual on the general medical ward, with several patients decompensating and requiring escalation to ICU level of care for use of a ventilator or other life-saving interventions. Finally, we had some very complex social situations and stressful interactions with patients and families, which in all honesty are not uncommon in medicine. The days were stressful and emotionally charged, to say the least.
Each day was relentless, with patient after patient being admitted and discharged, including many complex cases. For the first time in my medical career, I felt tangible effects of this huge workload on my mood and behavior. I found that the normal stressors of the job (of which there were many) were becoming more bothersome than usual. Small transgressions from upset patients or frustrated medical staff were making me irritable when normally they would not. Most of all, the relentless, unceasing flow of work was emotionally defeating. It was like swimming upstream against a steadily increasing current. There was no beating that current. There was no relief. There was no rest for the weary.
While working, I began to notice my mood and well-being suffer. Yet all the while, these feelings were intermixed with the usual positive aspects of the job: the fulfillment of caring for sick patients and improving their health and quality of life; the excitement of making an unexpected diagnosis or learning about an uncommon disease; the camaraderie of spending long hours working and bonding with your peers.
Due to these positive aspects of my work, I did not realize during the month that I was experiencing real burnout. Yet in retrospect, I definitely was. The feelings I described above were my personal experience of burnout due to an even greater workload and stress level than I had grown accustomed to as a resident.
In retrospect, I feel that I was overlooking the negative manifestations in my daily mood adaptively: not consciously acknowledging the burnout was likely a defense mechanism my mind and body were using to maintain productivity during a time of high stress.
Though perhaps beneficial for quantity of work, this adaptive behavior can be deleterious. If one does not acknowledge the burnout and make active efforts to improve well-being thereafter, they may suffer real physical and psychiatric harm. Realizing and acknowledging burnout is key; only then can we attempt to combat it.
How We Can Combat Burnout
The enormous workload and long hours of residency are an age-old issue that we need to continue to improve. This is no secret. We have made strides (such as the [recommended] reductions in maximum work hours), and I trust that we as a medical community will continue to do so. My program leadership is certainly attentive to resident well-being and offers support to those in need. I suspect that many other residency programs are acting similarly. But we need to do more. That is why efforts like #SaveOurDoctors, which strive to raise awareness about burnout and physician physical/mental health issues, are of paramount importance.
In addition to systemic changes, just as important is personal awareness of burnout signs/symptoms and an active effort to combat them. I find myself in the midst of a healing process as I write this. Only in retrospect have I acknowledged that I truly reached an experience of burnout in residency. I am now making a concerted effort to improve my health and well-being. I will reduce my time of work over the next several weeks (which is feasible due to my current lighter rotation schedule). Additionally, I will increase protective behaviors which I know improve my mental well-being: exercise, basketball, hiking, meditation, reading, and writing.
Even writing this post is a therapeutic exercise for me. I have always loved to write, so I derive pleasure simply from the act. Furthermore, reflecting on this difficult month and processing my feelings in a manner amenable to writing has helped me deal with the burnout symptoms I have experienced. I would encourage all readers to be cognizant of aberrations in their mood which may be evidence of burnout. Furthermore, be observant of signs of burnout in your peers. Be attuned to yourself and those around you because everyone needs support through difficult times. Do not be afraid to ask for support or lend a helping hand to a colleague who may be in need. We are all in this together.
Finally, please take a moment to look at the #SaveOurDoctors initiative and consider how you can make a difference in the battle against medical student and physician burnout.