Burnout- it's not just for doctors anymore, or workers

[The White Coat Investor]

http://nymag.com/scienceofus/2017/04/just-like-at-work-its-possible-to-burn-out-on-parenting.html

This is my life, right now: My children, ages 4 and 5, won’t eat anything but plain bow-tie noodles. My 5-year-old won’t go outside because a goose chased her at the park last spring, and now she has a paralyzing fear of the outdoors. My 4-year-old still routinely climbs into my bed every night, in the middle of the night, and sandwiches himself between me and my husband, insisting on sharing my pillow and breathing into my face as he sleeps. I’m sleep-deprived. I’m strung out. Between shuffling one kid off to physical therapy multiple times per week and coaxing the other to get on the bus every morning (there are geese in our neighborhood), I frequently feel like I’m at the end of my rope.

Parenting is stressful. I don’t need a study to tell me that. But sometimes, it feels more than stressful — it feels like total exhaustion. It feels like burnout.

How do you tell the difference between burnout and life being, well, hard?

[ENT Doc]

Great point.  I think the clear distinction is where it develops into pathological behavior.  For example, what tends to define alcoholism is when it impairs functionality, affects behavior, brings DUIs, makes people late for meetings, etc.  A mom, dad, doctor, etc. having it rough is an expectation.  We all face that - some more than others.  But what prevents it from getting to burnout, other than addressing the systemic problems around us contributing to it, is our resilience.  This acts as a barrier to prevent the daily grind from not making you want to go in the next day, getting depressed, take short-cuts that impair patient care, etc.  Every situation will be different.  Sometimes we can deal with or change the systemic causes.  But something we can all focus on is improving our resilience.  For those who don't want to, can't, have tried and failed, or where the systemic causes are impossible to address...that's when some go to the FIRE mindset IMO.

[Muaddib]

Though any parent will nod in understanding, and though burnout is different for different people, her examples pale in comparison to what other parents have to deal with - crime, fear for safety from abusive other, poverty, chronic medical conditions, fear of deportation.  It's hard to tell if it's tongue in cheek with that opening narrative or not.

I have a family with multiple adult children with severe MR-CP requiring 24 hour care, wheelchair bound with feeding tubes, multiple specialists involved, etc..  I think they would argue that this writer is sweating the small stuff.  I am in awe of them whenever I see them.

 

 

[hightower]

I agree with ENT Doc partially.  Burnout comes when it starts to get in the way of your happiness.  Life can be hard, but you can still be happy.  If you're burnt out you're likely going to be in a bad mood a lot, irritable at home, resentful towards others, easily angered/annoyed.  Those are all symptoms of a problem and if you or others sense them, you need to make a change.

But, I don't think its resilience that people need.  That makes it seem like its a character flaw if the stress gets to you.  Saying its resilience is like saying its "toughness."  "You just have to be tough and power through it."  I call that a cowboy mentality.  In my opinion, that's what gets so many people into trouble in the first place.  They ignore their feelings and emotions and just act tough.  Doctors are especially guilty of this.  We can thank residency (boot camp) for that mentality.

I think its different for everyone, but many people are completely unaware of their feelings/emotions and their behavior.  I know a lot of people like that, I used to be one of them.  I also think there are a lot of people that for cultural and religious reasons just try to power through the stress and see it as a their moral obligation to suffer a little.  I also know a lot of people like that.  There are a lot of different personality types that can also explain why some are more prone to burnout than others.  Our career needs to be good fit for our personality in order for us to feel good each day.  When you add stress or insane hours to a poor fit, that's a recipe for problems.

Burnout is possible in lots of scenarios.  Parenting seems like a common one.  People tend to let their kids completely run their lives and before they know it they don't like their lives anymore.  Then they tell themselves that they have to be tough "for their kids" and they ignore their own needs and feelings over and over again. That's an obvious formula for burn out.

I went through burnout last year and for me the solution was first becoming aware of my problems.  That came from learning some mindfulness techniques/philosophy and also learning about my personality (a strong introvert that prefers quiet, working independently, fewer interruptions, etc).  Then, it was making some changes to how I work (cutting back on hours, changing the type of shifts I work, etc).  I think anyone can benefit from learning more about themselves in that way.  I see burnout in others all the time now whereas before I was the one with the problems.  I'm just thankful my wife forced me to see a counselor.  That was the turning point for me.

[DMFA]

I've been keenly aware of burnout ever since it was track 1 on Dookie back in '94. I was burned out with fourth grade, then compulsory education in general, then college, then med school, etc. Ironically it stopped when I started residency.

It's a fact of life. It happens. Humans have finite energy and patience. It's reasonable that it would approach an intolerable level at some point in a myriad of situations. It's okay if it's happening at a certain level in the population...as long as it can be recognized, addressed, and prevented (or at least its likelihood or frequency reduced) in some way.

[ENT Doc]

hightower wrote:

I agree with ENT Doc partially.  Burnout comes when it starts to get in the way of your happiness.  Life can be hard, but you can still be happy.  If you’re burnt out you’re likely going to be in a bad mood a lot, irritable at home, resentful towards others, easily angered/annoyed.  Those are all symptoms of a problem and if you or others sense them, you need to make a change.

But, I don’t think its resilience that people need.  That makes it seem like its a character flaw if the stress gets to you.  Saying its resilience is like saying its “toughness.”  “You just have to be tough and power through it.”  I call that a cowboy mentality.  In my opinion, that’s what gets so many people into trouble in the first place.  They ignore their feelings and emotions and just act tough.  Doctors are especially guilty of this.  We can thank residency (boot camp) for that mentality.

I think its different for everyone, but many people are completely unaware of their feelings/emotions and their behavior.  I know a lot of people like that, I used to be one of them.  I also think there are a lot of people that for cultural and religious reasons just try to power through the stress and see it as a their moral obligation to suffer a little.  I also know a lot of people like that.  There are a lot of different personality types that can also explain why some are more prone to burnout than others.  Our career needs to be good fit for our personality in order for us to feel good each day.  When you add stress or insane hours to a poor fit, that’s a recipe for problems.

Burnout is possible in lots of scenarios.  Parenting seems like a common one.  People tend to let their kids completely run their lives and before they know it they don’t like their lives anymore.  Then they tell themselves that they have to be tough “for their kids” and they ignore their own needs and feelings over and over again. That’s an obvious formula for burn out.

I went through burnout last year and for me the solution was first becoming aware of my problems.  That came from learning some mindfulness techniques/philosophy and also learning about my personality (a strong introvert that prefers quiet, working independently, fewer interruptions, etc).  Then, it was making some changes to how I work (cutting back on hours, changing the type of shifts I work, etc).  I think anyone can benefit from learning more about themselves in that way.  I see burnout in others all the time now whereas before I was the one with the problems.  I’m just thankful my wife forced me to see a counselor.  That was the turning point for me.

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I actually agree with your assessment entirely.  To be clear, I don't think it's a character flaw issue nor was I trying to imply that.  Everyone has a breaking point.  All else being equal, the person with more resilience will last longer.  It helps keep the tank full.  That's all I'm saying.  It doesn't resolve the underlying problems, which is important to address for efficiency's sake.  But unless you plan on taking on the medical establishment (insurance, government, etc.) and rallying others to that cause (I'll be happy to join in BTW) then the only thing you have control over are your own emotions.  Having resilience starts with knowing thyself better, as you have said.  I agree with your assessment of burnout leading to unhappiness, but in a general sense - not being unhappy at any time.  That often, as you said, leads to destructive behavior, which was the distinction I made.  Clearly, the erosion of happiness creates those symptoms.  I think it's just easier to describe a pathology based on behavior/actions rather than feelings that can't be as well quantified.  Probably the only difference in our thinking.

[hightower]

DMFA wrote:

I’ve been keenly aware of burnout ever since it was track 1 on Dookie back in ’94. I was burned out with fourth grade, then compulsory education in general, then college, then med school, etc. Ironically it stopped when I started residency.

It’s a fact of life. It happens. Humans have finite energy and patience. It’s reasonable that it would approach an intolerable level at some point in a myriad of situations. It’s okay if it’s happening at a certain level in the population…as long as it can be recognized, addressed, and prevented (or at least its likelihood or frequency reduced) in some way.

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LOL, "track 1 dookie back in '94."  I'm unfortunately old enough to know exactly what you're talking about  haha

[CM]

hightower wrote:

LOL, “track 1 dookie back in ’94.”  I’m unfortunately old enough to know exactly what you’re talking about  haha

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Unfortunately, I'm so old that I don't know.

[wideopenspaces]

Lots of great and insightful comments here. I think that burnout, like trauma, is very specific to the individual. One hundred people can go through the same scary experience but not everyone will be traumatized by it and only a small percentage will develop PTSD. Because of the individual coping skills and the way the outside event was internalized. So what leads one person to burn out will be considered small potatoes or ' sweating the small stuff' or life just being hard. Just like I learned in residency not to judge what others find traumatizing, it's best not to judge what causes burnout in another person. Looking at the underlying cause to see what structural changes can be made ( ie finally sleep training your 4 yo, getting your 5 yo into therapy for that geese anxiety) is helpful along with increasing your own coping skills ( usually through therapy) to decrease the burnout. Living in Utah I see a lot of young moms with 4-5 young kids who are totally burned out and depressed and I can definitely see why. And those are the things we focus on (along with meds) and they tend to get better.

[VagabondMD]

This is a great thread. The interest in preventing, identifying, and managing burnout is increasing and not a moment to soon. It is my opinion that once burnout is established in the individual, it can never completely be eradicated (like other emotional conditions), it can only be kept at bay. If there is a pill, strategy, trick or some other magic bullet to eliminate it, I am not aware. This has significant financial implications for the individual, the burned out practitioner, and the broader health care system.

I do know that I attended a major specialty society meeting earlier this month, and the 1 1/2 hour session on burnout was completely packed, every seat taken, and dozens of additional attendees standing in the back. Five years ago, there would be no such session. Kudos for the society for acknowledging the problem and encouraging dialogue and education in this area.

[The White Coat Investor]

CM wrote:

hightower wrote:

LOL, “track 1 dookie back in ’94.”  I’m unfortunately old enough to know exactly what you’re talking about  haha 

Click to expand…

Unfortunately, I’m so old that I don’t know.

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I declare I don't care no more
I'm burning up and out and
Growing bored
In my smoked out boring room
My hair is shagging in my eyes
Dragging my feet to hit the
Street tonight
To drive along these ************************
Town lights

I'm not growing up,
I'm just burning out
And I stepped in line
To walk amongst the
Dead

Apathy has rained on me
Now I'm feeling like a
Soggy dream
So close to drowning but
I don't mind
I'll live inside this mental cave
Throw my emotions in the grave
************************, who needs them
Anyway

I'm not growing up
I'm just burning out
And I stepped in line
To walk amongst the
Dead

Artist: Green ay

Album: Dookie

Track 1: Burnout

[FIREshrink]

i'm burned out from my administrators giving me books to read about physician burnout.

[Live Free MD]

I agree with the value of learning ways to increase your resilience, such as being aware of your emotions, taking vacation time, exercising, and getting enough sleep.  Ultimately, however, I think the best cure for burnout is to get a bunch of money in the bank so that you are no longer constrained, and can do whatever it takes to transform that burnout into inspiration and vigor.

[resident_1]

FIREshrink wrote:

i’m burned out from my administrators giving me books to read about physician burnout.

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Nice. I agree.  Previous job was burning out its attendings, and administration would send these emails about physician burnout to "educate" us about it.

 

[WealthyDoc]

We are having meetings about it at my institution.  Although we appreciate the acknowledgement, the meetings at 7 AM and 7 PM are only adding to the problem!