Find Out If You Are Suffering from Stress or Job-Related Burnout

APRIL 03, 2016
Clark Gaither, MD
For more on physician burnout, check out "Beating Physician Burnout."

I remember the moment it happened. I came out of an exam room following a rather difficult patient encounter. The patient had multiple, complicated medical problems, a list of complaints, limited resources, and little motivation to change, and I had less than 10 minutes to deal with all of it.
 
I was feeling mentally and emotionally exhausted. Standing outside in the hallway were four of my office staff, each waiting to ask me a question. I heard the phone in my office begin to ring. Even before I picked up the phone I heard a clear and loud voice inside my head screaming, "I can't do this anymore."
 
The discipline of medicine is inherently difficult. There is a lot to know. Skill is required. The responsibilities are great. The ability to engender trust, demonstrate competency, and exude compassion are absolute necessities. An enormous amount of mental, emotional, physical, and spiritual energy is required for the job. All of this, and more, is needed to become "the good doctor."
 
Naturally, you would want or expect a physician to be on fire with passion and purpose for the practice of medicine, right? Tragically, this is not the case for the majority of physicians currently practicing within the US.
 
The house of medicine is on fire, not with passionate purpose, but with a majority of doctors who are burning out. The flames of passion for our profession have been replaced by the all-consuming fires of job-related burnout. We are in the midst of national medical emergency with physicians burning out.
 
What once began in slow motion is now rapidly accelerating. A recent study published by Shanafelt et al in the December 2015 issue of Mayo Clinic Proceedings documented a rise to 54.4% from 45.5% in the number of physicians reporting at least one symptom of burnout in the span of just three years, from 2011 to 2014.
 
I know firsthand how it feels to be burned out. It is a miserable feeling, almost one of complete helplessness and hopelessness. In 2009, I went to my practice partner and told him I had to change some things or I was going to have to leave the practice of medicine. I had hit all three hallmarks of burnout.
 
The hallmarks of job-related burnout have been succinctly described by Dr. Christina Maslach, as measured by the Maslach Burnout Inventory (MBI).



The three principal hallmarks are: emotional exhaustion, depersonalization, and a lack of a sense of personal accomplishment. While these symptoms are both sensitive and specific for burnout, they are not the causes of burnout.
 
The symptoms of burnout are often mistaken for job stress, which is decidedly different. Granted, physicians who are burned out are stressed out, but you can be stressed out without being burned out. Treating stress as burnout will not properly treat the symptoms or correct the underlying causes.
 
Stress Job Related Burnout
Characterized by over-engagement.
Emotions are overactive.
Produces urgency and hyperactivity.
Leads to loss of energy.
Leads to anxiety disorders.
With stress the damage is primarily physical.
Prolonged and excessive stress may kill you prematurely.
Stress is more easily identified and treated.
Stress is almost always recognized by the individual.
Characterized by disengagement.
Emotions are blunted.
Produces helplessness and hopelessness.
Leads to loss of ideals, motivation and hope.
Leads to detachment and depression.
With burnout the damage is primarily emotional.
Burnout will make your life not seem worth living and increases your risk of suicide.
Burnout can be much more difficult to manage.
Burnout may not be recognized as such by the individual. Symptoms will likely be attributed to some other cause.
 
 
Physicians, more often than not, become the focus of efforts to alleviate the symptoms of burnout by attempting to teach them stress-reduction strategies. It is not only the wrong thing to do, it is 180 degrees the exact opposite of the right thing to do. Stress-reduction strategies might help in the short term, but not in the long run. Any positive benefits from stress-reduction training will be temporary at best.
 
Also, it can be very demeaning to a physician to haul them into a room for a series of lectures or workshops on stress reduction. The subtle message becomes "you are too stupid, inept, or just don't know how to properly handle your own stress, doctor, so we are going to teach you."
 
If there is any message which should be repeated often and loudly, each and every time the topic of physician burnout comes up for discussion, it should be this:
 
"Physicians do not usually burn themselves out. It is the work environment which burns out the physician."
 
If you feel you are suffering the effects of job related burnout rather than job stress, your career doesn't have to end this way. Seek help immediately. There are plenty of burnout alleviation, mitigation and prevention programs, workshops, courses, even personal coaching, which can help you to reignite the fires of passion and purpose for your chosen profession.

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