Resident burnout. Or is it just smoldering?
Today’s episode is not about patients. It’s about providers. The physicians, the nurses, advanced practitioners, and other healthcare personnel whose needs and emotions are largely ignored. Because it’s hard to put your needs first when your sole job is to help others who are in even greater need. While there has been a paradigm shift in the last 20 years when it comes to quality of life for those of us who work insane hours—80 to 120 hours a week—and deal with extremely sick people in extremely unfortunate situations—I can’t deny that it doesn’t still get to us. It all adds up, and it still breaks us down. It’s not good for patients either. This week, you’ll hear from two resident physicians I work with about resident burnout. How they deal with it, and what they’ve done to overcome it. So read on, and don’t burn out on us yet.
WHAT IS BURNOUT?
One of the biggest challenges faced by physicians in their training is the steep learning curve that comes with the job. To tell me about it on the show this week, two Penn residents–John Best and Lindsay Raab–both in their second year of training, shared their experience on the podcast. I’d also like to acknowledge how committed they are to resident physician wellness by doing this. They came over to my house on a post-call day, after an overnight shift, on their weekend off, in the busiest year of residency–just to record this interview.
Burnout has been described as a “pathologic state of emotional depletion.” But it’s not as simple as that. According to some experts, burnout has 3 dimensions:
- Emotional exhaustion, in which overwhelming work demands deplete the individual’s energy
- Depersonalization and cynicism, in which the individual detaches from the job because you’re constantly facing horrible situations
- Feelings of inefficacy, in which the individual perceives a lack of personal achievement
But it’s not like burnout is a staged process, or that you have to meet all 3 of these criteria. There are varying degrees of each symptom, and they exist together along a spectrum. It can manifest in a number of ways for a number of people, depending on your personality.
So how can we cope with this? This episode can’t all just be about horror stories and struggles from when your life, age 22 until your early-mid 30s. There HAS to be a silver lining for neurology trainees. And for Lindsay, it was the support of her friends, and their shared experiences. Talking it out is one of the simplest approaches to get something off your chest, and to give others the opportunity to relate to you. But other times, you may want to process it on your own. In silence. Making conversation can get in the way of internal reflection, and sometimes it can just make you more aggravated–especially if the person you’re talking to is not a great listener.
As for me, my most challenging experience in residency took place during my child neurology rotation. Not only do I have zero experience with children, but child neurology is so far removed from adult neurology that nothing I had done in residency until that point could have prepared me for it. But there I was, immersed in a sea of sick children with the most unusual genetic abnormalities or brain malformations–or worse, healthy children who had suffered anoxic brain injury from drowning incidents during the summer. And every 4th night, no sleep. Q4 call. To suppress the emotional overload, I was known for keeping a drawer in the office chockfull of Reese’s puffs and chocolate bars and leftover cookies from various educational conferences. Chocolate got me through child neurology.
But there is no “one-size-fits-all” approach to preventing or coping with burnout. I cannot offer you a prescription, although some experts have tried. After speaking with John and Lindsay, I picked up on several themes that worked for both of them. Maybe you could find them useful in your own practice–whether you’re a burnt out resident physician, or just a fan of the show who is exhausted by work.
- Number 1. Be strong. And emotional. Also, know that being strong and emotional are not opposing qualities. Patients want a human doctor to care for them, they want to see you have some attachment–some investment in their wellbeing. But you cannot 100% commit that to them. You can’t treat them like they are your brother or sister or mother or son. Too many horrible things can happen to sick people for you to absorb the entirety of an emotional assault from each sick person you encounter.
- Number 2. Admit defeat. You are bound to be wrong. The odds are against you. Know when you are wrong, know when you cannot handle something alone, know when you need help. Recognize your mistakes and learn from them. People mistake this type of learning as a passive process. They often feel that just by being at work all day that you will recognize your errors and learn from them. But as we discussed in the episode on 10,000 hours, that is clearly not the case. Learning is an active process that requires deliberate practice.
- Number 3. Life maintenance. It kind of goes by the wayside during residency training. Not to mention a lot of your passions, which also get shelved for the 5-10 years of residency and fellowship. Unless, instead of finding time to do these things, you make time. Keeping an organized home, a stocked refrigerator, and folded laundry will do your mental health wonders. Because if work doesn’t go well, at least you have something calm to fold yourself into when you get home. If your home looks relaxing, you will feel relaxed. If your home is a wreck, how do you think you’re going to feel? For Lindsay, she definitely takes out her angst on the living room–rearranging furniture, furiously cleaning, and improving the atmosphere of her home. Playing with her two dogs in the meantime doesn’t hurt either.
- Number 4. Me time. I bring this up as a separate goal from life maintenance. I know it’s not in your blood, having chosen this extremely selfless profession. But if you don’t take care of yourself, how can you be expected to take care of others? Let’s think about it this way. As a doctor, or even a nurse, or a pharmacist or a social worker, when you’re committing these crazy hours and surrounded by patients, sick people, who depend on you to return back to health, you resort to using a lot of your left brain. God, I really hate saying that as a neurologist on a neurology podcast. But it’s true. That more abstract, creative half to your mind, your right brain, it will atrophy unless you feed it with some sort of activity.
CREATING THE CORTICAL RIBBON
For Lindsay, she is reminded by her family that becoming a doctor was all she ever wanted. A lifelong pursuit of knowledge and training. And the training would not just be for her, but it would be something she wanted to pass on as well. The same went for John. So together, they created a blog that would disseminate fascinating cases they observed on rotations filled with insightful clinical pearls, radiographic imaging, and…haikus? They called it The Cortical Ribbon. And it started off as a bimonthly newsletter that only went out to our residency program, but when I heard about it, I wanted to get the emails too. The faculty at Penn also picked up on it. So, it became a blog. It’s definitely worth looking into if you like the BrainWaves podcast, as the content is very similar. And both are–not surprisingly–terribly cheesy. Take a look at the end of the episode. Maybe you’ll learn something.
Whatever your outlet is, whether you are creative and enjoy poetry, or you’re into research, or cooking, or family, keep it alive in you. If I could leave you with any last message, as we’re about to wrap up the show, it would be that it is so important that you remember who you are, remember what it is that drives you, that gets you out of bed every morning, and drags you into the hospital to face these challenges, day in and day out. Because ultimately, you chose a very selfless and honorable path. And I’m not trying to justify this because it’s the path I chose, and this doesn’t apply strictly to physicians. I’m talking about nurses and social workers and pharmacists, physical and occupational therapists, speech pathologists, anyone who decided at some point in their lives, you know what? I’m going to spend the rest of my life helping others.
BrainWaves podcasts and online content are intended for medical education and entertainment purposes only. If you’re feeling burnt out, do not misconstrue this episode for medical advice. Featured image from https://www.flickr.com/photos/eflon/4638453675/ under a CC license.
- Thomas NK. Resident burnout. JAMA : the journal of the American Medical Association. 2004;292:2880-9.
- Shanafelt TD, et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population.