Dr Declan Whelan: “Burnout and Building Resilience”
Why is it that you can hardly open a journal nowadays without coming across some reference to physician burnout? Well, the simple truth is that numerous global studies, including one in Ireland, involving nearly every medical and surgical speciality, indicate that a significant proportion of physicians and trainees are experiencing burnout at any given time.
Why then are present day doctors prone to burnout? Let us start with a definition of burnout. Doctors who experience burnout describe emotional exhaustion, a sense of ineffectiveness, associated with compassion fatigue. Feeling of depersonalization and cynicism are common. Alcohol and drug abuse are often concomitant features. It remains widely under reported and untreated, can have significant adverse effects for the individual in terms of personal health and career. It is hardly surprising therefore that suicide rates among male and female physicians are higher than the general population. Burnout is not only bad for doctors but it is also bad for patients. It is directly related to consequences such as lower patient satisfaction and quality of care, higher medical error rates and malpractice risk, higher physician and staff turnover.
So why, here and now, in the twenty first century has physician burnout become such a major occupational issue? The simple explanation is that doctors are no longer in control of healthcare systems throughout the world. Healthcare is now a commodity traded like any other commodity. Providers, whether they be governments or private companies demand increased output while reducing both human and infrastructural resources. Added to this are the unrealistic societal expectations and hostility from the regulatory authorities when errors do occur. The doctor is then placed at the centre of this system and required to take responsibility for the outcomes. Is it any wonder then that they experience burnout when the very personal value characteristics of service, excellence, curative competence and compassion, which make for a good doctor, are undermined and devalued by such a system?
So how can doctors inoculate themselves from the inherent risks within the present day medical culture? Practical mental training can increase doctor’s resilience to their medical practice environment and develop their sense of insight. Developing healthy patterns of thinking is a good place to start and requires regular and skilful workouts. Otherwise the mind reverts to its default mental and emotional state. This can lead to a negative cycle of irritability and self-criticism. Mindful self-compassion and inner critic awareness are powerful interventions to prevent such thoughts from becoming pervasive. Reframing one’s thinking on patient contact scenarios so that they reflect appreciation and gratitude rather than negativity can be a potent bulwark also. Promote community and connection with your colleagues and associate it with generous listening and you have probably the greatest deterrent to burnout. Self-awareness and care should be the final cornerstone of a doctor’s defence against burnout. Silence can be energising and transformative so do not delay. Today is the first day whereby you regain control of your life. Enjoy being a doctor. It can be the best job in the world. You simply have to learn to look after yourself as well as others.
Declan Whelan FRCPI, FFOM.
Dean Faculty Occupational Medicine.