Burned Out?

Have you ever felt being drained emotionally at work or developed the dehumanized view that your clients/patients/customers deserved their troubles?  Have you ever developed the tendency to rate yourself negatively, with regards to your performance at work?

If you have answered yes to all the questions, then perhaps, you may be suffering from a burnout ( ICD Z73.0 ).

Burnout is a psychological syndrome of emotional exhaustion, depersonalization or development of cynicism towards work and people in the workplace, and reduced personal accomplishment.  Health care workers are prone to experiencing this, as they work with people, most of the time, people who are ill and who may be stressed on their own, thus, may be transferring these overwhelming emotions upon their caretakers to ease their burden, with the health care workers having to bear this deliberately, cautiously, and effectively to an extent more than what is expected of an average person.  As the person becomes overburdened with the demands but have decreasing resources to cope with it, he experiences physical manifestations of stress such as physical exhaustion, insomnia, increased use of alcohol and drugs, and even increased marital and family problems.

Others who may be prone to experiencing this are in the customer-service profession like taxicab drivers, law enforcement personnel, teachers, engineers, emergency service workers, vocational rehabilitation counselors, soldiers, and reporters, mostly professionals who deal with various kinds of people all the time.

I’ve to admit that, in the course of my medical career, I experienced burnout a lot of times.  Medical school had been a continuous struggle to be able to churn out quality work while trying to maintain a semblance of normal, quality life outside of medicine.  It was at that time that I have to learn that giving up gimmick times with friends to make way for study time (of which would initially seem to have been rendered useless because of disappointing exam results, leading to a false conclusion that it had been better to have gone out on a gimmick days prior to an exam, since there wouldn’t be a significant difference in the outcome anyway) is a necessary sacrifice, which as days and months passed, wouldn’t appear as sacrifice anymore, but rather, a logical choice.  It was at that time that I have to learn to accept that I do not know everything and I cannot know everything and to deal with that on a daily basis, in terms of toxic consultants and residents and, at the same time, a rocky, deteriorating romantic relationship.  It’s no different when I got into internship and general practice, as I come in contact with more irate patients who can leave one feeling inadequate or undeserving.

But reading medical students and practitioners forums and listening to colleagues’ stories, I think, is enough to conclude that it is a fairly common experience and would be unfair to merely label burnout complaints as mere whining.

The most common tool used in assessing burnout in research is the Maslach Burnout Inventory (MBI).  It contains 3 subscales that assess that different components of the burnout syndrome: emotional exhaustion, depersonalization, and reduced personal accomplishment.

Emotional exhaustion subscale contains 9 items (questions) and are concerned on the feelings of being emotionally overextended and exhausted by work.  Depersonalization subscale contains 5 items of which measures the impersonal response towards the receipients of one’s service.  Higher scores in both subscales mean higher degrees of burnout.  Personal accomplishment subscale has 8 items and assess feelings of competence and achievement in one’s work.  Lower scores in this subscale mean higher degrees of burnout.  The test can be self-administered, but if there’ll be someone who’ll administer it to another person, he should be seen as a neutral entity, and not someone with direct power/authority over the respondent, so as to ensure that answers will remain true and candid.

More information about MBI can be found in this article, “ Evaluating Stress “, edited by Carlos P. Zalaquett and Richard J. Wood.

So, how want a little bit of help to know if you’re indeed experiencing burnout?

Just do this little test from Mind tools, a Burnout Self-Test.  It’s not the Maslach Burnout Inventory tool, but rather an informal test that is easily available online.

I took the test and scored somewhere in the middle, meaning I’m already at risk for experiencing burnout and I needed to take extra precaution.

I think it’s important that doctors, like myself, realize how vulnerable we are at having this.  Though I couldn’t really be an expert to be talking about how one should avoid or treat oneself of burnout,  I just want to share some tips that have served me well so far:

1. No matter what happens, it is important that, in a day, you have to have a time for yourself. It could be just an hour or two which you do what it is that pleases you, be it surfing the internet or reading a non-medical book.  Having lunch alone, for me, can already be a relaxing time during a very busy day, especially during a duty.  It’s not because I want to stay away from people, but rather, to give some comfortable time for myself, so that I may eat at my own pace and do not have to wait for somebody else to finish eating or to have someone wait for me to finish whatever it is I’m doing.  The thing is, doctors are already surrounded by many people for the most part of the day.  Being alone with one’s self is already a good enough break from that.
2. And though time for one’s self is important, a good stress reliever is being with friends, too.  And not just being with friends…being with those people who understand your work and who’ll have the sense not to ask/talk about it all the time. It’s rather annoying at times whenever I see people and all they could ask me about is something on medicine or what happens in my work.  I don’t mind some quick questions on health, but long-drawn conversations on why their BP medications aren’t working or why they always having aching joints over dinner isn’t exactly what I’m looking forward to when going out.  I have a life, too, outside of medicine.  There are lots of stuff to be talking about during dinner besides medicine, like books, movies, politics, society, and even show business.  So, I really do appreciate it that, at rare times that I could go out, people would talk of something else that’s not related to my work.
3. Quit telling yourself that you could have done more because you already did. By this time, I’ve already learned that in healthcare, one has to always give his/her best.  But then, there are just patients whom we get emotionally attached to.  However, no matter how much has been given, still things will not go the way we want to.  I think it’s most difficult in the first few patients who die and there’s that lingering guilt that perhaps one could have done something “more”.  I’ve felt that way too.  But pondering on what I’ve done and what had happened, I’ve learned that even if doctors are healers, we cannot heal everything and everyone.  And we just have to acknowledge that.
4. Customers are right…but to a reasonable extent only.  Irate patients and their relatives are common nowadays.  And they seem to see it that it’s their right to be less civil with the doctors because they are emotional, they’re in pain, or simply because they’re patients.  One has to exercise a great deal of restraint (and believe me, I’ve had my fair share of the worst ones, even a “lawyer” having idiotic guts to pull out a gun and point it at me because he’s panicky).  But remember to protect oneself.  Make sure every order has been written down and carried out.
5. If you’re stressed, go talk to a friend, rip papers, or doodle on paper, whatever can help you get out that intense emotion! I think it would have been fun if there’s a punching bag at every residents’ call room/lounge.  That should really help get that stress out!  But since there is none in our call room, I usually just get scratch papers and manually shred them.  And of course, unloading to a colleague also helps but colleague usually is just as stressed!

I hope those little tips can help you.  And seriously, I do wish there’s a punching bag available in our call room.  Medicine can be a veritable source of life’s simple pleasures, but it can be a source of life’s great stresses as well.