How to avoid burnout and keep your spark
You can renew yourself, wherever you are.
Psychiatry is about intimate human relationships, connectedness, and accompanying our patients over the complex terrain of the human condition. Often, burnout develops when something disrupts the physician-patient bond. As Irvin Yalom reminds us, “It’s the relationship that heals.” That relationship is healing to the physician as well as to the patient.24
Burnout comes from decreased quality of fulfillment we derive from our efforts. It concerns intangible phenomena such as losing our sense of purpose or feeling we are not making a difference. We wonder: Am I doing what I was born to do? Burnout is suffering that goes beyond a worn-down body and approaches “erosion of the soul.”25
Diversify your portfolio
Physician-author Rachel Naomi Remen, MD, clinical professor of family and community medicine at the University of California, San Francisco, reminds us, “Service in medicine is the work of the heart and the soul.”26 To heal ourselves, we must by nurturing and cultivating our inner life. By plumbing these depths, you may rediscover your sense of purpose.
You may need to “diversify your portfolio” with reflective and regenerative activities. These may be as varied as reading poetry, paddling canoes, spiritual practices, gardening, hiking, or visiting art museums.
More importantly, you may need to re-examine and deepen your relationships with:
- your partner (Are you spending enough time together? Is your relationship growing?)
- your patients (Are you getting to know your patients as people?)
- your sense of purpose or spirituality (Do you see a higher or transcendent meaning in your life?)
- the community, the world. (Are you making them better?).
What’s your diagnosis?
How do you know if you have brownout (mild depression; a prodromal phase), classic burnout (severe depression), or compassion fatigue (a form of burnout)?
Brownout vs burnout (Table 2). Look for depressive symptoms: sad mood, lack of pleasure, low energy or motivation, poor concentration or memory, or insomnia. In addition, you may experience a “deadness” at work, as well as “marital deadness.” The “helper’s high” has become the “helper’s low.” You may anger quickly and have tensions with your family or co-workers. Signs of burnout include disorganization and chronic lateness, absenteeism, or “presenteeism” (physically present, spiritually and go beyond the mind and body to address the soul emotionally absent).
Irritability and lack of time for family can cause extensive collateral damage:
- Wife of a burned-out doctor: “My husband wasn’t there for our son’s 6th birthday, and he missed our daughter’s high-school graduation. He’s missed half their childhoods.”
- Husband of a burned-out psychiatrist: “I’m miserable. She’s not the same woman I married. She’s such a workaholic, she’s got nothing left for us.”
- A psychiatrist’s 13-year-old daughter: “He helps his patients have a good life; why can’t he do that with us?”
Are you suffering from brownout or burnout?
| Brownout (mild depression) | Burnout (severe depression) |
|---|---|
| I feel tired | I feel exhausted, listless |
| I’m having less fun and feeling less satisfied | I feel grumpy and joyless |
| I’m drinking more caffeine and eating more junk food | I’m drinking more alcohol, taking more medications, or using illicit drugs |
| I feel less interested and less caring about my patients, residents, and coworkers | I want to leave patient care, and I don’t care about my co-workers |
| I am dissatisfied, troubled | I am impaired |
Table 3
Is it burnout or compassion fatigue?
| Burnout | Compassion fatigue |
|---|---|
| Evolves gradually | Reaction to extreme circumstances or suddenly increased work demands, such as disaster relief, crisis work |
| Loss of meaning, unmet expectations | Vicarious suffering of others’ trauma (“emotional contagion”) |
| Diminished work capacity (depression, withdrawal) | Increased, relentless work effort (ignore physical health, work-‘til-you-drop mentality, obsessive-compulsive behavior) |
Intensive care for burnout
Treating or preventing burnout requires individual solutions, peer strategies, and group/organizational techniques. The first five suggestions below relate to individual steps, and the last two to peer approaches and organizational strategy.
Stop doing what you’re doing. In her book, The Joy of Burnout, Dina Glouberman, PhD, says, “Burn-out is life catching up with us…. Stop doing, and start listening to ourselves in a completely new way, to make space for our true self.”28 Better time management is not the answer; you cannot give what you do not have.
Take time off. Most experts recommend at least 1 month off to rethink things, and 6 months off to renew. I (PB) took 6 months off to recover from my burnout and needed every minute of it.
Take a serious inventory of your life and priorities, and set limits (Box 2). One psychiatrist decided he didn’t want to be on three medical society committees, two hospital committees, and a church task force. His wife had threatened to divorce him, and he was always exhausted.
