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Developing Resilience and Avoiding Burnout, Part Four

May 8, 2017

Series Part Four: The Road to Recovery Once Burnout Occurs

Burnout can manifest in different ways depending on the severity. Individuals experiencing mild degrees of burnout may appear to function normally, with their limitations only surfacing when high-stress situations occur. On the other hand, an individual experiencing severe burnout may struggle to perform daily tasks and get frustrated easily when faced with challenges. In extreme circumstances, individuals experiencing burnout may reach a breaking point and exhibit outbursts, thus jeopardizing their career and relationships.

The first step to recovering from burnout is recognizing and acknowledging that it has occurred. Indicators of burnout include emotional exhaustion, depersonalization and a sense of hopelessness. Dr. Christina Maslach and colleagues have devised a screening tool that can be used to assist in identifying burnout. The Maslach Burnout Inventory, published in three forms, is the most widely used tool for measuring burnout and has been validated by over 25 years of research.

The Maslach Inventory delineates three main components for burnout:

  1. Emotional Exhaustion – feeling overextended or depleted
  2. Depersonalization, Cynicism – feeling detached or insensitive
  3. Inefficacy – feeling unaccomplished or incompetent

Although burnout is not a recognized disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), it is associated with an International Statistical Classification of Diseases, 10th revision (ICD-10) code (Z73.0). Once burnout has been identified, focus should be placed on ensuring the recovery of the burned-out physician.  

Effectively tackling physician burnout requires a multi-pronged approach that includes:

  • Changes in the personal views/habits/lifestyle of physicians experiencing burnout
  • Support from medical institutions/practices, providing physicians with the resources and time needed to recover from burnout
  • A shift in the cultural norms of the medical community, such that more emphasis is placed on physician well-being and self-care   

Physicians suffering from burnout should spend time identifying the factors that led to their exhaustion, then take steps to remove or reduce the risk factors that led to their burnout. External factors contributing to burnout are often easier to identify and manage than internal contributors.

Persons who are naturally more prone to worry often perceive greater stress than warranted by external situations. Individuals who are “high-achievers” or perfectionists often place more pressure of themselves than the average person. When such individuals devote time to high-stress, demanding professions, (like the practice of medicine), the risk of burnout multiplies.

Individuals who have personality traits that predispose them to stress/burnout will not only have to make modifications to their external stressors but will also have to develop strategies to modify their outlook/perceptions.  

Physicians experiencing burnout should seek support by reaching out to someone they can trust. It is also recommended that physicians seek help from another physician instead of trying to treat themselves. Unfortunately, however, physicians often avoid expressing the need for help due to a fear of being viewed as incompetent. In addition, persons experiencing burnout tend to prefer isolation, which increases the potential for unfavorable consequences of burnout such as suicide attempts/completed suicide.

Although physicians may feel concerned about their professional image, it is important that they recognize that their failure to seek help could result in a personal or professional crisis. Persons experiencing hopelessness, depression or suicidal ideation are encouraged to seek prompt medical advice. 

Physicians experiencing burnout need to be cognizant of the fact that recovery will not occur overnight. The exhaustion/fatigue associated with burnout often takes weeks to months to resolve and typically requires a change in personal habits. When burnout occurs, it is important to take an immediate break from activities that deplete one’s resources and devote time to restoring energy.

The initial break however, has to be followed-up by more long-term strategies for addressing burnout. Although taking a vacation is a good strategy to remove oneself from a stressful environment, a single vacation will not adequately address burnout. Additional measures will be required to ensure that the physician not only gets a restorative break but also develops skills to prevent the recurrence of burnout. The self-care approaches recommended to avoid burnout in part 2 of this series can also be utilized in treating burnout.

Recommendations for recovering from burnout:

  • Take a “real” vacation to recuperate
  • Make an effort to identify why burnout occurred and plan a strategy to avoid recurrence
  • Reassess your goals, both personal and professional, then prioritize
  • Manage your time (for more details see part 2 of this series titled “Fostering Resilience”)
  • Learn to share responsibilities and delegate tasks instead of trying to do everything yourself
  • Set aside time each day for personal time
  • Try to avoid doing work at home. If you do have to do work at home, try to limit the work space to a specific place in the home and avoid doing work in more personal spaces in your home such as your bedroom
  • While recovering from burnout do not undertake any new responsibilities/tasks
  • Train your mind to think about the positive aspects of your career

Once an individual has recovered from an episode of burnout they should take steps to modify their lifestyle as needed, to build resilience and to prevent burnout from recurring. For more details see part 2 of this series titled “Fostering Resilience.”

Healthcare systems and medical practices need to ensure that the work environment is pleasant and that physicians are given reasonable workloads. Hospital administrators need to provide resources to support physicians experiencing stress and ensure that physicians know about the resources available to them.

The plight of physicians experiencing burnout behooves us to change the culture ingrained in the practice of medicine – so that the profession that prides itself in caring for others can also ensure the safety and wellbeing of its own members. Fostering a culture where physicians are cared for in the workplace will likely decrease burnout rates and enhance physician satisfaction.

References and Resources

Sherrie Bourg Carter, Psy.D. Overcoming Burnout. 10 Steps to Reignite Your Flame and Shine Brightly Once More. Psychology Today. https://www.psychologytoday.com/blog/high-octane-women/201104/overcoming-burnout. Apr 17, 2011.

Taub, S, et al. Physician health and wellness. Occup Med. 56;77-82. 2006.

Myers, MF et al. The wellbeing of physician relationships. West J Med. 2001;174:30-33.

Tackling Physician Burnout. http://www.drweil.com/health-wellness/body-mind-spirit/mental-health/tackling-physician-burnout/.

Stanford Medicine WellMD. http://wellmd.stanford.edu/.

8 Dimensions of Wellness. https://umwellness.wordpress.com/8-dimensions-of-wellness/.

Claudia Finkelstein, MDCM. Improving Physician Resiliency. https://www.stepsforward.org/modules/improving-physician-resilience.

Nedrow, A., MD, MBA; Steckler, N., PhD; Hardman, J, MD. Physician Resilience and Burnout: Can You Make the Switch? http://www.aafp.org/fpm/2013/0100/p25.pdf

Disclaimer

The information and resources provided in this course or publication have been prepared to provide general information only. It is not to be relied upon in lieu of or as a substitute for legal, medical or other professional advice. The laws, rules, regulations and case law may differ in your state. Please consult a licensed attorney in your state for specific questions and advice. While all care has been taken in the preparation of this course or publication, no responsibility is accepted by MagMutual Insurance Company or the MagMutual Patient Safety Institute or its employees or agents for any errors, omissions, or inaccuracies, or for any known or unknown consequences that may result from reliance on any information provided in this publication.

Footnotes