We may have strong (psychological) bones, but they are still susceptible to stress fractures. Face the new year armed with these guidelines on combatting symptoms of burnout, written by an expert in the field.
In May 2019, the World Health Organization recognized burnout as a syndrome marked by exhaustion, cynicism and mental depletion, and reduced professional efficacy. It is categorized by ICD-11 (QD85 Burn-out) and it results from “chronic workplace stress that has not been successfully managed.” Here, tips from an expert on burnout in the field of psychiatry.
It should go without saying that adequate sleep, healthy diet, exercise, time off, time with loved ones, and finding joy in other things, in moderation, are essential for well-being. Don’t forget the benefit of laughter, which in terms of burnout is sure to happen if you read Man’s 4th Best Hospital, written by a psychiatrist and the sequel to the 1978 perennial bestseller, The House of God. However, health care systems are overly controlling and often disengage clinicians. As such, they are a primary cause of burnout and wellness activities are not adequate to prevent it. According to a recent report by the National Academy of Medicine: “It is critical to address burnout not as an individual issue, but rather as a systems issue that emanates from workplace culture, health care policies and regulations, and societal expectations.”
The essence of the burnout process is this: it has varying degrees of emotional exhaustion, cynicism, and feelings of relative inadequacy. It is not clinical depression, but there can be some overlap. It is not PTSD, though daily micro-traumas are involved. It is not compassion fatigue, but the most compassionate practitioners are the most vulnerable. It is not best characterized as a moral injury, though someone who is in the midst of burning out may feel morally injured.
Since physicians tend to deny-or not recognize-that they are burning out (while at the same time reporting feelings of satisfaction), monitor yours by intermittently taking one of the many rating scales available or any valid new mobile apps that emerge to track burnout. Enlist feedback from trusted colleagues and loved ones; ask them how well they think you are doing at work. However, for this to work best, male physicians have to overcome their tendency to underestimate microaggressions that occur against female physicians. The same seems to be true of racial microaggressions.
Medical training is challenging enough-but trauma from loss is innate to patient care. Physicians and other mental health care professionals inevitably gain a strong sense of resilience. To a degree, resilience can be measured with a self-rating scale. However, one may “power through” and ignore the warning signs of burnout. We can have strong (psychological) bones, but they are still susceptible to stress fractures. The Serenity Prayer is one way to do so by accepting things we cannot change, having courage to change what we can, and having wisdom to know the difference.
Understand what provides you the most satisfaction and success in your psychiatric work and find a system that values and supports it. Occasionally, one may need to lower expectations and ideals to do what is realistically possible for a period of time.
Given the organizational constraints that administrators encounter (as well as their own burnout), they can only do so much to change the system. Clinicians must worry about job security and may develop learned helplessness. One other way to lessen stress is through formal and informal leadership that connects clinicians, staff, patients, and the public in a quest for wellness.
There are some promising possibilities. Meditation of various types, such as mindfulness and sound healing, are helpful to some. Process programs on burnout, such as the American Balint Society groups that adapted to these systemic challenges, are another. Coaching may help. The traditional admonition to “Physician, know thyself” helps to appreciate any individual vulnerability.
Here, we are not talking about wildfires and climate change. By connecting with our healing spirit to help others in society we know are lighting the candle at both ends, we may dampen our own stress. Helping psychiatric patients with chronic illness, as well as parents and even high school students, we will achieve satisfaction expressed in Hillel’s famous saying:
“If I am not for myself, then who will be?
And if I am only for myself, what am I?
And, if not now, when?”
Brooks D. The Edge of Inside. The New York Times. June 24, 2016. https://www.nytimes.com/2016/06/24/opinion/at-the-edge-of-inside.html. Accessed November 18, 2019.
Clark GH Jr, Vaccaro JV. Burnout among CMHC psychiatrists and the struggle to survive. Hosp Community Psychiatry. 1987;38:843-847, 1987.
Gross CP, Mead LA, Ford DE, et al. Physician heal thyself? Regular course of care and use of preventive health services among physicians. Arch Intern Med. 2000;160: 3209-3214.
Kjeldmand D, Holmstrom I: Balint Groups as means to increased job satisfaction and prevent burnout among general practitioners. Ann Family Med. 2008;6:138-145,
Mehta N. Physician Burnout: Why It’s Not About Resilience. Medpage Today. April 26, 2018. https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/72551. Accessed November 18, 2019.
Shem S: Man’s 4th Best Hospital. Berkley; 2019.
For Further Information
Loboprabhu S, Summers RF, Moffic, HS (Editors).Combating Physician Burnout: A Guide for Psychiatrists. Arlington, VA: American Psychiatric Association Publishing; 2020.
Dr Moffic is an editorial board member and regular contributor to Psychiatric Times. He is co-editor of Combating Physician Burnout: A Guide for Psychiatrists, with Sheila LoboPrabhu and Richard F. Summers. He was a tenured Professor at the Medical College of Wisconsin until he retired in 2012. Since then he has functioned as a private community psychiatrist providing pro bono services locally, nationally, and internationally. Currently, Dr Moffic is focused on these major advocacy initiatives: physician burnout, climate instability, Islamophobia, and Anti-Semitism.