How We Can All Learn to Practice Against Burnout
“I’m officially burned out,” someone said to me when his 18-year-old long time patient died.
“How do you know?” I asked. “Did you not feel for him? Do you feel like you’re past the point of caring?”
“No. I care so much I can’t take it. I can’t work like this anymore.”
Burnout isn’t just a buzzword. It affects over half of physicians and can lead to more than career dissatisfaction. Disengagement, poorer clinical performance, early departure from the practice of medicine, and even suicide can result.
Some say, “I’m not burned out. I love my work. I just can’t get it all done and I’m always behind.” My friend and colleague, Joseph Piccione, uses the word depletion. He says if you light a match and it burns all the way down, there’s nothing left. It can’t be salvaged or relit. That’s burnout. Depletion is a feeling of being spent, out of fuel — and it responds to renewal, refueling.
Both burnout and depletion are rampant among physicians.
We become physicians for a lot of reasons — the intellectual challenge, having a skill set that nearly assures the availability of work, and of course, caring for others. It’s a long road; training takes several years longer than most other professions. It’s also a hard road. We work extended hours, sometimes in very difficult situations — cognitively, physically, and emotionally. We pay a toll along the way, but most of us figure it will get better by the end of training. It should take less cognitive effort to care for patients and achieve excellent clinical results. We expect more manageable hours and volume of work (and more sleep). The myriad emotional challenges our patients, their families, and we ourselves have experienced seem like good preparation for us to handle the most challenging situations in practice.
For some physicians, that’s what practice is like — an intellectually stimulating profession, with an acceptable workload, providing care to those who need it. For others, it is not. Physicians in all sorts of practice — private, employed, academic, and non-academic — find it to be more taxing and less rewarding than they had expected. That’s where burnout, depletion, and dissatisfaction come in. Then what?
If there’s still some matchstick left before it burns out completely, a lot can be done.
Reducing the workload or the hours, if those are even options, reduces the pay, which is acceptable to some but not others. Changing the way some healthcare systems employ physicians is slow, and happens one system at a time. Could we change the complex payment structure and regulation of medicine in the US? Maybe, but that will take even more time. In the meantime, there might be some things physicians can do that allow them to thrive either despite their circumstances, or while they are helping lead broader change that will make for more fulfilling careers for themselves and others.
Mindfulness actually is a buzzword, but it has some value. It has become a loose term, used for all kinds of things, from paying attention to what one is doing at the moment to deeply contemplative meditation and other practices of focused attention. Setting aside the word, its intent is worth exploring.
A wondering mind is an unhappy mind. It is also an inefficient mind.
If I am seeing a patient but thinking about what I need to get done at home, I am not focusing my cognitive energy on the patient. I might miss some nuance of the history, order an unneeded test, or skip part of the differential diagnosis. If later I am wrapping up the documentation of that visit in the electronic medical record and thinking of what I need to do for an upcoming meeting, I will spend more time completing the work (which may then need to be completed at home, taking up personal time). That evening, if I am with my family thinking about that patient, I will be less engaged.
Learning to stabilize attention on the activity at hand may allow for greater effectiveness and satisfaction both at work and away from it. Like attentional stability, impartiality and compassion can also be learned. Cognitively-Based Compassion Training (CBCT), a course developed by Geshe Lobsang Tenzin Negi at Emory University, draws from Indo-Tibetan Buddhism to teach these principles, founded on our natural state of interconnection. Physicians who learn and practice CBCT have been found to have lower IL-6 and cortisol levels. Their patients also have better clinical outcomes. The University of Illinois College of Medicine at Peoria (UICOMP) offers CBCT to its students, residents, and faculty.
OSF HealthCare Illinois Neurological Institute (OSF INI) is doing some things to improve the physician experience and try to prevent burnout, such as after-work happy hours for physicians and a wide variety of clinical work designs that allow for greater work-life balance.
In an effort to bring awareness and some simple practice of attentional stability, impartiality, and compassion, OSF INI and UICOMP will hold a CME conference in Chicago called The Art of Neuroscience on June 22–23.
There is no simple fix to physician burnout and depletion. I’m also not naïve enough to think that a single conference is likely to change daily practice. At minimum, it will introduce the idea that focused attention and compassion can be learned, practiced, and might contribute to better patient care. For some, it might help allow them to enjoy being the physician they worked long and hard to become.
Sarah Nath Zallek is a sleep specialist neurologist at OSF HealthCare and Clinical Associate Professor of Neurology at the University of Illinois College of Medicine at Peoria. In addition to being the medical director of the OSF HealthCare INI Sleep Center and the OSF INI Physician Director of Strategy, Communication and Education, she is also the president of the medical staff at OSF HealthCare Saint Francis Medical Center. She is hosting the conference mentioned in this piece, but reports no conflicts of interest.
