Tara Riddell MD, Marc Legault MD
As we have come to learn, the problem of physician burnout is often multifactorial, involving a mix of environmental stressors, biological vulnerabilities, and coping styles unique to each of us (Wiederhold et al, 2018). Many of these factors are seemingly out of an individual’s control (Dyrbye et al, 2016). This is particularly true for residents, who often have even less input with regards to their schedule, workload, or income, and who face frequent institutional and organizational pressures, such as by being under close supervision, and having to complete various evaluations, exams, and projects all prior to their graduation.
While there is growing awareness of the role that these systems factors play, there is still much work to be done in this arena. We encourage medical students and residents to consider advocating for physician wellness and exploring ways in which they can help be involved in promoting change both within their institutions and with regards to the overall culture of medicine; however, in the meantime, we need to find ways to keep us well.
Though programs and services to aid physicians can vary by institution and region, by building awareness of what does exist and learning what personal wellness practices have been shown to boost wellness and fill up our reserves, we may be better able to fight against burnout. To learn more about some of these strategies and tools available to physicians in Canada and the United States, click on each of the following sections below.
Though medical training can be challenging and stressful in and of itself, how one perceives these stressors and copes with them, is also of importance. Though there are different forms of counselling or psychotherapy, they all generally provide an opportunity for an individual to openly express themselves and their distress, to explore their problems from a different lens, and to learn alternative and perhaps more constructive coping strategies and ways to problem solve (Dyrbye et al, 2016). As such, data supports counselling and psychotherapy as an intervention to address burnout (Ishak et al, 2009).
Most of the evidence for therapy in physician burnout has supported the use of cognitive behavioural therapy (CBT); however, there have also been positive findings with more general and even very brief counselling treatments:
Resources to consider:
As with our case example, Amanda, burnout can be a very lonely experience, both due to the fact that we can find ourselves detached or withdrawn from others, but also likely due to the culture of medicine which tends to instill some sense of competition and leads us to hide our perceived weaknesses and difficulties for fear of negative repercussions and embarrassment.
Despite this, social support is crucial. In fact, in a study of medical residents with burnout, the top two coping strategies that were highlighted as the most essential for managing stress were talking to other residents and talking to one’s significant other or family (Shanafelt et al, 2002). This is not surprising as humans have an innate desire to connect with others, as it provides not only a sense of belonging and community (McKenna et al, 2016), but it can help reduce stress and anxiety (Ishak et al, 2009).
Resources to consider:
With burnout, not only do we lose sight of our purpose and what is important to us, but often the work-life scale becomes unbalanced as we devote more and more of our resources in an effort to stay afloat at work and keep up with our various duties as a resident. The problem, however, is this tends to exacerbate the problem, as our relationships outside of medicine, our leisure pursuits, and basic self-care practices fall to the wayside even though they are vital for our self-identity and in replenishing our reserves and maintaining our satisfaction with our lives.
As such, to foster resilience and combat burnout, we may need to return back to the basics, such as by trying to regain a healthier lifestyle and working to instill a more equitable semblance of balance in our lives. While the right “work-life balance” may be different for each of us, one way that we can work towards this is by reflection to assess what is missing, and setting goals to help get us back to where we want to be (Deb, 2017). Goals in particular help keep us accountable and committed to our action plans, and help us build self-efficacy and confidence by frequently checking-in to evaluate our progress (Turkay, 2014). In considering some of the resources or suggestions below to foster self-care, consider formulating some goals to bring about these changes in your own daily routine.
Resources to consider:
As resident physicians and practicing physicians, our work revolves around caring for others and treating the ill. Given our commitment to our careers and altruistic attitudes, however, it is easy to spend most of our time helping others and prioritizing the wellbeing of our patients over our own. However, physicians are humans too. None of us are immune to the common cold, cardiovascular disease, or even burnout and depression. We tend to forget this, however, and even in the face of illness or suffering, we can become the worst patients. For instance, we work even when we are ill (Penedo et al, 2005), we downplay our symptoms and avoid seeking help (Davidson et al, 2003), and we self-diagnose and medicate (Christie et al, 1998).
These behaviours can be harmful to both our patients and ourselves. Instead, to function optimally and provide the best care, we need to start caring for ourselves and prioritize our own wellbeing. This can be accomplished by building our own healthcare network, seeing our doctors/team regularly (Shanafelt et al, 2017), and knowing when it is time to ask for help (Dyrbye et al, 2016). By doing so, we build resilience by attending to and filling up our physical and emotional reserves.
Resources to consider:
A study of internal medicine residents found that almost 50% had no primary care physician or considered themselves to be their own family doctor (Christie et al, 1998). Those that did not have a primary care physician were more likely to engage in self-treatment, of which over half reported self-prescribing a medication (Christie et al, 1998).
Another study of Australian physicians found that almost three in four physicians downplay their symptoms or feel embarrassed to seek out care from another physician, and 95% are likely to work when sick. Particularly when it comes to depression or other mental health issues, these numbers increase as 87% were reluctant to seek out appropriate consultation (Davidson et al, 2003).
1. To recap, what are the core features of burnout?
2. Which of the following have been associated with untreated burnout?
3. Which of the following learners is experiencing symptoms concerning not just for burnout, but for depression?
4. What are some effective strategies to increase one’s social connectedness and support?
5. If you were becoming increasingly distressed or were in crisis, where could you turn for help?