Vitality Signs

Burnout: Physician, Diagnose Thyself

Burnout can be insidious if you don't recognize the triggers and take steps to relieve the stress.

Jan 30, 2012

Burnout, first described by clinical psychologist Herbert Freudenberger in the 1970s, can creep quite insidiously into one’s professional life, disguised as irritation or rage, sloppiness, fatigue, boredom, or forgetfulness.

Freudenberger himself noted omnipotence in some professionals who struggled with the emotional exhaustion, cynicism, inefficacy, and depersonalization that define the disorder. They continue to "Do it all," despite entreaties of others and the possibility of sharing the load with others.

Sometimes, people know when they are approaching burnout. They recognize the signs: leaving the car keys in the ignition twice in a week; blowing up at a colleague for what was, in retrospect, a minor issue; making a no-brainer error on a chart.

But not everyone stops to consider how all the signs add up. They plug away, becoming more and more disheartened as burdens accumulate.

To that end, the Mayo Clinic newsletter offers a simple list of questions, applicable to all.

Take a few seconds and check off those that apply to you:
•    Have you become cynical or critical at work?
•    Do you drag yourself to work and have trouble getting started once you arrive?
•    Have you become irritable or impatient with co-workers, customers, or clients?
•    Do you lack the energy to be consistently productive?
•    Do you lack satisfaction from your achievements?
•    Do you feel disillusioned about your job?
•    Are you using food, drugs or alcohol to feel better or to simply not feel?
•    Have your sleep habits or appetite changed?
•    Are you troubled by unexplained headaches, backaches or other physical complaints?

The scoring is easy; all are signs of burnout and even one affirmative answer suggests the need to further explore ways of reducing stress in the workplace and managing burnout if it already has you in its steely grip.

Management tools specific to the unique stressors of oncology were reviewed in the Journal of Oncology Practice a few years ago (J Onc. Pract. 2006: 2(3):130-131). In this article, experts recommended recognizing and grieving losses inherent in field; implementing time management strategies; nurturing relationships with colleagues; and taking the time to care for oneself: physically, emotionally, and spiritually.

Dr. Jimmie C. Holland, chair of psychiatric oncology at Memorial Sloan-Kettering Cancer Center in New York City, and the founder of the field of psycho-oncology, advised in the article, "You should respect your recreation dates like patient hours."

These common sense ideas, if employed, would target the precise sources of burnout cited repeatedly by oncologists in well-conducted studies of burnout (reviewed in last week’s Vitality Signs column).

Here, in a nutshell, are some of those commonly-cited triggers of overload, along with approaches that might be of benefit to you:

•    Administering palliative care/caring for terminally ill patients and their families
Avail yourself of any institutional forums for processing grief and frustration at the culmination of difficult cases. If your organization has no such forum, or if you practice alone or in a small group, facilitate a less formal process for closure and honor it. Arrange to meet with a trusted colleague once a month to process such cases. Make it a ritual.

•    Spending too much time at work at the expense of time away.
Re-examine your work-life balance with a trusted friend. Ask yourself whether delegating tasks and re-negotiating your responsibilities would provide you more time away, or whether you actually have time away on paper (vacation days, etc.) that you do not use. Objectively assess your productivity, clinical acumen, relationships with colleagues and patients, and job satisfaction and determine whether you would be better at what you did, if you were meeting your own needs. Then, simply, make it happen. Reduce your workdays. Take time off. Take breaks during long days for "mental vacations." Surround yourself in your "away" time with people you enjoy, activities you relish, and moments of peaceful reflection.

•    Reimbursement headaches.
Identify ways in which you can better manage the time spent dealing with such issues, perhaps eliciting more help or expertise. Then, learn to complete necessary paperwork in a steady, task-like way, disengaging yourself from an emotional reaction to any situation you have no power to change.

Obviously, burnout is a complex and multifaceted phenomenon that is often specific to the individual and the situation. If you have endeavored to adopt a healthier environment and perspective, made a concerted effort to take care of yourself, and taken time off to no avail, it would be wise to seek counsel from a mental health professional who may be able to help.