This post is about doctors needing to look after themselves, a subject some say is the ‘last taboo’1. Whilst the blog will be about doctors, I feel the issue will resonate with anyone, and I hope the tips I give will also be helpful for anyone suffering from burnout, regardless of your profession.
I’ve reflected on this topic several times during my junior doctor career and a recent BBC article put the topic in my mind again1. It really saddens me that burnout and subsequent mental health issues are so rife throughout a field of individuals who are so caring, passionate, and often naturally upbeat. By talking more openly about the subject I hope to stimulate discussion, leading to change and openness around to topic. I would love to see the importance of self-care acknowledged and the workplace actively facilitating this. Whilst prioritising the wellbeing of those in healthcare roles will require culture change in may organisations, there are some things we can start doing today to minimise the risk of burnout.
So, what actually is burnout?
Burnout is a state of emotional, mental and physical exhaustion caused by excessive and prolonged stress,2 specifically related to work.
In fact, in the ICD-10 (the international classification of diseases published by the WHO) defines burnout as:
“Burn-out is a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions:
- feelings of energy depletion or exhaustion;
- increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
- reduced professional efficacy.
Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”
Burnout does not only affect your work life, but can lead to relationship problems, be a factor in depression and contribute to increased rates of suicide3.
Sadly, doctors are the most likely of any profession to suffer mental health problems4. One study showed nearly a third of doctors have a mental health disorder5. What’s almost more saddening is that a survey only last year from junior doctors revealed that 70% worked on a rota that was always under-staffed, 80% felt work caused excessive stress with a quarter feeling this had a serious impact on their mental health4. This gives insight into how these young doctors actually feel, rather than statistics.
I feel that given the scale of this issue it should not be a ‘taboo’ subject. Currently the psychological wellbeing of doctors is not being given enough attention and some say completely ignored4. Not only is this a significant health issue in its own right but a recent meta-analysis showed that burnt-out doctors endanger patient care6. Focussing on doctors’ wellbeing and reversing this risk, therefore, must be a key health care policy goal6.
Burnout is not just affecting doctors. Over 40% of adults have sleep disturbances due to stress in the working day7.
How do you know you have burnout?
Burnout isn’t something that happens overnight. It’s a gradual process. This means you might not realise it’s happening. There’s also a spectrum of severity.
Here are some of the signs of burnout to look out for:
- Sense of failure and self-doubt.
- Feeling helpless and trapped.
- Compassion fatigue (if a medical professional).
- Loss of motivation.
- Lack of sense of accomplishment.
- Being more cynical than usual.
- Feeling drained.
- Getting sick more often, weakened immune system.
- Poor sleep/change in sleep quality.
- Change in appetite.
- Isolating yourself.
- Increased alcohol use or turning to other drugs.
- Failing to turn up to work.
- Minimising your responsibilities.
Self-care strategies to aim to prevent burnout:
If you are feeling the effects of burnout, here are some ways you can help rebalance your working life.
Make a few minutes each morning to relax and start the day off well. This could be using a meditation app (Insight Timer is my favourite, but there are so many and it’s important to find one that resonates with you), stretching, yoga or breathing exercises. If these aren’t for you, you can find mindfulness in many ways: listening intensely to your favourite music, going for a short walk in the fresh air.
Focus on the aspects of your life that are going well, big or small, and remember to be grateful for them. You could start by writing a gratitude journal, writing down 3 things you’re grateful for at the end of each day. They don’t have to be related to work, they could help you focus on how well other aspects of your life are going. If this is too much, you could just think of them. Over time this will help you to focus on the positives and have a brighter outlook on life.
Pause at work:
Box breathing is an amazing tool I’ve used myself at work – and it’s also used by Navy seals so makes me feel hard core! I’ve drawn a doodle to explain box breathing for you:
I love breathing exercises because they’re so simple and subtle, you can do them anytime, anywhere and no one would be none the wiser. It’s amazing how effective they can be.
Healthy Habits – eating, movement and sleeping:
This is more about building up resilience. A healthy lifestyle will give you the energy to face the workday head on. I don’t know about you, but when I’m tired, I am way more emotional than normal and can’t swallow criticism or harsh words as I usually would. Sleep is often sacrificed first, weather for that extra episode on Netflix to wind down or to fit in that extra bit of work. Sleep needs to be prioritised. You will be more productive and mentally resilient the next day. Eating well will prevent sugar crashes at work, which make you feel more irritable, and provide you with more sustained energy. I’m all about meal prep – try it! Not only will it make you feel great, it will often save you time and pennies too! Movement – find what works for you, a rejuvenating walk, some mindful yoga or a stress busting run, all of these will help clear your mind from the busy day or get you ready for the day ahead. All these aspects are great for health in general too, so a win-win in my opinion.
Set yourself boundaries:
Know what is too much for you, and don’t overdo it. Make time for the things you value and are important to you, family life, seeing your partner, exercise, catching up with friends. Whatever it is, if it’s important to you remember to prioritise this too. Not only will giving time to your hobbies and relationships be rewarding, it will also feel you are succeeding in your home life. Creativity can be helpful against burnout too2.
Give yourself a time to stop o’clock. Don’t work past a designated time to allow you to recover from a busy day and be in a better mindset for sleep.
Learn to say no! This can be tricky, but overburdening yourself won’t help. You will often excel more and have more pride in the projects you are doing if you are not juggling too much.
Don’t focus on how others perceive you. You can’t control this and it will just stress you out.
Set aside some ‘me time’ where you put your phone down, don’t look at your emails and can’t be distracted. Workers are interrupted an average of 7 times and hour and distracted for 2 hours a day7. Constant interruptions add to the feeling of a work burden, and make you feel less productive at the task at hand. You will get around to answering your emails, but at a time that suits you.
Remember your passion:
Why did you choose your career path in the first place? What did you love about it or think it would add to your life? Have you still got these passions? Have you actually succeeded but didn’t realise? Remember a time you felt valued and appreciated, see if you can find those feelings daily.
Last but oh so not least – take time off! This is really, really important! Taking time out helps you to recharge and gain a refreshed perspective. They give you something to look forward to through the tough times too. Those who don’t have holidays are more prone to burnout3.
I hope you forgive a medical related piece of advice here – from personal experience I know with under-staffing and rota gaps it can be really challenging to actually get your annual leave and I know doctors who have not been able to take what they were allocated. This is firstly wrong, but raises the importance of planning ahead and getting that holiday booked asap!
Four aspect of holidays help the recovery: relaxation, control, gaining new experiences and mental detachment from work3. Key to the latter is avoiding work-related interruptions. Keeping in contact with your work whilst on holiday is associated with increased levels of stress and relationship discord3.
What’s the best length holiday? A psychological study demonstrated happiness rising quickly during the first few days of a holiday, but peaking at day 8 and falling after a plateau3. This suggests that shorter and more frequent holidays might be the most restorative.
So please – anyone who is suffering with burnout, acknowledge it, seek help and prioritise self-care.
- Doctors’ mental health at tipping point – BBC News. Available at: https://www.bbc.co.uk/news/health-45356349. (Accessed: 11th September 2018)
- Preventing Medical Burnout: The Increasing Dangers of Doctor Fatigue. Available at: https://www.carecloud.com/continuum/preventing-medical-burnout/. (Accessed: 11th September 2018)
- The secrets to a truly restorative vacation |. Available at: https://ideas.ted.com/the-secrets-to-a-truly-restorative-vacation/. (Accessed: 12th September 2018)
- Panic, chronic anxiety and burnout: doctors at breaking point. Available at: https://www.theguardian.com/society/2018/mar/10/panic-chronic-anxiety-burnout-doctors-breaking-point.
- Learner, S. Doctors and mental health. BMJ 342, d1708 (2011).
- Panagioti, M. et al. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction. JAMA Intern. Med. (2018). doi:10.1001/jamainternmed.2018.3713
- 12 Ways To Eliminate Stress At Work. Available at: https://www.forbes.com/sites/jennagoudreau/2013/03/20/12-ways-to-eliminate-stress-at-work/#167a78137f29. (Accessed: 12th September 2018)