We are already resilient AF. We are like canaries in the coal mine. Right? we don't need more resilient canaries. We just need to listen
Systems are formed by people and they are reformed by people but only by people who have enough of themselves available to imagine their way to a better future state
burnout is one of the most potent inhibitors of our quest to solve for joy in my opinion. And so it behooves us to understand it deeply.
You're listening to Solving for Joy. I'm your host, Dr. Chrissie Ott.
Hello everyone. And welcome to today's episode of the solving for joy podcast. I am going to talk to you today about burnout. I thought I would pick something a little scary just in time for Halloween. Burnout is one of the most potent inhibitors of our quest to solve for joy in my opinion. And so it behooves us to understand it deeply. It has become a word, especially since the COVID 19 pandemic that we just throw around, it's one of those words that has been so overutilized and overheard that it's actually lost some of its meaning. So I wanted to take this opportunity to dive into what actually comprises burnout and what we can do about it, and hopefully bring you some novel ways of looking at it, thinking about it. Uh, the summary might be. It's not our fault, but it is our problem.
So we have some unlearning to do around burnout. Uh, we have some, some facts that we will address, um, and, and hopefully we'll have some laughs along the way too, but the, the pandemic unearthed this teeming pandemic within a pandemic, like a Russian nesting doll. There was the great pause, and then there was the great resignation. So many people, in so many fields, left their jobs in response to what was unsustainable trauma in the pandemic. I think this is especially timely following the post traumatic growth episode that we had last week, but I want to explain a little bit about why we have so much of this lived experience, why burnout is not limited to our workplace, and why it's not a unidirectional cycle or a linear function.
I want to talk about how to identify it when it arises in ourselves and others. And of course, I'm going to bring an emphasis on the literature pertaining to burnout in medicine, because that's the space that I inhabit most of the time. And it's been so incredibly pervasive and prevalent. So, um, like the many decades old Supreme Court, uh, line about pornography, one knows it when one sees it, when it comes to burnout. That is, often the sense of it. We know that we're not thriving. We haven't been able to put our finger on it and it's been maybe slow and insidious to the point that that's what we think is normal, but it's been incredibly detailed and described in the literature. And we have multiple frameworks on drivers of burnout, especially in medicine from many inspirational thought leaders doing this work, but I want to say the three components of burnout to be aware of, the definition includes emotional exhaustion, which is, it's a bit self explanatory, but I want to say there is an inability to effectively recharge even when there is downtime. Um, it is distinct from depression or dysthymia, which is a mood disorder that doesn't quite meet the diagnostic criteria for major depression, but it is an emotional exhaustion that just feels almost insurmountable.
The second of the three components is termed depersonalization. I also kind of perceive this as a high level of cynicism, a negative outlook about work, and in particular about the people that you interface with at work. For people in medicine, that might mean cynicism about their leaders. It might be cynicism and depersonalization of their peers. And unfortunately as most of us can attest to at some point, it means depersonalization, cynicism, and disregard to the humans that we serve, othering.
The third component of burnout in its academic, uh, definition is inefficacy. So a reduced sense of personal accomplishment, competence, achievement, a loss of self evaluation. And this is often linked with a disconnect from feeling connected to meaning in work. So I want to say that burnout is not a ICD. 10 diagnosis, um, and it's not depression, but some people do think of it as a job induced type of depression. And importantly, this is not a talk about physician suicide, but I will mention that physician suicide in the U. S. occurs at a rate of approximately one physician dying by suicide per day. And it is burnout is a predictor in those models of morbidity and mortality.
My own story with burnout um, starts early. I remember listening to my co residents and students and even starting a wellness group in medical school, first year med school, and burnout was already there for us in our training. So we come to medicine, the data supports this, as incredibly resilient individuals, people who have skills and tools and, um, just innate resilience. And then we are faced with the brigade of hardships that comes with medical education, um, the competitiveness, the rigorous hours, the being frontline to unspeakable human suffering. And we come to this, experience with particular setups. There is a model called the triad of compulsiveness, which is thought to be an inherent part of the typical physician personality. So the triad of compulsiveness includes an excessive amount of doubt, especially self doubt, uh, an exaggerated sense of guilt and an exaggerated sense of responsibility. So doubt, guilt, and responsibility kind of already here. And then we're faced with extreme difficult circumstances. We experience psychological, sometimes actual physical trauma. Um, Abusive relationships are not uncommon in medical education. And then these things reinforce our inherent tendency toward compulsiveness, perfectionism, and having a very harsh inner critic.
So when we take those things together and multiply them over time, it's no wonder we get to an unsustainable point for many of us. Um, I will ask you to reflect on your own cycles of burnout, and I use the word cycles very intentionally because I do think that we cycle in and out of burnout at different stages of our career. Mid career physicians, again, I'm giving you a little bit of an extra glimpse at the medical experience with burnout mid career physician. So those have been out between 10 and 20 years are often simultaneously at the peak of their professional accomplishment and at the nadir of their happiness. So there is a, a well documented U shaped curve of happiness over the course of a lifetime. And the, the lowest point of our happiness is often midlife, uh, correlating with what we have you know, come to know as the midlife crisis. So we may be parenting young children, we may be caring for elder parents and we may be having maximal demands in our work life all at the same time. I can tell you that all of those certainly fit for me.
But my burnout story began first of all, with my first job out of residency with a job fit that was just not right for me. I did not click into the culture at that job and without, you know, sharing any further details, I was just like, this is not the job for me. So I created a solo micro practice, which I ran for eight years, um, very happily for the most part, but I also burnt out in this, you know, You know, fabled promised land of micropractice where I was making the rules. I could see patients for as long as I wanted to. I had a relatively small cadre of patients that I served and I loved them dearly and I still burnt out because I did not successfully find sustainability. And I was trying to parent a young child, and eventually those things did not pan out. I have been burned out as a hospitalist. I've been burned out as a well being leader. So I know that burnout can come and go in different iterations across the span of a career. And I want to normalize that and help people to know that if you are experiencing burnout or have experienced burnout, there's nothing inherently wrong with you. It is sometimes part of a long term relationship that we get tired of things, that we get emotionally exhausted by what we've been through, and that we begin to use less skillful coping mechanisms like othering, um, depersonalization, or cognitive distortions, like giving in to our negativity bias and developing that excessive cynicism Um, and sense of inefficacy or low self evaluation.
So I said earlier in the intro, resilience is not the problem. Um, I speak for us in medicine, but I know that I also am speaking to many of you not in medicine. Resilience is not the problem. We are already resilient AF. We are like canaries in the coal mine. Right? So, in medicine, we had this huge push to increase quality and reliability, but the bureaucratic burden of task after task has added and added and added to the Physician drivers of burnout. We have so many more clicks than we used to have, but the truth is, it's the system that's broken, right? It's really, it's the mind that has the problem and we don't need more resilient canaries. We just need to listen to those of us that are actually exhibiting symptoms and saying this system is not sustainable. And in fact, it's crushing us.
I saw a study last week and reposted it on LinkedIn, actually, about how many patient hours would create a 40 hour workweek for different specialties. Dr. Christine Senske from the AMA initially posted this and I shared it. So for geriatricians and for infectious disease specialists, seeing patients for 26 hours a week only, that is how much time it would take to create for them a 40 hour work week because there is so much work outside of work. W o w for short work, outside of work or pajama time, all of the charting, all of the deep dives, all of the things that spectacularly fatigue us and cause emotional exhaustion, cynicism, and a sense of inefficacy.
So one of the most important messages that I would like to communicate is this, systems are formed by people and they are reformed by people but only by people who have enough of themselves available to imagine their way to a better future state, i. e. people who have had adequate trauma recovery post traumatic growth, for example, and have access to tools of clarity, self actualization and engagement so that they can actually think about thinking. They can think about and share their ideas. They can do so in ways that are relational and effective, because whatever personal work we have done becomes available for our professional movement forward and for the reformation of the systems around us that are so often disproportionately the cause of our burnout.
So you may be familiar with the Stanford WellMD model. Um, if not, picture a pie chart with three equivalent sections. One section is personal resilience. Yes, that is important. It is necessary, but not sufficient. A second part is efficiency of practice. So this could be construed as work related environment, work related, um, specifics, whether that has to do in medicine with how is your in basket going? Do you have a smooth scheduling process? Are there obstacles that could further be removed from you and shared with the team? And then the third, very important part of this graph is a culture of wellbeing that it's integrated into the core values of your local and organization wide, um, identity and culture.
So there are many more things to say about that, but we will, we will leave it there for now. Um, I do think that burnout the book by the Nagolski sisters. That's N A G O L S K I is a really fantastic supplement and they talk about moving through cycles of burnout by completing a stress cycle. So this word, this Occupational Distress Syndrome that we somewhat annoyingly abbreviate with the word burnout, um, is a form of chronic stress, right? I think that by now most of us are aware we're built for acute stress. Acute stress is sometimes good for us. It amplifies our performance, our mental acuity, And when we have not turned off the acute stress signaling pathway, we have accumulated chronic stress more than we can actually deal with at one time. It begins to shut down our other systems, our happiness networks, our immunity networks, our brain and bodies suffer from that.
So we need to recognize that we are simply human. And I speak to all those people that got hero signs during the pandemic, whether you are a first responder, emergency worker, all of the things, all of the essential people, who we did get praised for being heroes. And I will tell you, it was meaningful to have something to contribute to the situation, but being equated to heroes. is as harmful, at least as harmful as it is helpful. We are human beings with physical, emotional needs. We are fallible and we need to recognize our healthy limits. We need to move forward with an eye to all of our technology and regulatory measures with the lens of human factors prior to implementation, preferably.
I love Dr. Tait Shanafelt's vision in his article, Wellbeing 2. 0, about re centering healthcare around meaning and purpose and calling, rather than transactional or productivity numbers. And to foster further our personal professional development and personal professional integration so that they're more and more helpful relationships around us, like a neural network to support us doing the work that brings us the most joy. So that when we do our work, we can bring the most joy, meaning, alignment and delight to other people.
I know a few things about getting there from here, getting to a world with increasingly reduced burnout. We need one another we need relationships. We need Transparency and we need brave leaders who are willing to embrace vulnerability and skillful communication. We need to partner with those who are at the decision making levels in our organizations rather than vilify and other them. Here is something that I know to be true; any organization that I have worked in, that I have had philosophical differences with, almost to a person, I would say, those same people who made difficult decisions that I disagree with are people who I think are very well intentioned, skillful humans who are navigating difficult factors at a different level. And when we're at a different level, we see different things, right? Not to negate what I believe have been harmful decisions in medicine. I do think that that also is part of the story. But I just want to acknowledge that that alone is one of the features and symptoms of the burnout we so much need to reverse.
Here are a few suggestions for starting to acknowledge one's own burnout, especially for those of us who care for others. If you're a caregiving professional in some way, teacher, massage therapist, Nurse, psychotherapist, all of us. We are great at ignoring our own wounding because it is never the loudest wounding in the room by nature of our profession. We have this front row seat to human suffering that appears greater than ours and therefore it is very tempting to simply reduce our acknowledgement of what's going on for ourselves. So that alone is a huge step. It could be acknowledging it to yourself through writing exercise. Um, I have a prompt, uh, that I share frequently when I give a talk about this. I am aware of my own suffering or wounding. The details of my suffering include or have included, and then just go. Make a list. Maybe you've never done that before. Take in a little inventory of how you've actually been harmed in the systems that have harmed you. Some ways that I could respond compassionately to my own suffering or wounding include blank. And this is a place to think, what would you offer to a loved one who had shared the details of their suffering with you?
And then the third step in this little prompt series is some external factors or small changes I could make toward relieving some of my own suffering include. So this is a place where your brain may actually serve you some of the things that you need to step back from. Some of the things you could opt out of that you could de volunteer yourself for. If you have been in survival mode for a long period of time, you need care. I know that this analogy gets old, but we must put our own oxygen masks on first. If we are to help those in need. So in medicine, we see a lot of people reducing their FTE or full time equivalency. So they go from working, you know, every day of the week to working 70 percent time or 60 percent time or 80 percent time. And I want to say that may be what we need for well being, and that may not be what is needed for the economic model of health care in the U. S. But, If our physicians and nurses have a greater risk of dying by suicide than the general public, then we all need to know that. We all need to recognize that that is serious and we need to get very real about the risk factors and what's contributing to that. I do not wish to bring, you know, toxic positivity or platitudes into the space of, um, our writing prompt or our own self evaluation. Um, what's real is what's potent. So if you want to address your own level of burnout, truly and deeply, we need to tell ourselves the truth about where we are today.
So after we've acknowledged our own wounding, we need to attend to it, whether that's with talk therapy. Um, making sure that we have connections in our social environment, um, asking for healing touch from people that are safe for that. And then notice what you've been through. Now, use those pillars of post traumatic growth and act in collaboration with others to affect meaningful change. There's so many things that can go into our own toolkits to respond to that. Um, I like to think of our toolkit as a choose your own adventure, uh, you know, radical acts of kindness for yourself and for others. But radical acts of self compassion are helpful. If you have never written yourself a thank you note, take a five minute timer and try it out. What do you need to be thanked for? When was the last time you gave yourself some unstructured play date time, a la artist's way? If you've read that book, take yourself on an artist's date, take yourself to the museum, heck, take yourself alone to ice cream, get yourself a massage. Enjoy a contemplative practice. Reading, writing, meditation, finding this sort of special time out of time to respond to your own suffering will help fill up that cup so that you have some reserve again to respond more effectively to the people that need you to be effective in your response to them.
So, I'm going to wrap up for this first little session on burnout, but I want to, I want to mention lastly, that when you are looking to recognize this entity in yourself and others, it can present in a variety of ways. It may present by people who are over engaged, who don't know how to say no and then get overwhelmed and may become less effective. It may present in someone who shows up to work with a very negative misanthropic attitude that finds fault with everything and prides themselves on their critical thinking. It may show up as somebody who is simply withdrawn and on their road to serious significant depression. And it can show up in just people not showing up to work, whether that's quiet quitting or just a higher call in rate. So, instead of immediately responding to any of those with aggression, I invite you as I invite myself to recall that when people show up with those unskillful coping mechanisms, just like anybody else, they are trying to solve for joy. They are trying to protect themselves and figure out how to get through another day. In what may be a potentially crushing situation with personal circumstances that are not visible to us. And so instead of going after them, you know, go for them, go for them, try and connect with them, figure out what is making them suffer and offer them tools. Yes. Offer them this podcast. Absolutely. Um, I have found coaching to be one of the most effective measures, especially for physicians and healthcare professionals, because there is nothing wrong with those of us in a crushing system saying, hey, I feel like I'm getting crushed. Right? It's not a disease model, and that is 1 of the reasons why therapy has not always been highly utilized by healthcare professionals who are suffering from this distress syndrome. We abbreviate as burnout. Thank you. But we do know that peer coaching can change the situation considerably. So tune in another time, and we will talk about some of the data that supports physician coaching and healthcare professional coaching in particular, with relationship to emotional exhaustion and to burnout. And thank you. For now, I will close us, but I'm so grateful that you spent this time with me today. Thank you for tuning into the solving for joy podcast. And please join us next time for a conversation with certified relationship coach, Peter Kahn. We're going to talk in depth about healthy conflict in relationship and Peter's own path to solving for joy. I want to take a moment to acknowledge my incredible team. Our music today is by Denys Kyshchuk,, cover photography by the talented Shelby Brakken. This podcast is produced by the amazing Kelsey Vaughn. Post production and more are handled by Alyssa Wilkes and my executive assistant, Rachel Osborne. A special shout out to my steadfast friend and director of operations, Denise Crain, and to the one and only loyal champion number one fan, Suzanne Sanchez. Thanks again for tuning in. May we continue caring for ourselves and others, and may we continue solving for joy.
