Recognize and manage physician stress and burnout

Recognize and manage physician stress and burnoutA guest column by the American Society of Anesthesiologists, exclusive to

“The tragedy of man is what dies inside himself while he still lives.”
- Albert Schweitzer

Statistically speaking

When is the last day you truly remember feeling peace, happiness and a deep sense of well being? If you cannot answer this question, you are not alone among your physician colleagues. Doctors, in general, tend to die at an earlier age than non-physicians. We also experience a higher than average rate of suicide, suicidal ideation, substance abuse and burnout. Further, approximately one third of us do not have a regular source of health care and 60 percent do not even have a personal physician; this is twice the rate of the general population. It also is reported that early in our careers, at least 20 percent of medical students report depression, a statistic considered grossly under-reported.

How do I know if I am experiencing stress or burnout?

Hans Hugo Selye describes our adaptive steady-state capability in his General Adaptive Syndrome. Stress, he theorizes, represents the insidiously destructive result of cumulative internal resource depletion. It is important to note every individual, has his or her own internal gauge for when they exceed their ability to cope; it is extremely important not to compare yourself to anyone else on this score.

Anesthesiologists frequently tend to be attracted to the specialty because we enjoy the short but intense relationships with patients, as well as the ability to work with our hands and the increasingly technical inter-specialty equipment we utilize. We also appreciate the ability to see the immediacy of intra-operative pharmacologic and interventional manipulation.

However, the price paid for these seeming advantages is loss of control–the outward manifestation of which is stress. Anesthesiologists face internal resource depletion daily. We have no control over the length of a surgery or schedules, time spent with friends and family, or even knowing when we may eat or use the restroom!

In the bigger picture for all physicians, we are involved in a non-reciprocal relationship with our patients, one that inherently sets us up to be in emotional debt as the caregiver. This situation may be intensified for anesthesiologists who may have less interaction with their patients. Further exacerbation may occur for any doctor who works daily with suffering patients such as in an oncology setting. In other words, if we do not receive many positive strokes with good outcomes in our doctor-patient relationships, we may lose our ability to empathize.

Other factors which may contribute to physician stress (loss of control): 1) the constant need to suppress symptoms of fatigue and exhaustion; 2) economic factors that compel the physician to perform in the dual roles of doctor and business manager/CEO; and 3) difficult relationships with colleagues.

How do I know if I am burned out?

Burnout is described by Chassot as the triad of emotional exhaustion, depersonalization (loss of empathy) and a lack of personal accomplishment. Symptoms of burnout may include: feeling tired even with adequate sleep, work dissatisfaction, forgetfulness, sadness, irritability, increased incidence of illness, subpar job performance, substance abuse, decreased concentration, avoidance of interaction with others, increased boredom with work, decreased work accomplishment despite seeming hard work, dreading going to work, avoidance of social activities, feeling like work is a dead-end (why bother) and the perception what you were hired to do is not meeting with reality.

Where do I go from here?

If you realize you are at rock bottom or heading there, it is essential to re-establish some modicum of control, meaning making some immediate changes in your life. Stress or burnout at this juncture may be a life-threatening situation. Unfortunately, at this point, it is likely you want to do less work, but change requires work. It is important to avoid the vicious cycle of avoiding change because this may breed a fear of change, leading to increased stress. It is crucial to take inventory immediately. The most practical way to approach the overwhelming task of where to begin is to make a list of the top ten most draining elements in your life you perceive need to change. After developing this list, you have three options: 1) Take care of the issue by yourself and do it!; 2) Delegate the task to someone else or hire someone to do it!; or 3) Throw it out and let it go!

This simple inventory process will take some time, but may be the most valuable gift you give yourself.

The wisdom of John F. Kennedy sums it up best, “There are risks and costs to a program of action, but they are far less than the long-range risks and costs of comfortable inaction.”

A few pearls

1. Do not compare yourself to others. What may be stressful to you may not be to anyone else or vice versa.

2. Do not wait for someone or something to change and make you happy. Abraham Lincoln said, “Most folks are about as happy as they make up their minds to be.”

3. As you leave work each day, find a specific place outside between work and home to literally unload and leave your day’s stresses.

4. Live each day consciously and make decisions that create less stress for you mentally, physically and emotionally.

Jessica A. Alexander is an anesthesiologist.

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  • Dike Drummond MD

    Thanks for this article Dr. Alexander.

    One of the original burnout researchers described burnout as, ”an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.” … a great description.

    The combination of the stresses of clinical medicine, the business of medicine and trying to have a life — can pile on to drive doctors into a relentless downward energy spiral. It is important to know that burnout can ruin your marriage, your career and even take your life if it is unaddressed. You may wonder if there is something wrong with you … there isn’t. 1 in 3 doctors are clinically burned out on any given office day, worldwide, regardless of specialty.

    I work with burned out doctors every day … my advice is a little more aggressive perhaps than yours. If you are saying to yourself, “I am not sure how much longer I can go on like this…”.

    - Know that burnout is what is trying to take you down
    - Take a break ASAP – Get Out of There as soon as you can for an absolute minimum of a couple days
    - Cut back your hours immediately to give yourself some breathing room to think about next steps – the quality of the care you are providing is compromised .. even if you are convinced it is not … cut back at least until you stop the downward spiral
    - Let someone know how you are feeling – your spouse/significant other for sure and a physician coach, therapist, your group physician EAP …. pick someone to reach out to and get some help and support

    Know too that there are significant differences in burnout symptoms between men and women – here is an article with the latest research on this

    There are lots of effective ways to prevent and treat burnout … and you have to recognize that is what is happening first.

    Dike Drummond MD

    • StephenModesto

      …Thank you for the link to the happy md.

  • drjoekosterich

    This is great advice. Many doctors need to practice what they preach when it comes to stress

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