I cannot accept that others have control of how I feel, act and think. I admit it’s easier to blame others — the disrupted system, the incompetent “leaders,” the unhealthy environment and the micro-aggressive behaviors. But I refuse to give that power to others! I’m the owner of my goals, thoughts, feelings and actions. And I refuse to burn out!
Dr. Freudenberger first coined the term in 1974 to define physical and emotional exhaustion combined with reduced accomplishment and loss of personal identity. In 2019, burnout was added to the International Disease Classification (ICD-11) as a “syndrome that results from “chronic workplace stress that has not been successfully managed.” It involves feelings of energy depletion or exhaustion, increased mental distance and/or feelings of negativism or cynicism related to one’s job and reduced professional efficacy.
The prevalence of physicians’ burnout in the U.S. is about 40 percent. Reports from 2021 reveal that 20 percent of physicians experience clinical depression, and 13 percent had thoughts of suicide, while the incidence of suicide is about 300 to 400 per year, meaning that on average, one doctor dies every day by their own hands.
We all agree that significant changes need to be done to foster health care workers’ well-being. However, those efforts may take forever and depend on the will, the agreement, and the actions of health care corporations, political organizations, medical associations and insurance companies, among others, all of them with a set of priorities that significantly differ from each other.
So, what do we do in the meantime?
Let us introduce four concepts that may change your perspective and help you to recover ownership of your personal and professional life: emotional intelligence (EQ), resilience, post-traumatic growth (PTG), and locus of control.
Introduced by Peter Salovey and John D. Mayer in the 1990s and further developed by Daniel Goleman, it’s described as “The ability to identify and manage one’s own emotions, as well as the emotions of others” and consists of self-awareness, social awareness, self-management and relationship management.
EQ is considered a predictor of physician well-being; individuals with higher EQ can deal better with stress and are more resilient. EQ has also been linked with academic success, effective problem-solving, social skills and empathy.
Data support the fact that EQ can be taught and may improve stress-management skills, promote wellness and prevent burnout in physicians. This opens the doors to the opportunity of establishing standardized training for medical trainees and health care workers.
Refers to “the dynamic process encompassing positive adaptation within the context of significant adversity.” Low resilience has been associated with fewer skills to manage stress and burnout, impaired personal relationships and feelings of being inferior to peers.
While there is some controversy regarding the effects of training programs to enhance resilience, several studies suggest that resilience workshops help health care professionals to understand resilience, identify triggers for workplace stress and promote the importance of self-care.
A recent meta-analysis by Angelopoulou, P. et al. demonstrated that emotional–supportive–coping interventions and mindfulness–meditation–relaxation interventions were associated with small but significant improvements in resilience.
Physician’s resilience is an emerging area that merits further research, having the potential of reducing stress and burnout while fostering well-being.
Refers to “the positive growth people experience following adversity and psychological struggle.” Psychologists Richard Tedeschi and Lawrence Calhoun developed this theory in the 1990s.
While health care professionals are more familiar with Post-Traumatic Stress Disorder (PTSD), PTG brings a different perspective on how to address traumatic events to foster growth instead of stagnation and move from a victimized image of ourselves into an empowered and better self.
PTG is often confused with resilience, but they are two different constructs. While resilience is the ability to bounce back and adapt in the face of adversity, PTG is the discovery of a sense of personal growth after a difficulty bouncing back, which caused psychological distress and challenged our core beliefs. Becoming more resilient is an example of PTG.
According to Tuck and Patlamazglou PTG is associated with the appreciation of interpersonal relationships, a more positive self-view, a greater appreciation for life, and a reevaluation of personal goals and values.
Locus of control
Developed by Julian Rotter in the 1950s, it is defined as “a construct used to categorize people’s basic motivational orientations and perceptions of how much control they have over their lives.”
In more simple terms, locus of control refers to the belief that your destiny is controlled either by yourself or by external forces. A person with an internal locus of control has the belief that outcomes have to do with his personal decisions and effort, while a person with an external locus of control attributes his success or failure to faith, luck or other external circumstances.
To avoid burnout, it’s extremely important to address the topic of “control.” Although having an internal locus of control is considered a sign of psychological health, it could lead to unrealistic expectations. Self-agency and self-determination are extremely important for success but place a great burden on us when we feel responsible for changing external circumstances that are not in our power to change.
What can we control? Our behavior and our responses to circumstances. Focusing on what is in our power to control and putting all our energy and efforts in the right places and for the right reasons seems to be a step in the right direction to make positive changes and avoid burnout.
Now, imagine not only surviving medicine but also enjoying it, using it as an opportunity for personal growth and development, as a catalyst that transforms challenges into amazing outcomes.
Close your eyes and remember why you decided to be a doctor. How did you feel the first time using your white coat, hearing the ticking of a heart, saving a life? It’s time to recover the power. It’s time to reassume the responsibility, the privilege and the joy of being a physician. Be healthy, be happy — and keep helping people and saving lives!
Miriam Zylberglait Lisigurski is an internal medicine physician. Yudith Furman is a psychotherapist.
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