Recognize and manage physician stress and burnout

A 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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