Is your spouse experiencing physician burnout?

Many things in life can only be truly appreciated once reflected upon — like the onset of dementia, depression, and cancer, just to name a few. This got me thinking about the onset of burnout and how the true presentation in life is quite different than reading about it.

The term “burnout” is often thrown around loosely but is an actual syndrome comprised of the progression of “exhaustion, cynicism and reduced effectiveness.” In the world of health care, we hear a lot about physician burnout as it has been shown to negatively impact patient care, result in physicians leaving clinical practice and can lead to the detriment of a physicians’ well-being including mental illness, addictions, and even suicide.

When it does manage to creep into your home and descends upon your spouse, you become acutely aware of how knowing about the presentation of burnout isn’t the same as living with someone who is experiencing it. This happened in our household about five years ago. Our story may be different than others, but the underlying message is universal — early detection and action make a difference.

First step: recognizing warning signs

Burnout didn’t just appear one day — it was so insidious that it took a long time to piece together. It is difficult to even quantify the timeline. My husband, a radiologist, was working in a very busy community radiology practice. Most people perceive radiology to be a lifestyle specialty. But very early on, we realized it didn’t offer a “balanced” lifestyle. Although he was afforded a lot of time off, the workload/volume of cases on the days he did work was often overwhelming. On top of this, radiology is fraught with constant interruptions, so when you are finally getting your head around a complicated CT comprised of hundreds to thousands of images, your train of thought often gets derailed when a technician or other physician needs your attention.

My husband was leading a life like many other radiologists, and we accepted it at the time as both the remuneration and holiday time were incomparable. He also worked in a culture where you couldn’t complain about the work, given the benefits that came with it. In addition to this, we were well aware of some of the challenges faced by other specialties, such as mine in family medicine, so we felt very fortunate for his situation overall.

However, we quickly learned and realized that incentives are not enough when you take into consideration the six domains of burnout identified in the article by well-known burnout researcher Christina Maslach and Michael Leiter, “Understanding the Burnout Experience: Recent Research and its Implications for Psychiatry”: “workload, control, reward, community, fairness and values.”

Although workload was a key factor for him, the mounting lack of control over how he had to work, set up a cascade of mismatched values, and in retrospect, should have been a warning sign of what was to come. As indicated in the above-mentioned article by Maslach and Leiter, “A clear link has been found between a lack of control and burnout.”

Second step: recognizing emerging signs and symptoms

The most profound sign I first noticed in my husband was exhaustion. He would admit to feeling chronically tired, no matter how much sleep he got. It was starting to show on his face and was compounded by his eye fatigue, after long days staring at images on computer screens. His generous amount of holidays would allow him to recover slightly, but then after the first day back to work, he felt just as tired as the day he left.

Along with his fatigue came a sense of both “discontentment” and “dissatisfaction.” He was discontent with his work life and dissatisfied with his work situation. I think these are underused terms when it comes to burnout compared to more commonly used ones such as “lack of joy,” “lack of fulfillment” and “loss of meaning.” He started to dread going to work and came home emotionally exhausted and frustrated.

I noticed some depersonalization as it related to interactions with his partners at work, but never saw signs of “reduced effectiveness.” He has always taken pride in his work ethic and abilities. And no matter how many cases he has to read on a given day, he treats the first case the same as the last. This never changed but became more difficult to work against when he was already feeling beaten down.

Piecing it together

Around this time, I was expanding my knowledge of wellness and lifestyle medicine and anything to do with prevention. I started to learn more about physician health, wellness and subsequently burnout, and then, my moment of realization. A “burnout tick box” doesn’t exist, per se, but some scales do, such as the Maslach Burnout Inventory. Not surprisingly, he scored high on “burnout” during that period, and we know that he is not alone. As current numbers indicate that over 50 percent of physicians are experiencing professional burnout.

My husband and I liken burnout to “an erosion of the soul,” where all the pieces that make you who you are start to fall apart. When you are in the throes of it, it becomes very clear how unsustainable it is. You’ll either get better or worse, and the only way to get better is to make a change. Thankfully, the changes that he has made have transformed his professional life, and in doing so, he has reclaimed the joy he once had in medicine.

Sara Taylor is a family physician who blogs at Sara T., MD. 

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