Burnout and what to do about it

Physicians have the highest rate of suicide of any profession.

I told this to a friend of mine the other day and she was shocked. And I was shocked that she was shocked. To me, it seems obvious—we have high stress jobs, high rates of depression, and knowledge of as well as access to lethal drugs. We take on the suffering of the world without training in how to deal with burnout, loss, abuse, and failure. Residency is only possible for those who become, as Dike Drummond notes on The Happy MD blog, lone-ranger-superhero-emotionless-workaholics. How else are you supposed to survive being solo on an overnight call with the sickest patients in the hospital? So that’s how we cope. But that’s not the answer. In one study, 40% of interns (first-year residents) met criteria for major depressive disorder.¹ Forty percent!

I was discussing this with a colleague recently, lamenting the fact that we have to turn off our compassion in order to survive difficult situations. If you get too close to the teenager dying from cancer, it’s too hard to do your job. So you create distance. “You have to!” I said, meaning it. She looked at me sadly. “No, you don’t.”

I’m not sure I completely believe her, but I think that’s because I was trained (as we all were) to become a lone-ranger-superhero-emotionless-workaholic. Thankfully my faith and my amazing support system have kept me from going too far over the edge, but what if there was another way? One that didn’t involve having to always be right or never being able to ask for help? Medicine will always be difficult (especially in today’s world with its constant fight for reimbursement, poor access to care, and patients who diagnose themselves with Dr. Google and get their vaccine advice from celebrities) but we don’t have to get burned out.

General estimates among practicing providers are that anywhere from one-third to over half suffer from symptoms of burnout (defined as depersonalization, emotional exhaustion, and decreased sense of accomplishment). So what do we do?

There has been a lot of promising research in the areas of mindfulness and positive psychology, and I’m starting to immerse myself more in it as I take on the task of improving wellness and reducing burnout within our section (not a small challenge, with some 100 providers and the lowest employee satisfaction rates within the hospital).

I’m not under the impression that things will change quickly, or by great percentages, but I’m going to try to do something. I have to. Because the alternative is to accept the unreasonably high rates of depression, burnout, and suicide in my colleagues and friends. And we were made for more.

To finish, I’m going to borrow an exercise from the Positive Psychology department at Penn to challenge you, dear reader (and myself). It has been shown to improve wellbeing and to have lasting effects even 6 months down the road. It’s called “What Went Well”.²

Here’s how it works:

            For 2 weeks, at the end of every day, write down 3 things that went well that day. Doesn’t have to be big things. Then write down why those things went well.

            Example: I was able to work out today because I was disciplined and had the time to commit to exercise.

            Another example: My best friend called me to catch up because she cares about me and wants to know how I am doing.

            That’s it. That’s all you have to do. You don’t have to show it to anyone or make it eloquent. Just give it two weeks.

Here’s to wellbeing. For all of us.

1. Guille, C., et al. (2010) in Journal of Graduate Medical Education.

2. For more exercises and resources, visit www.authentichappiness.org