Physician burnout is a hot topic right now. Some don’t agree with the term and choose to use “moral injury.” Regardless of the term you want to use, the problem is real. And while we’ve identified this as a major issue amongst physicians and have highlighted its prevalence and causes, have we really addressed preventing it?
Being a physician, I have attended many leadership classes. I’ve learned about conflict resolution, empathy, selflessness, flexibility, listening and humility. All of these are great tools that will help strengthen my leadership skills so that I can serve others. Yet, in all the classes that I have attended over the years, no one has spoken about taking care of yourself.
‘I have so rarely heeded my own advice’
Some of the best advice that I have given to weary family members who have spent countless hours by a loved one’s side is: “Go home. Get some rest. Get a shower. Have a good meal. You are not going to be any help to your loved one if you have not taken care of yourself.” And as many times as I have told family members this, I have so rarely heeded my own advice.
There is an often forgotten skill in leadership training: Self-help.
And you may be thinking, “But if I am to be a leader, I am to help others. It just seems selfish to put the focus on me.” But if you yourself are not well taken care of, then you will not be able to lead or take care of others effectively.
But to know when to implement self-help, you must also use another leadership skill which is often taught in leadership classes, and that is self-awareness—being self-aware means having a clear perception of your personality, including strengths and weaknesses, thoughts, beliefs, and emotions.
Being self-aware is looking inward and asking yourself “who am I, how do I feel about myself, who do I want to be in this world, and most importantly have I become the person I wanted to be.”
Accurate self-awareness is essential for optimal daily living. It allows us to know what our limitations are and will enable us to make choices based on our capabilities.
When we decide to become leaders in the community, we feel that we must be strong. We feel we cannot have weakness. We don’t talk about our feelings for fear we will be viewed as weak or not good enough. Eventually, this takes a toll.
These internal stressors begin to manifest both mentally and physically. We start isolating, retreating from friends and families. Sleep and appetite are affected. Coping skills are strained, and we become anxious and depressed. We become burnt out.
The dreaded night float
Sadly, I have been there. I was a second-year resident. Arguably, the hardest year in my residency and on the hardest two months of that year: The dreaded night float. When your days are literally turned upside down, you take care of the hospital all night and return home during the day to sleep.
For some physicians, it is an easy adjustment, for others a nightmare. It was an impossible adjustment for me. I could never get my sleep cycle to switch. I worked nonstop throughout the night and was awake throughout the day looking at my clock, counting how many hours of sleep I could get if I were able to fall asleep at that very moment. With each passing hour awake, I got more and more anxious.
Exercise has always been an outlet for me, but I had no energy to exercise. I was so exhausted on the weekends I did not want to do anything social. I had no appetite and was, in fact, horribly nauseated because to complicate things even more, I was eight weeks pregnant.
So, I continued to forge on thinking, “Everyone goes through this. I am no different. This is part of it.”
Two great losses
Well, mid-way through the first month, I suffered a miscarriage. I told no one other than my husband. My ob gave me the pills to help complete the miscarriage and encouraged me to take time off. Well, I wasn’t going to do that. So, I loaded up on Advil and heavy-duty pads and continued to work. After three days, I went in for my ultrasound and still needed a D&C. I was warned there would be cramping and still more bleeding.
My ob told me that I would need to take the rest of the day off. But I did not listen. I demanded to have the procedure Friday morning, thinking, “I’ll go to work that night and then have Saturday and Sunday to recover.” My ob warned me that the emotional toll would soon catch up to the physical.
At the beginning of my second month of night float, I experienced another great loss. My grandfather died. He was essentially another father. He was my world. I loved calling him and telling him all my stories of being a physician. I continued to try to forge on. I certainly could not take time off to go home to the funeral. What resident would take time off?
I wasn’t eating. I could not talk without crying. I could not sleep. I was so sleep deprived that I was having hypnagogic hallucinations. We know these are often brought on by exhaustion.
One day, my husband came home to find me in a fetal position on the floor rocking and crying.
Thankfully, although I had zero self-awareness at the time, my husband was fully aware of the decompensation that was happening. One of my fellow residents stepped up and got night float covered for me for a week. I was told to go home to my family, go to the funeral.
I was able to rest. I was loved on and cared for immensely. Being from the Mississippi Delta, I was fed and fed and fed some more. I took runs around the neighborhood that I had so many times before as a teen. I returned much healthier after just one week. Because of the self-help, I finished out the month with no issues. And I became so much more self-aware.
Why do we wait so long to implement self-help? We know that the suicide rate has risen more than 30% in half of states since 1999.
We know that anxiety, depression, and stress are factors that increase the risk of suicide. The physician suicide rate is more than double that of the general population. We need to shift our focus to self-help as a way to prevent physician burnout.
Self-help may not always be enough
Establishing good self-help skills now is something that will come in handy through the course of your life. There are multiple pathways to self-care: Sensory, pleasure, mental, spiritual, emotional and physical. We, as physicians, must recognize the importance of self-help and truly engage with it. As a psychiatrist, I counsel my patients on the importance of self-help daily.
We must heed our own advice.
But as a psychiatrist and fierce mental health advocate, I want you to know that self-help may not always be enough. Knowing when to seek professional help and doing it is the strongest thing you can do. We know that mental health care is essential for total health and treatment is effective. So if needed, seek it.