The Pathophysiology and Treatment of Physician Burnout

In my work with over stressed physicians I have noticed a consistent misunderstanding of the pathophysiology of burnout – the hidden methods burnout uses to sap your energy and steal your passion for medicine. This is vitally important because once you can clearly understand how physician burnout operates, you will begin to see the simple ways you can keep the normal stresses of being a doctor.

Each and every shift in the clinic or hospital requires a significant input of our energy. As doctors, we are drained on multiple levels by the demands of the clinical practice of medicine every single time we see patients. Physician burnout begins when you are drained and NOT able to recover between your shifts. Burnout can take you on a relentless downward spiral that has been described as an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.

Physician Burnout Pathophysiology – the 3 Core Symptoms

When you cross the line from the “normal” stresses of being a doctor into physician burnout you will begin to notice one or more of the following symptoms:

  1. Exhaustion
  2. Depersonalization: Usually showing up as Compassion Fatigue, sarcasm, cynicism and blaming your patients
  3. Lack of Efficacy: Doubting that your work makes any difference and/or questioning the quality of your work

It is common to use a battery metaphor to describe stress and burnout. “My batteries are run down” or “recharging my batteries” are common phrases you might hear. As physicians, we are perfectly capable of  “running on empty” and continuing to see patients long after we are completely drained and exhausted. Building this capacity to work despite complete exhaustion is a core component of our medical education. Learning how to keep going no matter what is part of surviving residency. There is only so long that you can continue to practice on empty before something bad happens.

Preventing Physician Burnout – the 2 Core Methods

Preventing and treating burnout involves a series of simple steps and none of them are easy for a practicing physician. You have never been taught how to lower your stress levels or create work life balance. There are two main ways to both prevent and treat physician burnout:

1) Decrease the Drain: Decreasing the drain begins when you take a good hard look at what you hate about work, accept it for what it is, stop the blaming, complaining and making excuses and make some changes to eliminate some of that stress.  Here are some examples:

  • Learn how to lead your team more effectively so that they do some of the activities you find draining and don’t require an MD in the first place.
  • Get some lessons on how to become a Power User of your EMR from the person in your practice who is acknowledged to be the best at it and the least stressed by it.
  • Exercise ANY flexibility you have over work hours and days. Make your schedule work for you.

You can also decrease the drain by doing more of the things you love at work. If you are an expert at a particular diagnosis/treatment you love to do, who doesn’t know about your skills in your local community and when and how will you reach out and tell them?

2) Become Skilled at Making Deposits: What are your favorite recharging activities?

      Physical

  • What things do you do outside of work that you find the most restful and rejuvenating?
  • How can you take better care of exercise and eating right?

     Emotional

  •  What relationships in your life give you the most joy and satisfaction?
  • When can you spend some quality time with these people?

How can you get more of those encounters in your work day?

First you have to be clear on the kinds of things that feed your spirit at work. Remember the last office encounter that gave you the feeling I describe above? Take a moment and write down the details of that patient/problem/situation/diagnosis so that you are very clear on who and what you are looking for.

Guest post by Zintro expert Dike Drummond, MD

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