Exhausted and Frustrated in Healthcare: Burnout Isn't Just Your Problem
There are many contributors to
Healthcare Burnout
Words matter. They have the power to unite and the ability to tear apart. They can lift you up and push you down.
Whoever said, "Words can never hurt me," was wrong.
The word "burnout" rubs some healthcare professionals the wrong way. Because I call myself a "burnout and career wellness" coach, I thought I'd use this week's blog to share what this word means to me.
The Meaning of Burnout
Let's start at the beginning.
Burnout first gained its name in the 1970s. Herbert Freudenberger, a New York psychoanalyst who worked with people battling addictions, is credited with coining the term after his own experience of physically debilitating burnout.
At about the same time, a California professor of psychology, Christina Maslach, used the term in her own work examining how people, including healthcare workers, respond to crises. During her interviews, she found that people deeply resonated with "burnout" as a descriptor of what they were feeling.
From the start, those in healthcare were among the OG casualties of burnout.
Fast forward to our present day, and you will find burnout defined by the World Health Organization as:
"A syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
feelings of energy depletion or exhaustion;
increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and
reduced professional efficacy."
I suppose it's the phrase "stress that has not been successfully managed" that causes trouble. To many, it implies blame. It can be interpreted as placing the burden of responsibility squarely in the hands of the healthcare professional experiencing burnout.
Whose responsibility is it to "manage" this workplace stress in healthcare? I say it's up to all of us.
To suggest burnout is the sole responsibility of the individual is absurd.
Like the medical conditions healthcare professionals treat daily, we are subject to and influenced by the atmosphere in which we function. We know genes can be turned on or off depending on the environment they're exposed to. Why would we expect something as complex as burnout to be any different in its etiology?
On the other hand, suggesting that the healthcare system is solely to blame is also discouraging. This would imply that we, as individuals, have no recourse, that we're powerless. This is certainly not how I want to think of myself or the other amazing healthcare professionals I encounter daily.
So, where do we go from here?
Burnout And……….
If you've experienced (or are smack in the middle of) burnout, you know it wields a multi-forked dagger.
Burnout can lead to feelings of…
Isolation
Inferiority
Anger
Shame
Anxiety
Depression
Apathy
Resentment
Exhaustion
Avoidance
Cynicism
Insufficiency
The list goes on. Clearly, the formal definition of burnout feels inadequate for the all-consuming, real-world experience of burnout.
Combine this with the subtle feeling that individuals experiencing burnout are being pegged as weak, and it's not hard to see why those in healthcare have started searching for a better way to describe burnout.
From this exploration, other characterizations of healthcare professionals' experiences have emerged. These concepts overlap with and contribute to burnout and are essential to understanding today's healthcare environment.
Moral Injury
Awareness of moral injury is becoming increasingly pervasive in healthcare. Moral injury involves being forced to abandon one's moral beliefs, values, and ethical codes of conduct.
It threatens the core of one's being.
When healthcare professionals are forced to repeatedly function in a way that doesn't feel ethically aligned with their being, moral injury can result. For example, this can be seen when a physician is repeatedly required to delay or withhold what they feel is the appropriate treatment to satisfy insurance requirements.
The damage moral injury can inflict is real. Moral injury and burnout share many of the same symptoms. It's also an established contributor to increased rates of depression and suicidality.
Compassion Fatigue
Compassion fatigue can be another challenge faced by those delivering patient care. Again, symptoms are often similar to burnout, and compassion fatigue may represent a specific aspect of burnout.
Caregivers, especially empathic healthcare professionals, can be at risk for taking on the traumatic experiences and suffering of their patients. This can result in overwhelm from carrying the feelings and burdens of the individuals they interact with on a daily basis.
The emotional and spiritual "saturation" that healthcare professionals may experience can paradoxically leave them unavailable to be emotionally present for their patients, family, and friends.
What “Burnout” Means to Me
When it comes to the challenges, frustrations, and struggles healthcare professionals face, we don't have the perfect, all-encompassing word (or definition) for the experience.
It reminds me of conversations with foreign language speakers who try to explain an eloquent word in their native tongue and give up, saying, "There isn't an English word for it. I can't really explain it."
While we're waiting for definitions to change, we make do with what we have.
In my mind, I believe there's room for yes, and…..
The WHO definition of burnout doesn't specify who's responsible for "successfully managing" burnout. Maybe it should.
Is it the individual, the healthcare system, or our culture that needs to bear the burden of burnout? I say it's all of the above.
As someone who considers herself strong and capable, I'm not ready to cede my fate to the whims of others.
There were many aspects of my burnout experience I had power over. Was my situation influenced and colored by things outside of my control? Most certainly.
Yet, I still had choices within the constructs I found myself in.
*I became more pragmatic about charting. I quit spending my time and energy crafting beautiful, grammatically correct notes and directed those resources to my patients and their care.
*I learned to delegate more effectively and trust my staff to get the job done, even if their approach to tasks sometimes differed from mine.
*Shifting my mindset and attitude about how I approached patients, the people I worked with, and my day-to-day in medicine created a new lightness I had been missing. It rekindled my curiosity and sense of adventure.
*Changes I made outside of work gave me new energy and excitement, which spilled over into my professional life.
Acting on those choices positively influenced the experience of my last five years in medicine.
There were also burnout contributors and circumstances beyond my control.
I couldn't change the bureaucracy and demands of the government and insurance companies on my own. I couldn't change the fact that medicine has become a business that feels increasingly focused on profits over people.
These items require transformation at the systemic and cultural levels.
For that to happen, we need large numbers of healthcare professionals, patients, and other stakeholders demanding a shift in the priorities and goals of the healthcare system. It requires all of us to be willing to create boundaries and act when those boundaries are crossed.
In that way, burnout does come back to individuals - individuals recognizing their responsibility to one another and working together to effect change.
Not all workplace pressures result from moral injury, and not all stress in healthcare is emotionally focused (as in compassion fatigue).
I continue to use the term "burnout" because it seems the broadest definition of what many of us in healthcare are facing.
That doesn't negate the role of influences beyond our control. It doesn't mean we, and we alone, are responsible for "fixing" our experience of burnout.
At the same time, we can champion ourselves now. When we're suffering under the weight of our healthcare careers, we don't have to wait for someone else to start making it better. We get to choose.
Want to learn more about how introverts experience the 12 stages of burnout?
Create calm in the middle of your busy day with my free Mindful Minutes Toolkit.
You can access it for free here.
Ready for 1:1 support from someone who understands your introverted nature?
Learn more about working with me here.
Charity is a physician burnout coach helping introverts in healthcare escape feelings of apathy, irritability, and resentment brought on by the increasing demands and decreasing rewards of medicine.
She uses her 20 years of experience in clinical medicine combined with coaching to help introverts discover ways to be diligent, thoughtful clinicians while prioritizing their needs and protecting their energy. She wants you to know you don’t have to feel guilty for wanting a thriving life inside and outside of medicine.