I have taken several burnout score quizzes but none of the scores and explanations has returned what I know I'm feeling, so I have concluded I may have a strange, yet to be described type of physician burnout. I say strange because as a wellness and well-being coach myself, I have read about and even helped clients suffering from burnout but mine doesn't fit the classic picture of burnout as described in the books.
What is burnout? The three cardinal signs of burnout are 1. Depersonalization,(feeling of cynicm/detachment from the job), 2. Reduced sense of personal achievement/effectiveness and 3. Emotional/ physical exhaustion which can be overwhelming. I have a bit of all of it and somehow find that I'm circling between extremes of these three.
Starting with depersonalization. Simply put, personalization means you often treat patients and colleagues as objects; you've become a working robot, you just do the work required of you and nothing more, nothing less. It is what we call in Nigeria "I can't kii mysef o'. In fact when I'm in my depersonalization element, another song that automatically come to mind is 'bare necessities' from the Disney cartoon Jungle book.' For example earlier this week the patients we had booked for elective surgery didn't turn up and I unapologetically said 'great, that means tomorrow will be a free day to do my research work'. The Old me would have called up the next patients scheduled for the next week, 'so we waste valuable elective surgery slots'. I'm glad it isnt so bad that i treat colleagues as objects. On the contrary, I'm becoming increasingly concerned about mine, patients and colleagues' mental health. Now more than ever before. Odd. Odd. Odd. For example now I'm more likely to sense when a colleague is struggling with personal problems before they voice it out. Its like I can read their faces. I will often cold call them about my concern and ask how I can be of help. Earlier this week during my ward rounds, at the bedside of my patient, a 14 year old child who had accidentally stepped on a high tension cable and sustained extensive electrical Burns. He now needs to have both legs amputated and I could read that he was becoming increasingly withrawn for a child his age and may be going into depression. I stopped myself from going back to him after the ward round to talk to the parents and him to give them hope. I planned to tell them that even after losing both lower limbs he could still live a productive life. I had even planned on showing him videos of Nick Vujicic who's living a very productive and inspirational life despite being born without arm and legs. I suspect (I will eventually have that talk with them). I'm however really cynical about how an institution as big as ours does not have a clinical psychologist to help patients deal with such conditions and cynical about my work frequently involves dealing human suffering and how I need to get out of the system before it destroys my mind.
This is my kind of depersonalization.
Looking back, I can see I have been yo-yoing between facets of these symptoms, I just didn't know it was a thing. When I started out as a medical student I did a lot of crying when I saw patients suffering and though often short of funds, I would give my feeding money to help patients that couldn't afford their treatment. Then as I grew in the profession I sort of developed tolerance but I cannot say I totally became immune to patients' suffering. I would occasionally find myself thinking about patients over and over long after I was no longer in charge of them or after the patient had died. Post qualification, till today, when I operate on a patient I know no peace until they are discharged and I know all is fine with them.
I'm thinking any wellness and well-being coach reading this piece will be thinking oh 'I can help here', but I don't want help I don't want to be here anymore I just want out. Whilst I badly want out, I'm not entirely sure I can completely take my heart out of medicine. My dream is to come into hospitals that need me, donate my skills pro bono, and be so well off that I can fund those who cannot afford the treatment and I'm gone again for a very long time.
On a sense of personal achievement, I like to think I have a pretty decent sense of personal achievement and ironically grateful for what medicine has given me though I think I have paid very well for it. I just know the the system can be so much better if only it would listen to those on the Frontline.
Concerning physical and emotional exhaustion, I think I realized early how I needed to save myself from the system so I upped my physical activity level and even registered a fitness and wellness start up. That means most times I'm full of energy and hardly if ever physically exhausted and can help clients in the process. Emotionally however, I'm utterly drained for the system most times that I push thoughts of intervening deep into the basement of my mind when I see processes going wrong. You guesssd right, one or both of the songs I mentioned goes into autoplay and replay in my head.
I'm not the TGIF or 'I hate Mondays' person, and would sometimes dread the weekend because I have no excuse to not attend social gatherings.
So much is my belief in saving one's self from the system and vice versa that at a recent lecture to first year medical students, I told them to start to plan their exit from medicine the day they find they can no longer fulfill any part of the physician's oath.
Are you a medic and can relate to my type of burnout? Please let me know in comments section.
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Dr Z, been at number 3 without the first two aspects you mentioned and it was such a sad sad place. It took hiring a health coach to prioritize my physical and emotional well-being plus stepping away from the environment that did that to me. I can’t imagine having all 3! I do think of some of your responses are your self preservation mode in simply impossible situations. However, we have been conditioned as docs to feel guilty when we self preserve forgetting that what is happening is a basic human response to intolerable stress! It may help to have someone coach you through this. The impact of burnout is too soul crushing to let it fester. Please take care of yourself.🙏🏽