Healer Burnout

It is not easy to be a healer. Doctors and other providers experience a number of challenges in the healing role. How do you rate on the Headington Institute Burnout Scale?

Mythologists describe the “Wounded Healer” as an archetype, and many would argue that most people trained in Western medicine currently are or have previously been in this role. Many physicians, in particular, have personalities that set them up for suffering a great deal because of their approach to their work. As Spickard et al, note:

“Certain personality traits may enhance the risk of burnout by influencing the individual’s response to stressors in the workplace. Compulsiveness is a character trait found in many physicians and, although it may be adaptive behavior for the demands of medical education, it can also have an enormous detrimental impact on their professional, personal, and family lives. The compulsive triad of doubt, guilt feelings, and an exaggerated sense of responsibility has been well described. Physicians with compulsiveness have chronic feelings of not doing enough, difficulty setting limits, hypertrophied guilt feelings that interfere with the healthy pursuit of pleasure, and the confusion of selfishness with healthy self-interest. A dissociation (diminishing awareness of one’s physical and emotional needs) leads to a self-destructive pattern of overwork. A psychology of postponement takes root in which physicians habitually delay attending to their significant relationships and other sources of renewal until all the work is done or the next professional hurdle is achieved.” (JAMA 2002;288:1447-50)

A slide presentation on burnout by Dr. Hakam Yaman defines burnout and explores how it arises and how it might be addressed. The Canada Medical Association has created the Center for Physician Health and Well-Being, acknowledging that this is an important issue. A 2007 Occupation Health Article, and 2004 JAMA article review study findings related to burnout and how it might be better-addressed.

Burnout doesn’t just affect physicians themselves. It has been found to negatively affect prescribing practices (SSM 1980;14A:495-9) and patient compliance (Health Psych 1993;12:93-102). It also decreases overall quality of care (Med Care 1994;32:745-54).

What are some strategies to avoid or deal with burnout? The American College of Physicians lists several. Some great tips are also available in the student section of a past issue of the British Medical Journal. An article by Zeckausen in Family Practice Management has some excellent tips and resources as well.

Specific suggestions found in many of these resources include:

• Be certain that you have control over your work environment
• Spend time with people you love; a supportive partner is key
• Cultivate religious, spiritual, creative pursuits
• Be aware of your self-care needs, including for healthy diet, exercise, social contact and a sense of meaning and purpose
• Set limits and boundaries
• Begin a mindfulness/meditation practice
• Manage stress. Mind Tools has some useful tips
• Have good mentors and confidantes
• Cultivate your sense of humor. Check out The Doctor’s Page for a treasure trove of healthcare jokes and anecdotes
• Ask for help. Do you have your own healthcare providers to take care of you?
• Avoid common thought distortions that healthcare providers often fall into, as outlined in the box below, as created by Felice Miller in West Medical Journal 2001;174:49-50:

Common thought distortions and how to challenge them

1. Magnification or minimization. One aspect of the situation is over- or underemphasized: “I didn’t check with the patient whether or not he understood why I gave that medication. That was a wasted visit.” “Too much was going on to discuss that dizziness today.” Take stock of what you did well.

2. Polarization. Using black and white thinking: “My colleagues are going to think I am incompetent.” “I made a mistake; I am a terrible doctor.” Are there shades of gray? Can you rephrase the thought to be less extreme?

3. Personalization. Taking the situation personally and ignoring the total picture: “It’s my fault.” What would you say to a colleague in the same position?

4. Stress-producing language. Using words such as ‘should’, ‘have to’, ‘must’, and ‘need’. Instead, try ‘would like’ or ‘want’. Instead of “I should never make a mistake,” say “I would like to improve my skills in that area.”

5. Pessimistic thinking. Thinking of the situation as permanent, pervasive, and personal: “I’m never going to have the respect of my colleagues” or “I’m not suited to this profession”. Instead, acknowledge that a situation can be temporary, specific, and related to factors other than oneself.

6. Catastrophizing. Is this unfortunate incident a catastrophe? Note thoughts such as “I’m going to be sued” or “I killed the patient.” If the bad outcome happened, what would/would not be the actual consequences, and could you handle them?