Health and Wellbeing: Burnout

Ok, it’s time to get more serious now.  If the constant stress of work and life is leaving you feeling disillusioned, helpless and worn out then you may be suffering from burnout.

Burnout is a state of emotional, mental and physical exhaustion caused by excessive demands and prolonged stress. It leaves you feeling increasingly helpless, hopeless, cynical and resentful. Life loses its meaning and you may feel you have nothing left to give.  On the BMA website is a link to a questionnaire to rate your risk of burnout  Are you in danger of burn out?

Research into burnout suggests that GPs are at particular risk.  A Dutch study suggested that 40% of GPs were experiencing high levels of burnout, and a recent study by Pulse amongst UK GPs showed that 50% were experiencing symptoms suggestive of burnout.

Here are some common signs that you might be experiencing burnout:

• Exhaustion­ mental, physical or emotional, or all three;
• Neglecting your needs no time or energy for anything else other than work;
• Lack of motivation­ don’t feel enthusiastic about anything anymore;
• Frustration, cynicism or other negative emotions ­ these become overwhelming;
• Slipping job performance­ tasks building up, complaints increasing;
• Interpersonal problems at home and at work ­ more conflicts, withdraw from colleagues and isolate yourself;
• Not taking care of yourself ­develop unhealthy coping strategies ­ drinking more alcohol, eating too much, junk  food, smoking more, having affairs, self-medication;
• Being pre-occupied with work, even when not at work;
• Generally decreased satisfaction­ in everything you do;
• Health problems digestive issues, heart disease, depression;
• Depersonalisation ­lose contact with yourself, no longer see yourself as valuable and lose track of personal needs.  Your view of life narrows to the present time and life turns to a series of mechanical functions or tasks that are not to be enjoyed but just completed.

Stages of Burnout

There are several different models but the stages are similar:

Honeymoon period

High energy, good satisfaction from trying to solve problems and make changes, you find the job interesting most of the time

Fuel starting to run low

• Gradual onset of frustration, tiredness and loss of interest. Distancing yourself from colleagues and patients, become more cynical
• Denial of emerging problems ­ blame increasing problems on time pressure and all the work you have to do
• More mistakes
• Physical symptoms increase ­ fatigue, sleep disturbances
• Escape activities such as ­drinking or eating too much,  smoking, buying things

Towards a crisis

• Symptoms and dissatisfaction with the job dominate all areas of life
• Wanting to be alone, rejecting help, lots of anger and inability to relax
• You start thinking of extreme measures to escape ­ - moving, resigning, divorce or even suicide

Apathy

• Energy is very depleted and symptoms get worse
• CRISIS

It is often the best doctors that burnout, because they invest the most energy, emotion and commitment to their patients, but at the expense of themselves.  If you are a hard working idealist or a perfectionist your risk is even greater.

Causes of Burnout

There are many causes of burnout, in many cases it stems from your job but can result from any situation where you feel overworked and undervalued. This may be a combination of work and home life. Other factors also contribute to risk of burnout, including lifestyle and personality traits.

Work related causes

• Feeling like you have little or no control over your work
• Lack of recognition or rewards for good work
• Unclear or overly demanding job expectations
• Doing work that is monotonous or unchallenging
• Working in a chaotic or high-pressure environment

Lifestyle causes

• Working too much, without time for relaxing or socialising
• Being expected to be too much to too many people
• Taking on too many responsibilities without help from others
• Not getting enough sleep
• Lack of close or supportive relationships

Personality traits

• Perfectionist tendencies, nothing is ever good enough
• Pessimistic view of yourself and the world
• The need to be in control, reluctance to delegate
• High achieving type A personality

Preventing Burnout

There are lots of tips, books, websites out there with plenty of advice. Most involve some of the following and spending some time reflecting on how you can avoid burnout is never wasted, even if after reading the above you don’t feel it applies to you.

• Give yourself planned time for a relaxing ritual. This might be doing gentle stretches, meditating, writing a journal, reading, listening to music etc. The key is to do it mindfully, with your whole attention.
• Eat healthily, exercise and get enough sleep
• Set boundaries
• Take a daily break from technology, ­ "disconnect from an overly connected world"
• Do something creative and chose activities that have nothing to do with work or achievement
• Learn how to manage stress ­ you may need help with this

Recovering from burnout

If it’s too late, and after reading this it is clear to you that you need help, then you need to take your burnout very seriously. You can’t push through burnout and serious harm may come to you and your family if you do.

Step 1

SLOW DOWN. ­ You need to force yourself to slow down or take a break. Give yourself time to rest, reflect and heal.

Step 2

GET SUPPORT. ­ You need help. Share your true feelings, stop trying to deny the situation and talk to another person. Consider seeing your GP and perhaps book a double appointment, or contacting the BMA counselling or Doctor Advisor service on 08459 200 169.

Step 3

RE-EVALUATE. ­ Burnout is a sign that something isn’t working in your life. Your task is to find out what and put it right. You may need help to do this.

Step 4

TAKE TIME OFF. ­ If burnout seems inevitable then you might need to take a complete break from work. This often seems impossible for doctors as we tend to put our responsibilities before our health. This of course is part of the problem! Take a holiday, ask for leave of absence, take a sabbatical or you might need to take sick leave. Unless you take a break you will not be able to find the solutions.

Doctors are often very poor at managing their health and wellbeing, constantly putting work first and the traditional culture in medicine is that of needing to always be strong and not show vulnerability. We worry what others will think if we “confess” to having problems and of course if we do we may have to speak to a colleague who knows us professionally as well as being their patient. However, it is really important to put those fears and inhibitions to one side and trust the professional judgements and decisions of others. The strong person is the one who recognises the problems and decides to take action positively to get a better life.

Ref: The Stress of Medicine  -  David Rainham

More Helpful Links:

HelpGuide.org

Wessex LMCs: Health and Wellbeing: Introduction

Wessex LMCs: Health and Wellbeing: Stress

Wessex LMCs: Health and Wellbeing: Organisational Stress

Wessex LMCs: GP Support Offer

Wessex LMCs: Practice Manager Supporters

Wessex LMCs: GP Health Service & Financial Support for Doctors in Difficulty

Wessex LMCs: The Cameron Fund