Identifying Burnout in Medicine

For those who know the definition of depression well, this is not much different. Sleep, Interest, Guilt, Energy, Concentration, Appetite, and Psychomotor changes  +/- Suicidality are the very definition of depression- (abbreviated SIGECAPS). Recent studies have shown that 86% of those diagnosed with burnout also met criteria for depression because of this (Though there is no DSM diagnosis for burnout). Some providers suggest burnout is just having symptoms at work, with depression being general symptoms. But let’s be real- if you have symptoms of burnout all week long at work, it is going to affect your energy, relationships, and mood at home as well, so this distinction is a bit nitpicky. Leiter defines burnout as a crisis in employees’ psychological connection with work, which is a good way to think about it. Again, depending on the degree of symptoms, this may be concurrent with depression or with some runoff after work as well.

Personally, I was aware of burnout early in my career. Immediately before starting residency, I had bacterial meningitis and cognitive dysfunction. Therefore, loss of identity, sleep, energy and even appetite occurred the second I got meningitis and continued for weeks at home, and then continued when I went back to work as well. So was I burned out or not? Depressed or not? Everyone just kept saying I was being dramatic- how was I to know the difference? Not to mention, this was residency. I clocked 128 hrs one week (don’t tell my bosses). I didn’t have time for meditation classes, and yoga therapy, and whatever other random things you wanted me to try. So I changed nothing. And I kept working. And honestly, this is what most people will do.

The height of my burnout symptoms came with a meeting with my boss. She expressed how several people were really worried about me. I angrily retorted that what was anyone going to do? My situation was bad and wasn’t going to improve so who cared and could I go now? Thankfully, I didn’t lose my job over my angry outburst, but honestly, that was just three months into my medical career. I was really not calling it burnout at that point, but how many options did I have even if I had admitted it? I started seeing a counselor and tried to ignore symptoms.

Especially in medicine, stigma kills a lot of people- not wanting to admit that you are under the same treatment as the people you care for, and assuming you are the only one struggling is far too common. But we are forced to wade through a lot of awful things- and how do you get through the difficulty? To this day, I still flash back to the first patient I saw die- an eighteen year old boy in a car accident who we pumped full of 10 Liters of blood, but he still managed to bleed to death before our eyes because of lacerations behind his liver. How do you get rid of the pain and memories and exhaustion and heartache you face?

So my counselor and I eventually came to the conclusion that I had talents outside of medicine that weren’t being used there and admitted especially with the illness that this was a hard year. We decided for me personally, my frustrations and symptoms were coming both from my career (burnout) and from coping with my illness (depression). Her solution? Quit my job. But I had literally sold my life for my career, and I couldn’t give up because of a few months of frustration. So instead, my counselor fired me! She said she couldn’t help me anymore. And though I was shocked at the time, I am more shocked now at the fact that the only thing we have to offer people for burnout is complete abandonment. If burnout is present outside of medicine too, isn’t it possible I might just find a new job and burnout there? If the statistics about depression are correct- quitting my job doesn’t free me from it, so that step doesn’t necessarily eliminate my symptoms. But this dichotomy gave me the clarity I needed- I was still willing to fight for my career even if it caused me heartache. So instead of leaving, I looked for other solutions than this.

To start with, you don’t do it alone. I actually attended counseling at my programs’ Occupational Health department all three years of residency. I made it a priority and they worked around my schedule so that either my lunchtime or right after signing off, I headed straight there- clinic, ICU, or anything in-between. Though I was initially guarded with what I thought was appropriate, it was a safe place that I could just hash out and work through whatever was ailing me most that week. Unlike the rest of my coworkers far too often did, they didn’t degrade, shrug off, and run away from the things I was struggling with. It was a breath of fresh air in a crazy hectic week, however brief it was.

Second, you admit that this may have ramifications. From a physician standpoint especially, there are consequences- the fear of being cited for the remainder of your career as requiring treatment or requiring medications or what-have-you. Having to rearrange a schedule and take time off work can be nightmarish, I understand. But remember there are consequences for every decision you make in life, and just like I tell my parents with newborns- you can’t take care of anyone else if you don’t take care of you. Are you going to keep ignoring the elephant in the room, or are you going to admit the difficulty and commit to a change? Would you rather take the steps to make changes now, or be forced to give up your career entirely later? And an estimated 400 physicians die by suicide each year, and that’s too high a statistic for us to not face the music now and seek help.

 Next, find the silver lining at work. In residency, this was taking it one day at a time and remembering that it was just a month until the rotation changed and I got to learn something new. Nowadays, I try to find funny little pearls of silliness that happen through the day that make me laugh. It doesn’t fix it all. But it gets you to refocus off of the cynicism and back on the beauty in your work. Find a small flame and fan some life into it all you can.

 Also, make a point to fight for your stress reliever. Whatever you love outside of medicine- be it massages, or baking, or reading, or hiking- find a realistic timeframe and make it a regular priority. Maybe it won’t be daily, but how about a great activity to look forward to each month? For me, I was in a bluegrass band and playing with them was the main highlight of any month for me.