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acquisition of a repertoire of strategies that allow recognition of signs of recurrence as the inevitable challenges of life arise , and effective timely response . For milder cases , recovery may take a few months , whereas in severe cases it can take up to three years , although most of this occurs within the first 12 months .
Management
There is no universally agreed approach to management . Indeed , some of the popular approaches are incomplete , at best , and have the potential , at worst , to do harm .
Many workplaces place the responsibility for wellbeing and burnout prevention on employees , with proposed solutions including self-management of fatigue levels , accessing health providers ( including Employee Assistance Programs ), ‘ resilience training ’, engaging in healthy eating and regular exercise , and seeking work-life balance .
This approach largely abrogates the workplace of its responsibilities for occupational health and safety , doing little to acknowledge or address workplace contributions to burnout . Employees tend to respond to such strategies with increasing resentment and burnout , and this approach can in fact lead to a reduction in individuals participating in healthy behaviours .
An emphasis too far in the opposite direction can be similarly unhelpful . When employees see the workplace as not only the source of all their challenges , but also as responsible for all the solutions , then they miss out on the potential for positive change through self-reflection and addressing personal responses to circumstances .
To best manage burnout , both workplace and individual factors warrant consideration , as well as identifying specific action areas in which there is scope for change . Individual factors include the way in which the person responds to stress as well as personality factors such as perfectionism . 4
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Many workplaces place the responsibility for wellbeing and burnout prevention on employees .
Anyone who suspects they are burnt out
Doctors with severe burnout may require a prolonged break from work , moving to a new job , or an entire career change .
warrants an initial assessment with their GP to receive an objective diagnosis and consideration of differential diagnoses , and to assess severity and safety . This is best facilitated by doctors already having their own GP with whom they are comfortable discussing mental wellbeing . Unfortunately , 40 % of doctors do not have such a relationship with a GP . 16 Persisting stigma poses an ongoing barrier to disclosure of burnout , so it is important for doctors to consider carefully who they disclose to . 9 Simply acknowledging the presence of burnout often provides a sense of relief and validation , and instils a sense of hope that things can improve . 15 A period of leave from work is often beneficial and recommended but will not lead to recovery on its own . 15
Workplace factors are a helpful starting point . This involves consideration of workload , work hours and responsibilities . It ’ s important to identify where the individual has agency , and how their choices can be leveraged to reduce stress and improve wellbeing . 15 Certain workplaces or stages of training limit autonomy and scope for change , in which case it ’ s necessary to optimise the individual ’ s stress response strategies
and protective factors to endure a fixed period of training , or to seriously consider a change of workplace . 15
Perfectionism is a key contributor . 4 This may result in perpetuating behaviours such as longer work hours , excessive time creating thorough notes and letters , repeated checking of assessments and results , and over-preparing for presentations . It can also lead to procrastination and avoidance of new
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opportunities and responsibilities , due to a fear of failure .
Connection and support are important , 15 including spouses , children , colleagues , mentors , and more formal arrangements such as Balint groups , social media groups and other wellbeing support groups .
Professional psychological support is particularly important in addressing the vicarious trauma intrinsic to many medical roles . Engagement can be challenging , as burnout frequently leads to a desire to withdraw and isolate . Counterproductive interpersonal interactions such as bullying , harassment and poor boundary-setting are also vital to consider and address . 15
Maintaining interests outside of work and medicine is important so that being a doctor doesn ’ t become the individual ’ s core identity . Outside interests aid the capacity to view work challenges from a different perspective and enhances capacity to take meaningful action . To maintain wellbeing over the long term , doctors must make time for important people in their lives , hobbies and other interests .
An individual with mild or evolving burnout will usually achieve good recovery by addressing these factors . Those with severe burnout may require a prolonged break from work , moving to a new job , or even an entire career change . This is best done with professional guidance to avoid unnecessary reactive decision-making , which can have a large and ongoing negative career impact .
To achieve optimal outcomes , it ’ s critical that we accurately identify burnout , assess its severity , and tailor management strategies to the individual ’ s personality , work and circumstances . With acknowledgement of the issue and good support , doctors can achieve a sustainable career that also allows space for personal wellbeing .
References on request from kate . kelso @ adg . com . au
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Tips for dealing with burnout
• If you feel burnt out , seek help early from your GP and a trusted professional who can guide you in the medium to long term .
• Avoid making big irreversible decisions while you ’ re experiencing significant burnout , especially without the guidance of an objective informed second party .
• Start small — you will make more progress with small sustainable changes than diving in with drastic change . However , if burnout is severe , you may require immediate significant changes , including a period of leave from work .
Resources
• The Burnout Project : theburnoutproject . com . au The Burnout Project provides burnout counselling , group support programs , online courses , events , workshops , training and burnout packages .
• The Black Dog Institute ’ s ‘ Navigating Burnout ’ online course : burnout . blackdoginstitute . org . au /#/
• Burnout : A guide to identifying burnout and pathways to recovery by Gordon Parker , Gabriela Tavella and Kerrie Eyers
• Doctors 4 Doctors : drs4drs . com . au 24 / 7 peer support , information , and training .
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