MENTAL HEALTH
“ I GUESS I AM BURNED OUT ! WHAT DO I DO NOW ?” John J . Wernert , MD , MHA
This issue of Louisville Medicine is
dedicated to a complex and worrisome topic – the growing problem of accessing mental health treatment – for our patients and ourselves . Several of our articles focus on provider burnout . We all know that the field of medicine is in the midst of constant technological , regulatory and societal changes that contribute to an increasingly stressful work environment for physicians and caregivers . As physicians , we have taken an oath to care for our patients , but are frequently caught between the ethics and values we vowed to uphold and the demands of the system . Today ’ s medical practice can cause stress levels that lead to emotional exhaustion , depersonalization and a loss of a sense of professional efficacy . In the literature , these combined psychological reactions are known as “ burnout ”, but there is significant disagreement in the literature about what constitutes burnout . We do know that “ burnout ” is harmful to the physicians themselves , impacts productivity and can most definitely impair the quality of care they give to their patients .
The causes of physician burnout are complex and multifactorial . Many wellness professionals believe physician burnout is hardwired inside us . Ironically , the same characteristics that allow physicians to excel also make them more vulnerable to burnout and psychological fall out . We see danger and sickness everywhere . We were taught the “ prime directives ” in our medical training – from “ the patient comes first ” to “ never show weakness ,” causing additional stress and avoiding self-care . Our workaholism was conditioned in to our professional being and creates a direct block to our ability to recharge when our professional batteries are exhausted . Since physicians are high achievers by nature , many of us tend to push ourselves to see more patients and do more work than resources allow . When we have had enough , we either switch business models – such as moving to concierge medical practices – switch careers – such as insurance work or consulting – or sadly continue down a path of frustration , malaise , cynicism and despair . A growing number of doctors are caught in a “ life of quiet desperation .” They ’ re at risk for a downward spiral , for developing significant psychological and psychiatric issues that can result in disability or just giving up practice . We are warned - if you are having symptoms of excessive anxiety , or chronic sadness that feels like depression , it is imperative that you reach out for help . Sadly , many of us will not . Most tragic of all is the escalating rate of physician suicides . Over 400 physicians died by suicide in 2019 , the equivalent of more than one doctor per day . This is the highest rate of any profession , and twice the rate of the general population .
Burnout is not normal or inevitable . Burnout is not about what is happening to you , it is about whether or not you can cope with the things you find stressful . Some humans are wired to handle massive amounts of emotional stress where others are easily overwhelmed . Consider your own individualized ability to recover the energy drain caused by things that stress you out .
How can you tell the difference between being “ stressed out ” and having “ professional burnout ?” The simple litmus test is , how well do you respond to time off ? Put simply , if you are physically and emotionally stressed , then time off from work will improve your energy and attitude while at work . On the other hand , in the face of burnout , taking time off will not reverse the symptoms . When you have thoughts of “ I never thought my career would be like this ,” or “ I can ’ t take this anymore ,” then bulldozing through your feelings will only accelerate a downward spiral . It is OK to feel that there has to be a better way !
It is important to understand that burnout is not a problem , it is a dilemma . You can “ solve ” problems , but must learn to “ manage ” dilemmas . Learning to recognize and manage dilemmas will make your life easier , and will help flush out the higher purpose of professional burnout . That ’ s right , burnout can be beneficial ! Humans often make the most difficult life changes when they are unhappy , uncomfortable and exhausted . Perhaps this is the highest and best purpose of professional burnout ?
So , what to do now ? Asking for help is not easy . It has been my experience in 30 years of psychiatric practice that women in gen-
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