Burnout: “A syndrome of emotional exhaustion, depersonalisation, and sense of low personal accomplishment that leads to decreased effectiveness at work.” ( Maslach 1996)

Surveys of prevalence of burnout internationally suggest that over 50% of primary care physicians admit to one or more symptoms of burnout  and it’s getting worse with time[1]. This is reflected in our collective view of our profession in the RNZCGP annual workforce survey 2015 when less than 20% of respondents were “extremely likely” to recommend GP as a career [2] .

There may be a multitude of reasons for this lack of enthusiasm for our specialty, God knows we don’t do it for the money, but perhaps it also reflects exhaustion and a sense of low accomplishment many of us feel at the end of the day? You tell me – I’m too tired to think about it too much.

Symptoms of burnout include:

Signs of physical and emotional exhaustion – chronic fatigue, insomnia, weakness, poor appetite, depression, anxiety.

Signs of emotional detachment – anger, isolation, pessimism, lack of enjoyment in work.

Signs of reduced effectiveness – complaints from patients and colleagues, poor performance, irritability, apathy. [3]

My own first experience of burnout came as a junior doctor, the only on-site doctor for a community of 30,000 in a 50 bed hospital unit. I was working only the 12 hour night shifts so I could play with my young children during the day, and consequently was sleeping only for a few hours in the middle of the day for months on end.

I can easily put myself back into the emotional space I felt when a poor patient with chest pain arrived at 2 am one morning towards the end of this time.

My only feeling was of resentment that this man was going to be taking up my time which could have been spent having a few minutes sleep. I did the necessary, but had no compassion or ability to empathise left in me.

The only option I could see at the time was to change my job which I did shortly afterwards, out of the frying pan into the fire as it turned out, but that’s another story.

One definition of “stress” is the emotional result of having a gap between how you want or expect the world to be and the reality of lived experience. This means that if we want our patients to be good communicators, who get better as a result of our interventions, and who are cared for in a system that is efficient and responsive we are going to be subject to stress, because patients find it hard to communicate, and the health system is not efficient or responsive.

Add to this reduced resilience through poor sleep, long work hours, the pressures of bureaucracy , a lack of general self-care and you have a recipe for disaster.

So what can you do about burnout?

Prevention is better than cure – stay well, exercise regularly, eat healthy foods, don’t abuse alcohol or other drugs, get plenty of sleep, maintain interests out of medicine, read fiction, be creative, have strong interpersonal relationships and take regular holidays – it ain’t rocket science is it?

If you recognise the symptoms – talk to your own GP – you should have one and get one if you don’t.

Remember “The physician who treats himself has a fool for a patient” (William Osler). Take the advice your GP gives you, even if it involves medication or having a long break from work.

Listen to “The Doctor Paradox” podcast and learn from others how they have coped with burnout [4] – often it involves making a significant change in the way you approach work – I know – this is NOT easy which is why preventing burnout in the first place is a better approach.

Above all else “First you save yourself” – there is no point handing out the oxygen masks to everyone around you whilst you become slowly unconscious. As a profession we have twice the risk of death by suicide compared to the general population and female doctors a four-fold increase in suicide risk[5] – so be careful out there, listen to your body, be mindful of your mood.

Consider whether or not the increasing number of complaints you are receiving is a result of your lack of engagement and not a reflection of the ignorant low life you are obliged to serve – if you think this way it is a symptom of “de-personalisation” and a sign you have a problem, not them.

If you have a lot of  “heart-sink patients” (those whose name in the appointment book makes your heart sink because you feel defeated, overwhelmed and exasperated by their constant demands and unsolvable problems [6])  consider re-framing the problem as being a sign that it’s time for taking a holiday, reading a good book and learning how to play the clarinet.

Dr Jo Scott-Jones

[1] http://www.medscape.com/viewarticle/838437

[2] http://www.rnzcgp.org.nz/RNZCGP/Publications/The_GP_workforce/RNZCGP/Publications/GP_workforce.aspx?hkey=a7341975-3f92-4d84-98ec-8c72f7c8e151

[3] https://www.psychologytoday.com/blog/high-octane-women/201311/the-tell-tale-signs-burnout-do-you-have-them

[4] http://thedoctorparadox.com/

[5] https://www.mcnz.org.nz/assets/News-and-Publications/Newsletter/DEC08.pdf

[6] http://www.bmj.com/content/297/6647/528