Stress & Burnout
We all have to deal with stress in our lives. But, it turns out that medicine is one of the most stress-filled occupations. Characteristics of the health care environment, including time pressure, lack of control over work processes, role conflict, and poor relationships between groups and with leadership, combine with the emotional intensity of clinical work to put clinicians at high risk of chronic stress.
Medical professionals tend to see stress as normal because they are so accustomed to feeling it, it’s the air that they breathe. Many of them are even proud of their ability to work hard, soldier on, and keep going no matter what. At the end, the endless small daily stresses gang up to produce the classic phenomenon “death by a thousand cuts".
There was no time for all this in medical school. It takes wisdom, self-compassion, mindfulness and self-care to find a healthy work-life balance and take control over your health.
“Never mistake knowledge for wisdom.
One helps you make a living,
the other helps you make a life.”
People experience stress in many different ways: “like a fifty-pound weight on my chest,” “like a knot in my stomach,” “like a vacuum in my lungs that doesn’t let me take a full breath,” “my heart pounds like there is an assailant, waiting for me.” These metaphors are grounded in the body, because stress is as present in the body as in the head. When the stress-response system is on high alert, the body produces more of the stress hormones cortisol and epinephrine. The heart beats faster and blood pressure increases. The vagus nerve, which helps modulate the physiological reaction to stress, withdraws its activity. That’s why it’s harder to breathe, harder to stay in control, harder to imagine that the world is a safe place.
Ideally, your body responds to stress and then quickly returns to normal. You’re prepared to meet whatever challenge is facing you, and then you recover. When you are exposed to chronic stress, however, your diastolic blood pressure and cortisol levels become blunted, a sign that your stress response is, basically, broken from overuse. Your systolic blood pressure increases, but instead of returning to normal levels after the stressful event is over, it stays elevated for a long time afterward. This keeps your body in a constant alert, a state of physiological vigilance that has ravaging events on your health.
Job Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of exhaustion, cynicism, and inefficacy. It has become an epidemic among medical professionals.
Here is an excerpt from the annual analysis (2016) of Audrey Lyndon, PhD at the Agency for Healthcare Research and Quality:
The emotionally exhausted clinician is overwhelmed by work to the point of feeling fatigued, unable to face the demands of the job, and unable to engage with others. The burned out clinician may develop a sense of cynical detachment from work and view people—especially patients—as objects. Fatigue, exhaustion, and detachment coalesce such that clinicians no longer feel effective at work because they have lost a sense of their ability to contribute meaningfully. In the past few years, the growing prevalence of burnout syndrome among health care personnel has gained attention as a potential threat to health care quality and patient safety.
Burnout is common among health care workers. Until recently, estimates for the prevalence of burnout ranged from 10%–70% among nurses and 30%–50% among physicians, nurse practitioners, and physician assistants. In late 2015, a study conducted by the Mayo Clinic, in partnership with the American Medical Association, found that more than half of American physicians now have at least one sign of burnout, a 9% increase from the group's prior results in a study conducted 3 years earlier.
Burnout is viewed as a threat to patient safety because depersonalization is presumed to result in poorer interactions with patients. Clinicians with burnout are more likely to subjectively rate patient safety lower in their organizations and to admit to having made mistakes or delivered substandard care at work. Thus a number of influential organizations, including the American Medical Association and the Mayo Clinic, have highlighted addressing burnout as a priority.
With a burnout rate over 50%, things have only gotten worse for physicians since 2015 according to the Medscape National Physician Burnout & Depression Report 2018.
Nurses, nurse practitioners, and PAs do not fare much better. According to the American Nurses Association (ANA) staffing survey, nurses report leaving work feeling “exhausted and discouraged (50%); “discouraged and saddened by what I couldn’t provide for my patients” (44%); “powerless to affect change necessary for safe, quality patient care." Surveys show that burnout for PAs is around 50% and for nurses over 35%. Existing data suggest similar prevalence of burnout among nurse practitioners.
It is important to note that the category “More educational growth opportunities” was pointed out by clinicians as one of fourteen factors that reduce their burnout. The Healthy Clinician Newsletter is here to fulfill this need by presenting a variety of evidence-based resources.
Job burnout symptoms (Self-test)
Have you become cynical or critical at work?
Do you drag yourself to work and have trouble getting started?
Have you become irritable or impatient with co-workers or patients?
Do you lack the energy to be consistently productive?
Do you find it hard to concentrate?
Do you lack satisfaction from your achievements?
Do you feel disillusioned about your job?
Are you using food, drugs or alcohol to feel better or to simply not feel?
Have your sleep habits changed?
Are you troubled by unexplained headaches, stomach or bowel problems, or other physical complaints?
If you answered yes to any of these questions, you might be experiencing job burnout. Consider talking to a doctor or a mental health provider because these symptoms can also be related to health conditions, such as depression.
Mayo Clinic experts offer several possible causes of job burnout: unclear job expectations, dysfunctional workplace dynamics, and lack of social support. One factor is especially important because it is within our control to affect it.
Work-life imbalance. If your work takes up so much of your time that you don't have the energy to take care of your basic needs or spend time with your family and friends, you might burn out quickly.
What Do You Do About It?
Here is some advice from the experts. Megan Weigel, DNP, ARNP-c, MSCN (from Provider Burnout, in the Flesh, “MD Magazine”, Sep 2015)
Pills are not the solution. Self-care needs to become a priority. What else is going on in your life such that you cannot recharge? What are you doing TO recharge? For example, are you investing time in unhealthy habits that actually make you more tired and can cause depression, like alcohol overuse? Can you start small? For example, go for a massage, do some deep breathing, prayer, or meditation? Cultivate a positive attitude and a light outlook, rejuvenate, and re-engage. In short, you have to make yourself a priority. Follow Anthony de Mello saying, “Life is a banquet, and the tragedy is that most people are starving.” Dig in. To your life. You will be a better person for it, for yourself, your family, your friends, your staff, your colleagues, and your patients.
Mayo Clinic suggestions for fighting burnout:
Try a relaxing activity. Explore programs that can help with stress such as yoga, meditation or breath work.
Seek support. Whether you reach out to co-workers, friends or professionals, support and collaboration might help you cope. If you have access to an employee assistance program, take advantage of relevant services.
Get some exercise. Regular physical activity can help you to better deal with stress. It can also take your mind off work.
Mindfulness. Mindfulness is the act of focusing on the present and being intensely aware of what you're sensing and feeling at every moment, without interpretation or judgment. In a job setting, this practice involves facing situations with openness and patience, and without judgment.
Fortunately, the past ten years have witnessed extensive research on practices that build resilient thinking and allow you to shield yourself from the effects of stress and negative thought patterns. They are encompassed in a new generation of therapies based on self-compassion, life purpose, and mindfulness.
The Healthy Clinician Newsletter and Programs offer insights into how you can shift you experience of stressful events to be healthier and more functional in your daily life. Our evidence-based exercises are incorporated in a unique daily self-care regimen that is both pleasant and effective.