Let’s play a little game today.
I’ll list some symptoms, and you think about the likely diagnoses. Here we go:
- Shortness of breath
- Palpitations
- Hot flushes
- Persistent tiredness
- Insomnia
- Unexpected weight change
- Headaches
- Muscle tension
Given that list, there are plenty of conditions that might have crossed your mind, including:
- Pulmonary embolism
- Atrial fibrillation
- Mitral valve prolapse
- Poisoning
- Iron deficiency anaemia
- Excessive caffeine use
- Influenza
But while we all tend to gravitate towards potential diagnoses within our own spheres of medical expertise, one condition that can encompass every single one of the symptoms describes is – you guessed it – burnout.
Burnout is the result of stress – an almost inevitable consequence of working too hard, of facing constant, heavy demands and striving to achieve impossible goals.
Cure everyone you meet in the next twelve hour shift, inside target waiting times, with a packet of paracetamol, some gauze and a saline drip. Get yelled at if you don’t.
Agree to your third concurrent shift because two fellow doctors are ill and we need you to step up and cover. Be told in no uncertain terms that you’re not a ‘team player’ if you try to refuse.
As a doctor, it’s a given that you’re used to targets. It goes all the way back. A-level targets to get into the University you wanted; targets to pass each course and module once you’re in higher education, and then targets for treatment of patients once you’re qualified.
But what happens when the targets are unrealistic? Sure, they might be achievable on some days, or in some places, but not for everyone – and far from consistently. Perhaps a colleague is off unexpectedly and there’s no-one to fill in. Maybe patients can’t be safely discharged just yet, meaning there are no free beds and new patients must wait longer. There are so many ways reality can throw a stick in the spokes of expectation.
But to the ears of management, these often don’t sound like reasonable explanations. They’re excuses. You must try harder! Work harder! Do more with less! You’re a professional, aren’t you?
And as a good doctor, a doctor who cares and who wants to succeed for yourself and your patients, you do try. You try so damn hard to meet targets while you get shouted at in work and lambasted in the media. You keep trying even though the goalposts are shifting more than your feet as you go from ward to ward.
Then, one day, it’s too much. Maybe something snaps. Or it might just bend – that sickly feeling that something you just can’t put your finger on is awfully, terribly wrong. You stop caring – about targets, about your patients, or even about your family and yourself. You have lost the energy that drove you. No amount of sleep seems to bring it back.
A snap can be a moment, no matter how small, that pushes you over the edge. The proverbial straw that breaks the camel’s back. You might get angry, or cry, or feel out of control in your life. You don’t want to go into work – you dread the thought of setting foot in the place and start planning your excuse for absence. Yet seeking that excuse clashes harshly with the guilt of knowing you’re trying to get out of doing what you love: helping people. And it turns in your gut.
Worst case scenario, you go beyond a sudden snap, and shatter into a thousand jagged pieces. Shattering is the worst. All parts of your life are affected. Your work is awful and your family life feels dreadful; even the inside of your own head is a horrible place to be. There seems to be no escape. No respite from the confusion, the frustration, the questioning of self worth and the physical nausea this whole situation seems determined to inflict on you.
A bend, and even a snap, can be repaired. A shattered mind – one that has been completely broken and exhausted – is much more of a challenge. Recovery is, of course, definitely possible, but things might never return to their previous state.
The ways each individual mind can burn out is unpredictable. Mental health is an incredibly complex thing, and can offer a remarkably unique set of challenges from case to case. After all, it’s hard to inspect and make capable judgments about a biological machine that’s breaking by using that same machine to do the inspection. How do you know what you’re thinking is actually true when your mind is turning against you?
That’s a horrific situation to be caught in. And it’s why the best approach to physician burnout is one of prevention – both for the industry, and for the individuals within it.
If you find yourself feeling anxious, is it because of a bad day, or is it a sign of things getting on top of you? Are your thoughts beginning to define you (as I discuss in my article here)?
Watch out for your internal monologue. A stressed mind might blame the situation: This is shit! But a mind approaching burnout internalises the issues: I’m shit. Everything I do is shit. I’m only thinking this because it’s what I am.
A mind approaching burnout will feel that a catastrophic end is inevitable. For too many, that’s exactly what happens.
It almost did for me.
Doctors need to open their eyes to the nightmare they’re walking into, and management structures need to pay close attention to the demands they’re placing on their practitioners. Until major changes happen, look out for yourself and others. It may be you, or it may be a colleague, who could be the next victim.
Wake up to physician burnout. Be aware. Extend the care and attention you offer your patients to yourself and your co-workers. Reach out for help as early as possible.
What I want you to take away from this is that everything you’ve read in this article is not normal. It isn’t the price we pay for the work we love; it isn’t something you just put up with… and it doesn’t deserve the respect that treating it as such extends to its existence. It doesn’t have to win.
Together, we can be vigilant – and even save lives. Perhaps your own.
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