Burnout mostly affects caring, high-performance people in high-demand settings—sound familiar? With more than half of medical staff experiencing burnout at some point in their careers, knowing how to identify this insidious problem is crucial to reversing it, before it spirals out of control. In this video, from our Resilience Masterclass course, Professor Gary Simonds takes a look at examples, gleaned from the surveys of 40 high-functioning neurosurgeons and support staff, to extract the behaviors, thoughts, and feelings that clinicians with burnout will instantly recognize in themselves.
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Burnout is a state of emotional exhaustion that particularly affects caring, high performance people, in high demand settings. Burnout manifests itself as decreased energy to meet normal daily demands, and to interact with others. Depersonalization, that is going numb, losing empathy, and sense of inefficacy. A sense of futility to one's actions, or nihilism.
In this Medmastery course we'll focus on combating burnout with resilience. Resilience is the ability to come through the stressors and challenges of work in healthcare and of your home life. And grow and strengthen, rather than break down and burnout. Now, you may maintain that you're already plenty resilient and are in no danger of burnout.
But we would suggest that in your busy day, there are many signs that you, and, or your teammates may be experiencing psychological distress, and symptoms of burnout. Let me give you some examples gleaned from surveys I did on my own team of 40 high functioning neurosurgeons and support staff. See how many of the following behaviors thoughts and feelings are applicable to you, and, or your workmates.
For example, when I asked my teammates to tally how many times in a week, each member experienced an unpleasant interaction with a hospital co-worker, the average was 33 times. That means 33 conflicts in a week. All team members admitted to occasionally losing it with a co-worker. When asked how many wards or units in the hospital did they feel were outright inhospitable.
The average was five or six. These are places they didn't feel comfortable working in. When asked how many days in a week did they actually settle down for a full and relaxed breakfast, lunch and dinner. The average was zero. When asked how many work days in a work week, did they actually allot themselves more than 15 minutes to eat their lunch, and, or a 15 minute coffee break somewhere.
The average was just one time a week. With every member admitting that they continue to work throughout these breaks. When asked how much sleep do you get on non-call nights. The average was less than six hours, with sleep routinely sacrificed for work related activities, and maintenance activities of daily living.
When asked about the quality of their sleep, no members rated it good or great, and 100% reported sleep disturbances or sleep pathologies. And none admitted to arising from bed in the morning, feeling energized and excited about their new day. In addition, 80 percent reported frequent nightmares, often involving some sort of work scenario.
When asked on average, how much of their post work time was allotted to pleasant and restorative activities and hobbies each day. The average was half an hour or less, with many admitting to no such activities during the actual work week. When asked how they most commonly spent their quote, "Free time", at home during the workweek, 100 percent of the team admitted to crashing on a couch before a mindless TV show.
When asked about contact with extended family members and friends, 85 percent admitted to near none. When asked how they responded to seeing a row of teenagers in coma from car accidents, the most common response was quote, "I'm not really significantly affected." All admitted to feeling more callous to the suffering of others, than they did 10 years ago.
As a quick aside here, in our group per member, the average number of patients that they saw in a week, who were at high risk of dying was 65, with a high of 120, and this was before the pandemic. When asked to describe thoughts and feelings that they experienced when they got out of the hospital, and out into friendly happy social situations, common responses included shock when encountering helpful strangers.
Discomfort with the trivial nature of interactions. Discomfort with the unhurried pace of others, and ultra low frustration tolerance for poor service. A lack of anyone who appreciated their dark gallows humor. A lack on their own part of interest in politics, culture, and current events, all the common fare of discussions out in the real world. In addition, when released out into the happy real world, participants described sense of surrealism to the whole thing, and a normalization of the deviancy of the hospital environment, where the hospital environment felt more real than the outside world.
Also guilt at leaving work to their comrades. Also, a sense of doom for some of the happy laughing people around them, that they would soon be found in the emergency rooms and trauma bays. Some even described a strong desire to get back into the hospital. Here are some further common phenomenon behaviors noted in our evaluations.
When working, even on a simple or trivial task, and interrupted politely by friendly co-worker, all admitted to feeling annoyed, and to giving nonverbal cues that they did not wish to be disturbed. All admitted to occasionally belittling those of other specialties and services for being dumb, lazy, worthless, or selfish. And all admitted to being far less than civil, patient and polite, when on the phone with their co-workers. All admitted to failing to inspire others around them, and to making their co-workers feel good about themselves.
In fact, many found it hard to remember many of their co-workers names, or details about their lives. Most admitted to coming home and routinely dropping the stress of their day, right on top of their significant others. Many admitted to occasionally focusing their work frustrations on those significant others.
All admitted to trivializing the concerns of their family members, and continuously comparing them with what they had been facing in the hospital. All admitted to routinely becoming annoyed at trivial matters, both at work and at home, and to being more irritable in general than they used to be five years in the past.
All felt that their normal daily activities drained them, and annoyed them, rather than energize them and filled them with satisfaction. All admitted to regular bouts of guilt, intense guilt, about their work life balances, their care of their patients, their attendance to their children, and many admitted to feeling a free floating guilt and anxiety much of the time.
All admitted that they did not live up to the person they saw themselves as, or that they wanted to be. Now, understand this, none of our team who took the Maslach Burnout Inventory scored in the burnout range. Technically, they weren't burned out. Yet, we would argue that they were all exhibiting significant signs of psychological, and, or emotional distress.
And, in presenting this information across the country, audiences everywhere conceded that many of the described thoughts and behaviors were directly applicable to themselves. We believe that if you give this some thought, you and those you work with, may find that you're affected more than you think by your work.
That you, and those around you may be feeling and exhibiting more emotional strain than you think. And that you may not be who you would like to be because of this. And are thus, at frank risk of full blown, or episodic burnout. So, what can be done about this? We say that we need to recognize that we all could do with some regular resilience training and exercises, because we're all elite performers.
And, just like elite athletes, much work has got to be invested in maintaining peak performance, and in the prevention of injury. Which, in our case, can be profound psychological injury. Now, most of us know that it's felt that 50 percent of people in medicine are burning out, or are burned out. In the next 10 lessons, we're going to give you strategies that the 50 percent who are not burning out, and who indeed thriving, have used to build and maintain their own resilience.