Burning Out

Do you ever feel that everyone seems to have amazing coping skills yet you seem to be the only one who struggles with even the most basic aspects of “adulting”? Why does everyone else seem to live this perfect life and achieve so much, yet make it seem like it’s no big deal? Well, apparently it’s all a lie! We’re all struggling!

While that seems terrible, it is also a tremendous relief to know that we are not alone. I know this to be true because Dr Clare Skinner (Director of Emergency Medicine at Hornsby Hospital in Sydney) told me so. She obviously touched a raw nerve as evidenced by the ubiquitous nods of agreement to everything she said.

Clare shared her story. It was a deeply personal story. It was heartfelt and moving and sad and hilarious and inspiring. It was also normal. It was normal in the sense that we all related to everything she was saying. This is her story which I have paraphrased with her permission…

This is part 2 of the series from the NSW Emergency Trainee Health and Wellbeing Day. You can read part 1 here.

Why do we burn out?

Because we’ve been set up! According to Clare it’s almost inevitable. Think about it.

1. What we do is incredibly difficult on all levels. It is intellectually difficult especially when it comes to the sheer volume of decisions that we make each shift.  It is emotionally difficult in having to deal with patients, who are all experiencing the worst day of their lives. And it is physically difficult. We don’t eat. We sustain a mild form of pre-renal AKI every shift because we know that we won’t have the chance to pee….so clearly the solution is to ignore thirst and not produce urine in the first place.
2. We are all perfectionists who don’t cope well with uncertainty. Our sense of identity is strongly linked to our performance as an emergency doctor. We seek external validation and care too much about what others think of us.
3. We seemingly accept bad behaviour and being treated poorly by our medical colleagues, because that’s the way it has always been. We are also tough on each other….because hey, we’re perfectionists.
4. Yet, the system does not support us. It’s poorly designed. It is always short-staffed. The KPIs seem to value patient flow over quality care.

We are destined to break down.

Clare’s personal story

Clare shared with us her story of burn out. She talked about her relationship breakdown combined with physical illness at the end of her RMO year which led her away from clinical medicine and into a Masters of Public Health. She talked about her frustrations in attempting to pass the primary exam and how she strongly considered leaving the life of emergency medicine when it became clear to her that a life of night shifts would never ever end. Many in the audience smiled a knowing smile, the kind of smile that says “I know that torture…I’ve been there”.

How does burnout feel?

Have you ever resented your patients for their mere existence? Have you ever cut corners? Ever felt that only a big bag of chips could provide true happiness? Ever found yourself not being able to sleep despite being exhausted? Have you ever driven into work and felt so anxious that something bad will surely happen on this shift that you’ve had to pull over to throw up? Maybe you just feel that all your hard work just isn’t worth it…I mean, does anyone really care what you do? If you answered yes to any of these questions, then perhaps you are burnt out.

What does Clare suggest we do about it?

1. Assume that periods of burn out will happen and have a plan for how to address it early before you get caught in a bushfire
2. Recognise the warning signs and act on them
3. Why don’t you try the novel idea of taking a break…a toilet break…or perhaps maybe you’ve heard of something that normal people do called “lunch”…or could you treat yourself to a holiday?
4. Have a mentor outside of your hospital – someone without a conflict of interest
5. Choose your workplace carefully. Find a department where you can be yourself. It’s too hard to pretend to be someone you’re not.
6. Have an identity outside of emergency medicine. When all you are is an emergency doctor and you feel that you’re doing that job badly, then it’s easy to tell yourself that you therefore must be a bad person. Have interests outside of medicine. Wear different hats.
7. Be kind to yourself. Be realistic about what you can achieve in the current system
8. Beware of the myth of resilience. Often the problem is the system and not you. If you force a size 16 bum into size 8 knickers the elastic will stretch and eventually snap.
9. Create a positive culture. Be generous about the emotions that contribute to your workplace. Be nice. Thank your colleagues. Get involved in changing the system

If you are struggling please consider the following resources: