This post accompanies Andy Tagg’s talk for Grand Rounds for RU OK Day
I have a confession to make to you all.
And I know this is a safe space, so here it goes…
I am burnt out.
I have been a doctor for half of my life, and my journey to burnout has been a 25-year slow burn that began the day I graduated.
I had always wanted to be a doctor, and only now do I recognise my parents’ sacrifices to get me to where I am today.
I was the first person in my family to stay at school beyond sixteen, and I made the most of every opportunity. I took the requisite classes, did the extra homework, and even captained a sports team – if you can call bridge a sport – to help me get into medical school.
When I got there, I continued to work hard and at the end of six years, I received a shiny medal for the struggles that I had overcome. I wore those two letters, DR, to show the world I had made it and was worthy.
My identity and worth as a human were tied up to those two letters.
And then, I entered the workforce.
My individualism, the things that made me, slowly became subsumed by my identity as a doctor. By constantly focusing on other people’s needs, I began giving up control over my time and energy and my sense of self.
I was the person who translated my boss’s wishes into action. I was the one who chased the lab results and wrote the discharge summaries. I was the one who, inexplicably, had to make tea and toast for the morning X-ray meeting.
I had become a replaceable widget in the great engine of healthcare. But I wanted to stand out, to be the perfect doctor—someone with the brains of Mark Green, the curiosity of John Carter, and the smouldering good looks of Doug Ross.
So I put out my hands and said, Please, Sir, can I have some more?”
But therein lies the rub. I become a victim of my success.
I agreed to the unpaid overtime, the extra audit duties, and the unpaid tutoring roles, hoping they would land me in that place—a place where I would finally get seen.
What happens when you do a good job of something? Your bosses smile down upon you, and you get asked to do it again—and again and again. When your sense of self-worth is tied up to your identity as a doctor, you feel seen and valued, so you take on more and more.
This adds to the sense of overload and overwhelm. You don’t have enough time to get everything done at work—even though you should never be the one to do everything—so you take it home.
When you first become a consultant, everyone likes to give you advice.
One of the most common things you’ll hear is, “Say Yes to everything”, but I take umbrage at that.
A group of US researchers surveyed managers and office workers and found that the more often someone said yes to requests for help from their co-workers, the more they felt their internal batteries were drained. Focusing on the job in front of them became harder, and this sense of depletion lasted well beyond leaving the office. It dragged on into their evening at home with their families and the next day.
As I continued my journey from intern to consultant, I held onto that toxic belief that I could be a perfect doctor rather than a good enough one. I set impossible standards at work and home and berated myself when I didn’t meet them.
I loved work. But work didn’t love me back.
It slowly took away my sense of autonomy, my sense of belonging, my sense of control.
Working and surrounding yourself with suffering – the physical, mental, and spiritual suffering of patients and, perhaps more importantly, your colleagues is exhausting. And that exhaustion is contagious.
What is the price of work?
Everything. The price of work is everything.
But, the reason I’m telling you this story is because it doesn’t have to be.
Burnout comes with serious personal, social, and professional costs, and it took me a long time to realise that I was burnt out.
If one of my colleagues had come up to me and asked me, “Are you okay?”
Do you know what I would have said?
I would have said, “Yes, I’m fine, thank you.”
I would have been just as likely to answer honestly to the KitKats in Coles that wellness-shame me whenever I go to the supermarket.
And not because I have a congenital British stiff upper lip, but because it was easier to admit the truth. That I was not fine.
Glennon Doyle was right, “People who need help sometimes look a lot like people who don’t need help.”
And COVID has made it even easier to hide behind a mask, physical and psychological. If this is all you can see, it is much harder to see the suffering underneath.
Demands deplete your reserves, making it harder for you to deal with the daily insults of the job, which, in turn, deplete your resources further. And so the slow burn continues…
As you become increasingly exhausted, you lose self-control, making it harder to protect yourself from the demands of your job. You become cynical and start complaining, pushing people away. Nobody wants to have lunch with Debbie or Davy Downer.
And as you become more and more overwhelmed and less and less effective, your self-esteem suffers because you have lost your identity as a doctor.
Exhaustion, cynicism, lack of efficacy – these are Maslach’s Pillars of Burnout.
But after every great burn, there is a space for growth. There is still time to repair.
And I know that repair has to be an active process—something done by and with me, not to me or for me.
And yes, the system is, in large part, to blame. But if I wait for the system to fix me, I will be waiting a long time. It’s time for me to take back a little bit of control.
As a perfectionist, it would be easy to get caught up in the details, write a checklist, and berate myself for not meditating, exercising, or pre-slicing all my vegetables for the week.
So I’d like to introduce you to something simpler, something kinder.
Let’s call it the ABC approach to repair.
It’s about regaining a sense of autonomy or agency, belonging, and connection.
And how am I going to do that? How are we going to do that?
We are going to show compassion – to ourselves and each other.
So, let’s talk about those three things.
First, let’s talk about autonomy and recognising what is not in your circle of control.
You have no control over the number of ambulances ramped outside your emergency department, You have no control over the glitches in the EMR. You have no control over the length of time a patient is waiting for an outpatient appointment. Wishing, hoping, and raging about these things do nothing.
Expecting those things to be perfect will never be a winning strategy.
Mole was right – “One of our greatest freedoms is how we react to things.”
We can choose to get angry and frustrated and complain about the system that is making life hard or we can choose to be kind and show a little self-compassion.
Just a tiny bit, just a smidgen, and you’ll realise that you cannot do everything.
Things started to get better when I realized that I could not do it all and took some time off work.
When I called in sick, they didn’t put an announcement on 3AW telling patients not to come into hospital. They still had accidents and emergencies and somehow got treated, even without me. Who knew?
The healthcare system will not collapse if you are not there. Sometimes, it is okay to be a widget.
What about belonging and connection
Your cynicism is often due to a state of social depletion. You’ve lost the ability to sense-check what you say and become disconnected from your patients, colleagues, and perhaps even the job itself.
But compassion for others grows one’s self-esteem. Like George Bailey in It’s a Wonderful Life, one can start to see one’s positive impact on one’s community and place in it.
But you can’t spend all your time performing random acts of kindness, helping people wherever you go.
The perfect me thinks I should say yes to every request for help, but the good enough me… knows that it is okay to be selfish.
And I’ve got science to back me up here.
If you spend your days sprinkling happiness indiscriminately like a hospital CEO sprinkling Tim-Tams on RU OK day. Nothing changes. You might get a little, but that little dopamine bump is just a distracting blip that soon settles back to the baseline, exhausting you in the process.
But if you chunk all of your good deeds together. Say you decide to help three people every Feelgood Friday. Then, that really is something, you feel as if you have really made a difference.
And what does that look like in practice? It means being present.
It means seeing someone – not as a problem to be solved or a diagnosis to be made – but as a human being.
We crave connection. We crave recognition.
Let’s try a little experiment. On a piece of paper, write down the names of three people you work with and see every day.
I’ll give you thirty seconds.
Okay, and now for the hard part. I want you to give yourself a gold star if one of them is the clerk who has to endure the hostile stares from the overcrowded waiting room. Give yourself a gold star if you put down the security guard who is spat at every Saturday night. Give yourself a gold star if you named the cleaner who wipes up the shit in the waiting room toilets.
What are their names? Who are they?
Because they are sons and daughters, parents and lovers, footballers and friends.
Do you see them, too?
Self-compassion improves our sense of agency, and Compassion for others drives belonging and connection. And agency, belonging, connection – they drive meaning.
Why do you do what you do? What is it that makes you jump out of bed in the morning? What have you done when you come home at night and say, “Wow, I had a great day?”
Because if you ask every healthcare worker why they went into their profession, they say the same thing. “Because they wanted to help people.”
But what does that really mean when the system does not make it easy? When you have to make five phone calls to get a patient admitted for a problem that they did not ask to have?
For me, it is about sitting down and listening, really listening to a patient or a colleague, seeing them and connecting, and not trying to fix everything. That is how I know I have had a great day.
Perhaps my burnout was inevitable… I will never be perfect.
Kristin Neff reminds us, “As humans, we are imperfect, and we make mistakes.” And that is okay.
Gaining back just a little bit of agency, belonging and connection allows us to say
I see you. You belong.
