A Guide to Burnout for the Tough and Gritty.

Essay on the experience of burnout in medicine.

As a codirector of the Resiliency Center at the University of Utah, I spend a lot of time talking about the epidemic of burnout in health care. Recently, I had lunch with a group of first-year medical students just starting their medical career, and our conversation turned to burnout and the state of medicine. One of them asked me if I had ever been burned out in my career. After considering the question, and thinking over my experiences, I said that although I had tough experiences, I had never been burned out. Later that same day in another conversation, I remembered a distinct moment in residency. My hospital offered chair massage in one of the main corridors. In all of my years of training, I never stopped for a massage. I distinctly remember one time walking past and thinking how incongruous it was to see a person getting a massage in the hospital, in a place I equated with speed walking, hard questions, fatigue, and keeping emotion under wraps. Perhaps some part of me suspected that if I sat down for a massage, I might never make it back up again to see the next train wreck come up to the floor from the Emergency Department (ED).

Emotional Exhaustion is 1 of the 3 components of burnout.[1] Although if you had asked me if I was experiencing burnout, I would have said, “No, I am fine.” I think I can safely say my experience in that moment represents an example of emotional exhaustion. An example of the second component of burnout, depersonalization, also quickly comes to mind. During my training, one of the other programs was struggling with resident moral. Many of the residents felt the program director was part of the problem. Their response was to photoshop a picture of a squirrel onto the director’s body. The squirrel picture was everywhere, on the back of resident badges, pagers, very small versions on desks, team room boards. Residents, myself included, smiled and smirked as they found versions of the photo in new locations. By turning their program director into something other than human, they found a way to manage their hard work and difficult emotions.

The third component of burnout is a sense of reduced personal accomplishment. Finding stories of health-care professionals who feel their work is “wasting time” is not difficult. Everyone in health care has stories of times that, despite their best efforts, no progress seemed to be made whether that be the patient who kept bouncing back to the hospital, the person who committed suicide after you tried your best to treat their depression, or the error that inevitably happens if you practice medicine long enough.

These stories got me thinking that many others may have the idea that they are immune to burnout, that they are “fine” despite their experiences that make them high risk for persistent burnout or worse. Medicine attracts the tough and gritty, the resilient who can tolerate a high degree of stress and uncertainty. These skills make them successful, but they can also mean their downfall.

Feeling comfortable calling yourself “burned out” or not really isn’t relevant. What is important is self-awareness. The ability to recognize when you are starting to slide, when you’ve passed that invisible line toward a dark place. The ability to recognize what skills and people will help you chart a course through dark waters. I still don’t know if I would call myself “burned out” as a trainee, but I definitely had symptoms along the way. I am grateful that I now have the opportunity to help guide others toward well-being in their careers and beyond.[2]

Resources for more information about well-being in health care are numerous but several are highlighted in Table 1.

Table 1.

Well-Being in Health-Care Resources.

Organization	Website
National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience	https://nam.edu/initiatives/clinician-resilience-and-well-being/
American Medical Association	www.stepsforward.org
Accreditation Council for Graduate Medical Education	https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being