Let's take a break: Burnout & Chronic stress

Introduction 

Let me get straight to the point- we doctors love to work. I do and it is almost like I get a high by working. Each patient, every successful intervention, makes us feel good about ourselves. It is quiet natural to feel good at your own success and in today’s world, driven by performance and high expectations from our work, being successful can be major booster in our self-esteem. 

Soon, our work takes precedence over other areas of our lives and everything else is put on the back burner. 

This is majorly reinforced by the medical education system in our country where a number of years in a doctor’s early career will be spent in studies, examinations, hospital duties, academics and so on. Remember, the post graduate training days? Being a resident means to be on duty 24*7, even though official duty hours are not supposed to extend beyond 8-12 hours.

However, a lot of us doctors are not able to find a balance even though our rigorous residency period gets over. 

Many of us have very few social connections outside our profession because obviously we had been busy in studies when our other school friends were getting married or roaming around the world and the only contact they make with us is when they need free consultations. We even become disengaged from our own families because we keep missing social engagements and soon many may forget inviting us completely. 

So, we become cocooned in our work shell. We work to feel good, we work to avoid feeling bad. Soon, we start identifying ourselves only with our work ‘I am Dr…..’ ‘I am a specialist’. We find purpose in our work and lost when we are not. 

This can reach a point when our work starts taking a toll on our health, both physical and mental. The work that we once found pleasurable starts getting stressful. We may deny the tell-tale signs (doctors try hard to convince themselves a lot) and say this is just a passing phase, but it does not, instead increases with each passing day till we reach a point when we begin to resent our work and this is what is called Burnout.

Definition of Burnout

WHO defines burnout as chronic work stress which has not been properly managed and is characterized by exhaustion, increased mental distance from one’s job or cynicism towards it and decreased professional efficiency.

I felt it and for months, I would get irritated even at thought of working and yet I could not dare to take a break. I needed to get a life outside my work and then I realized how I had ignored my mental health all along (despite being a psychiatrist, funny right!). And the most frightening aspect was not that I wasn’t aware of my exhaustion, I just could not stop myself from working. 

It was like you are speeding towards a cliff, you can see that there’s nothing beyond the edge, and despite that you cannot slow down, push the brakes and stop when it was needed. 

Then one day I had enough. I had exhausted all my energy and I decided to push the brakes even if it meant going against a lot of things- career, others expectations and opinions, my own insecurities and anxieties, because I could not put down my mental health any longer. 

Impact of Chronic Stress on our Health

Burnout or chronic stress can impact our physical health even more than we think- hypertension, diabetes, chronic aches and pains, insomnia, increased risk of heart attacks- have all been linked to chronic pernicious stressors.  

I realized that for many of us, it may not be possible to reduce the work stress but we can definitely change the way we perceive the stress.

How can we Cope?

This is where our mindfulness skills are very helpful. As I mentioned earlier, the more we identify ourselves with work, we become wrapped with certain thoughts about ourselves like ‘I am a top performer’ ‘I must not fail’ ‘I should be able to attend to every patient’ so we become the thoughts, instead of thoughts being just a part of us. 

Once we begin to notice our thoughts just as thoughts, instead of getting caught in them, we realize our self worth is not just determined by our work. 

For a starter, we can start maintaining a journal and start jotting down your thoughts to increase our awareness. We cannot solve anything until we know what the problem is.

We can begin making small changes in life like limiting work hours, taking small breaks between works and meeting people outside your work. 

It is okay if you take few hours or days off from your practice. However, a lot of time we are hesitant to take breaks because of the constant comparison and sense of competition amongst ourselves. 

We become consumed with worries if our colleague has few more patients or visits few more hospitals. Chronic worry can have similar effects as chronic stress. 

We focus so much on quantity that we forget its quality that really matters. Opening ourselves to our fears and anxieties can be liberating as we shift our attention from being the perfect doctor, trying to please our patients and ourselves (and putting extra pressure to live up to these expectations) to being more realistic and rational clinicians. We become okay if some patient outside our specialty walks in, and instead of trying to hold on that patient, we just guide them to the best possible options available.

I know it’s a long way to go and many may be resistant, even opposing these suggestions and that is alright. However, if embracing these small changes can improve both your work quality and your mental health, you are welcome to try.

Dr. Suhasini Das