Burnout and Burnt Breakfast: A Clinician and Educator’s Perspective

Abstract

It is clear that burnout is on the rise among physicians. ¹ And while there are articles detailing areas that could be addressed, ² change takes time, and progress on a large scale is slow. While we watch the system evolve, we have to take accountability for our own personal well-being. We cannot sit around and wait for the whole industry to change when we can have control over our own circumstances. I sat down to analyze my own stressors and think about their impact on my work–life balance. Stress will continue to exist and evolve, but we can grow from it and shift from negativity to positivity to continue improving our own well-being. As an educator, this is particularly important in ensuring the well-being of future generations.

“...Stress will work its way into almost every situation, but there are ways to mitigate it and avoid burnout to improve personal well-being...”

I would argue that most healthcare workers are highly driven individuals who will stop at nothing to achieve the best possible outcome for their patients, even at great personal cost. Demands on healthcare workers are rising ³ and have been for some time. Simultaneously, stress levels not only across society but specifically in healthcare are on the rise as well, greatly exacerbated by the COVID-19 pandemic.^4-7 This should come as no surprise since there is a critical national shortage of healthcare workers and frequent turnover in certain positions. ⁸ The term burnout has gained a lot of traction in recent years, and has specifically been highlighted as on the rise among healthcare workers. ⁹ I have noticed colleagues across various disciplines and geographic locations announcing a change in employment, hearing statements such as “I just can’t take it anymore” and began to reflect on my own experience. Undoubtedly, life brings all kinds of twists and turns, and there are certain parameters over which we have less control, but I began to wonder if I was also experiencing higher stress levels and how that was affecting me, and thinking about which parameters, if any, were in my control.

I noticed that I was waking up earlier, more often with my mind racing, and that I was rushing through parts of my day that I normally like to enjoy, such as uninterrupted time to enjoy my morning coffee. I recognized that I had been shortchanging these acts, which I had subconsciously told myself were self-indulgent, so that I could justify foregoing them in order to prioritize other items on my to-do list. At my own expense, I was sacrificing activities that supported my own well-being to accomplish other tasks. In some instances, I would tell myself that providing help to a patient in need of help that I could provide was ultimately the most fulfilling outcome for me so that I could rationalize the personal cost or sacrifice. I missed dinners with family and catch-up calls with friends, the list goes on.

Many healthcare workers are goal-oriented people who develop a framework for what steps need to be taken to achieve the end goal, and we can become very rigid in how we see that play out. There is a reason we ascribe to so many formulas and keep such a structured way to care for patients; often times, these are tried and true methods and knowing you can navigate yourself through a systematic approach is easier than reinventing the wheel. It is often also safer. We follow a systematic approach through CPR because those methods are tested rigorously, and the order in which we pursue those steps can literally be the difference between life and death.

But why, then, am I so hard on myself? Why can’t I appreciate the good things I have done? Why doesn’t it matter that I accomplished the task but not in the way I wanted to? Why do I take personal responsibility for a “failure” even when it’s not a failure but simply the way things unfolded? Am I the only one feeling this way?

I struggled for a long time internally about these questions and tried to work through these feelings. I would almost describe how I felt as inadequate, frequently falling short of my goals. What I failed to realize was that I was getting in my own way. I was making a difference for patients and loved ones, and in most cases, a positive, helpful difference. I was accomplishing nearly all the tasks I set out to accomplish, both professionally and personally. But I could not recognize success in achieving these outcomes, and instead repeatedly felt as though I was somehow failing my patients, my colleagues, my friends and family, and most importantly myself. How could I even recognize the positives if I felt so drained, so exhausted, so completely spent?

I attended a conference just before the COVID-19 pandemic hit. At that time, I attended a talk where the speaker presented the PAVING the Path to Wellness wheel.^10,11 In that one-hour session, there was not nearly enough time to self-analyze, but it was an eye-opening exercise which I would later come to utilize often in my own reflections. I filled out the PAVING wheel on that day and revisited it a few months later when talking about wellness and self-care with some peers. When I compared my 2 wheels even just months apart it was striking to see how the pandemic had affected me in ways that I could tangibly look at and visualize. Without a doubt, the COVID-19 pandemic has affected every member of society but just seeing my own transformation by use of that chart was very informative. For example, while social connections and variety went up due to the nature of more online/video hangouts and more experimentation with hobbies I had time to try out on my own, sleep and stress management went down in the setting of a higher workload and work-related anxiety.

A year later, I attended a leadership retreat where we discussed burnout and resiliency. At the end, participants were invited to partake in one-on-one wellness coaching sessions. I had been thinking a lot about my stress levels, my resiliency, and my own happiness both in and out of the workplace, and I figured why not give it a shot.

My coach asked me to identify what I perceived as my biggest weakness in my work life. I shared that sometimes I am exceedingly determined to reach a goal with regard to patient care and will often not take no for an answer, and because of the high expectations I set for myself, I am frequently disappointed or let down. She posed the question back, could I not see that what I felt was my greatest weakness might also be my best attribute for a patient in need of the care I could provide? That while I am obstinate and adamant that a particular goal must be reached no matter how, ultimately that end goal is for the good of someone else. And maybe I could work just as hard for my patient and the desired outcome but not at such a great personal cost.

I told her on occasion I would find it difficult to take a break for a snack or lunch, or that finding time to stretch my legs seemed impossible, and that the sense of needing to accomplish a task is often of utmost importance. She taught me that breaks for physical and mental well-being are essential. With quick breaks here and there, I could still accomplish all of the tasks I needed to accomplish while doing so in a happier, healthier, and more relaxed way. Without pausing, all of the stress and strain would just continue compound and intensify. These sacrifices I had been making unknowingly creeped up on me, taking physical and emotional tolls in ways that I had not been able to articulate. What she explained was that at the end of the day, my patients could have the same outcomes if not better ones, and I could feel more at ease along the way by learning some strategies to temper my stress levels. I began to incorporate mindfulness and deliberate thinking into the way I structured my days. This was not easy, as my habit has been to focus on the task at hand and how to be more efficient while neglecting my own needs. I think we subconsciously drill this into ourselves throughout our medical training. It seems to be part of the culture for high achievers.

After a little while, it became easier and more fluid to incorporate small changes. I could appreciate a true difference in how I had more control over the day’s outcome and how I felt. A few months later, I happened to rotate onto a teaching service where I had the opportunity to work with medical residents and students. On one afternoon, I decided to share the PAVING wheel^10,11 with them for our teaching activity. The feedback was that it was a breath of fresh air to fill out the wheel and also a nice way to positively reflect upon one’s strengths and one’s areas that could benefit from improvement. Not weaknesses per se, just not top strengths. One of the residents scored a bit lower in physical activity and social connections. She was able to articulate that focusing more on social connections would lead to a greater benefit for her than focusing on exercise. The activity allowed for each person to identify not only their strong points but also determine where to focus their energy. Perhaps eating one more vegetable per day is not as important as sleeping for an extra 20 minutes.

As much as didactics are a critical part of the curriculum throughout our education, no amount of textbook learning is going to matter if you cannot keep calm and focused while taking care of yourself. Along the way, there will be plenty of opportunities to drill Light’s criteria for pleural effusions or atypical organisms for endocarditis. But learning about wellness is just as important as learning about hyponatremia. Wellness is the backbone of our own well-being, and we need to make time to consciously work on it. ¹²

On the day I sat down to write this piece, I more or less did whatever I could do to delay having to sit down and actually gather my thoughts. I do not consider myself an expert in many fields but in procrastination, I am capable of excellence. I have now come to appreciate this as a strength in that while I may find the time to defer certain tasks, I can enjoy myself along the way and appreciate that I feel more at ease when I allow myself to take a break. Nonetheless, before I sat down to write, I decided to make an elaborate breakfast. Again, my subconscious wanted me to do literally anything but for the task at hand. Thank you, subconscious.

I am a bit embarrassed to say that not only did I burn my breakfast so badly that it was inedible, I also set off the fire alarm. After clearing out the smoke and getting the alarm to turn off, and regrettably throwing away my pile of charred remnants, I shrugged off the situation and went on to eat what was salvageable. Prior to the last year or 2, I am almost positive that I would have been incredibly frustrated with myself and by the state of my burnt breakfast. And I would have likely given up on it altogether and grumpily found some other form of sustenance. But now, my mindset is different, and I was pleasantly surprised by how I was able to move along with the day. It is an example of how something so innocuous and simple has the potential to set the tone for the day. We have all heard the expression about waking up on the wrong side of the bed. By shifting one’s mindset to realize that sometimes things are out of your control, or even if they are in your control, they may not line up perfectly, you can still get to the end point regardless of the journey you take. Practicing positive self-talk and appreciating yourself for what you do accomplish rather than being negative for what you did not accomplish or the way in which you reached the end point helps reduce stress and negativity.

There is an abundance of data on burnout and physician well-being. It is clear that our workload continues to increase and that we are reporting worsening symptoms of burnout without a clear, sustainable solution to address this problem. ² The system has to change, and while I am cautiously optimistic that it will slowly evolve for the better, we have to nurture ourselves too. A quick internet search will pop up with hundreds of articles about healthcare worker burnout, physician stress, COVID-19-related challenges, etc. But no one single person can lead the entire system, which is complex and convoluted with a lot of factors out of our individual control, to address the multitude of elements that contribute to burnout. And while change is vital in this domain, we can start with ourselves and our own actions. Developing our own resilience and self-care are critical at this stage. ¹²

I am not perfect, nor am I the version of myself I envisioned, but I have to strive to be better while accepting and appreciating who I am and what I have accomplished, and what I will continue to accomplish. Taking the time to feel gratitude for one’s circumstances, as imperfect as things may seem, is an important exercise in self-care and well-being. I have to remind myself, almost on a daily basis, to take a step back and embrace the way things are. Stress will work its way into almost every situation, but we can find ways to mitigate it. In my role as a teacher, I have to continue to self-reflect and be aware of burnout so that I can continue to educate others. What works for me may not necessarily work for you, but I encourage you to find your own silver linings next time you burn your breakfast.