I had passion. I was driven by it. It consumed me. It pushed me forward. I had to follow it. I had no choice. Now I am ready, almost eager, to let others take over. What has happened to me?
I am tired. Years of pushing burned the candle down. I can flicker up at times but it never seems sustained. I seem to do things because I am supposed to. At times I want to but then wish I could retreat. I dream of just being able to sleep. To know what it means to really rest. For once to not feel so tired.
I feel beaten down by the repeated tasks that consume me. Rounding is not about taking care of patients or making a difference. It is about how to get through the list. How can I finish and keep up? Another note to write. Another question to answer. Keeping my inbox empty. And there is always another. And then the emails just keep piling up. And then the things that I want to do seem to keep getting undone – length of stay, readmission, survival, appropriateness – it all seems to just stay the same. I feel guilty that I have not achieved more and wait for someone to point out my flaws. Why have I not achieved the best in outcomes? Why have I not pulled it all together?
I am numb. Because I don’t know any other way. How can I keep going when the losses keep piling up? In a field where 90% one year survival is considered good, that means that we are forced to endure losing 1 out 10 of our closest patients. I am supposed to be strong, right? These patients all meant a lot to me! Chris, John, Richard, Patrick. The list goes on and on and it never seems to stop. And just when I get my confidence back it happens again. Another punch to the gut and I just take it. Don’t let it show. Don’t let anyone know. Because how can I?
I do have a bad case of FOMO (Fear Of Missing Out). I have a deep fear that I will get to the end of my life and have someone come up to me and say, “Surprise! You were tricked. You missed out on life because you were so busy living it that you never felt it – never actually experienced it.” I dream of retirement as a time when maybe I will be able to slow down enough that I can see and hear and feel again. I worry a little bit because lately people have been asking me if I am going to retire soon. I am ashamed to tell them I am only 53 years old and so I have a ways to go. I also am afraid that I will be like others who finally get to retirement and then dream of the past. They look back to the days that they had purpose and things to do. I think I am a fool.
What can I do to be able to live today? Is it possible? Can I come and play with the other kids? Or do I have to stay inside and work all day? Am I going to get to go outside while it is still summer or will I get tricked and only finish my work in time for the cold dark winter?
ADDENDUM:
I wrote this prior to my cancer diagnosis and my medical leave of absence. It is raw and honest. I never intended to post it. I wrote it for me but now am going to bravely post it. I intentionally left it with some sense of hopelessness and no real answers because that is really what burnout does to us. In all honestly at that time I did get to go outside and play, but burnout makes it so you are not able to fully enjoy it. Your brain remains inside and hard at work even when you go through the motions of going outside to play.
Now with the perspective of several weeks off I see a few answers:
- Dogged Focus on Patient Care: We have to have the strength to be doggedly insistent on focusing on patient care. The pressure of charting in the EHR (Electronic Health Record) can drag us down and distract us. We need to have the EHR be the side item and still insist that the focus of our energy is on the patients. That is where the joy is. A less complete chart is a lesser sin then an incomplete care of the patient. (The EHR is breaking us. We MUST come up with better solutions. Perhaps the answer is scribes?)[1]
- Ring-Fence Your Personal Life: We must put a fence around our clinical or work activities. We have to have time to think, breathe and exist. When you are home, without shame, be home. When you are on a walk, look at the trees and the birds and don’t feel guilty about what is not yet done at work. The undone tasks will always be there whether you spoil your walk or not. Fight to protect work from creeping into the rest of your life.
- Put Down Your Phone: Turn your phone off or put it down if you are not on call. If you cannot do this, give it to your spouse or friend when you go out. Ask them to give it to you only if there is an urgent matter that you must attend to. Get in the habit of having your brain free of work. Get free of the addiction to the phone. It is hard for me to do this but I have to. I get twitchy at first without my phone in my hand. Eventually I get over my withdrawal symptoms and start to become human again!
- Go Away: Go to the national meetings. These always are inspiring and recharging.
- Read Novels: I call these “sorbet for the brain.” Like in an expensive meal where they serve sorbet to “cleanse the palate.” It helps to restore your ability to taste before the next course. Novels can have a remarkable ability to do this for your brain!
- Sabbaticals: I still think that physicians should have sabbaticals. A 4-week period to recharge could result in a re-energized far more effective physician. If only health systems could be wise enough to invest in their physicians in such a way.
- YOU TELL ME! What else? PLEASE RESPOND TO THIS POST! I really want to hear what you think works!
There is an epidemic going on. The ICD-10 is Z73.0 and the term is “burnout”. The vaccines are not very effective. The treatments are still rudimentary and need a lot more work. Like many papers I think I will need this one to conclude, more research is needed. We desperately need it…
[1]Interestingly the EHR issue is finally getting some attention. Please read this blog post for more information: https://www.healthit.gov/buzz-blog/health-it/strategy-on-reducing-regulatory-and-administrative-burden-relating-to-the-use-of-health-it-and-ehrs-released-for-public-comment
31 replies on “Burnout”
Although I am not a physician, I can relate to putting fences/boundaries around work. I also was consumed with working tons of hours so I could bring home enough money to “make sure my daughter had everything she needed/wanted” because I was a single parent (which if I could now change I would-being home more is what she needed at that time-not an absentee mom working all the time-money doesn’t buy time and it would of been better to be poorer but loved than how I did it-hindsight! She is 36 now and I am 59). Then I worked countless hours on call to support my lifestyle with my late husband who ended up passing away only after 6 years of marriage and I had worked so much we hardly had a life).
I stopped after that. On call was not important anymore. Weekends were needed to be off. I am remarried and I am trying to get the balance better. I still work two jobs but it doesn’t consume me and I always have weekends and holidays off. I refuse to work any other kind of job now. I need down time and I need my vacations and I need to connect with family and friends.
Health care is so hard to balance because it’s about people’s lives.
But it’s also about our lives too.
We have to ask God how to live. How do we give and how to we do self care. It’s tricky sometimes…,
I belong to a 12 step group for food addiction. And as I learn to surrender my life to God, I learn how to care for others and myself better.
Praying for you. Dr. Dickinson-all the revelation that God has for you and for complete healing. 😊
Although I am not a physician, I can relate to putting fences/boundaries around work. I also was consumed with working tons of hours so I could bring home enough money to “make sure my daughter had everything she needed/wanted” because I was a single parent (which if I could now change I would-being home more is what she needed at that time-not an absentee mom working all the time-money doesn’t buy time and it would of been better to be poorer but loved than how I did it-hindsight! She is 36 now and I am 59). Then I worked countless hours on call to support my lifestyle with my late husband who ended up passing away only after 6 years of marriage and I had worked so much we hardly had a life).
I stopped after that. On call was not important anymore. Weekends were needed to be off. I am remarried and I am trying to get the balance better. I still work two jobs but it doesn’t consume me and I always have weekends and holidays off. I refuse to work any other kind of job now. I need down time and I need my vacations and I need to connect with family and friends.
Health care is so hard to balance because it’s about people’s lives.
But it’s also about our lives too.
We have to ask God how to live. How do we give and how to we do self care. It’s tricky sometimes…,
I belong to a 12 step group for food addiction. And as I learn to surrender my life to God, I learn how to care for others and myself better.
Praying for you. Dr. Dickinson-all the revelation that God has for you and for complete healing. 😊
great thoughts Mike…we ALL get caught up in the distractions of life and get burned out. We need to LIVE the life that we are given and enjoy the moments we have here on earth. I pray for strength for you and your family. Praying that you can get the rest you need so that you can refocus on the things that are important….
To be bold enough to really live not just pretend to do so!
Mike thank you for these blog entries, so
much resonates with me. Fragile, fractured, flawed and Burned out.
I battle daily with decisions to care for patient , family or myself never feeling good enough at any attempts and then find myself guilty for not doing enough or enjoying what I have.
I am so sorry that you and your family are going through this. I pray for you and your family, for grace, peace and healing.
I thank you for saying what many feel but are to engrossed to articulate.
Thank you for being you ! I am hoping to be in Michigan for Christmas would love to see you and visit if at all possible.
Chris
Thanks. I hope that if we all talk about this stuff – even get angry at the pressures that push us to burnout – we can have the strength to resist! (And we would love to see you!)
Your description of burnout sounds like my depression. Normally I have tons of energy and can get so many things accomplished. But when depressed (Sept – half of Jan.) it is an entirely different story. And even though I now understand why I hit depression this time every year, it still doesn’t give me my energy or the will to accomplish things.
Thanks for sharing. Challenging topics but good that we work together on them.
Thank you… many thanks for courage it took to share this, Mike.
Your points are so wise.
I have such admiration for you… wishing you were not under the insurmountable stress of the EHR as a physician.
I appreciate your authenticity.
Thanks so much. We are all struggling to figure out how to put the focus on our patients and the face to face interactions we can have with them!
As a writer and poet, I must have my brain in fourth gear, to receive, interpret and produce.
I’m in burn out too. For the first time in my life, I’m failing and letting myself fail. Have serious breathing issues and an undiagnosed exhaustion.
So, I’m a fellow sufferer of burn out.
Unlike you , I had terrible asthma as a child and could not go out to play. Had to eat carrots instead of birthday cake at parties.
Then, slowly, I found that I was the only person who could really help me and there followed decades of my energy and spirit guiding me to teach, to write and to love.
After my husband rather tragically and unexpectedly died in 2000, along with grieving, I started writing a lot of poetry. I became very productive writing and publishing essays. And recently about two years ago: I’m paralysed, tired, breathless and frozen.
The only way out is in, I know. One has to make oneself glow to oneself so that the details of the world become precious again. Listen to music and move with it physically. Right now Dr Dickinson is your time to be free of work and full of you. Yes that.
It’s your make over time and taste everything now in all its uniqueness. I promise you that you’re a success, a loving person who allows people to trust you completely.
Think of those personal moments with people, like how you talked to me after Buck died.
You’re not to blame if someone goes. Please remember what you gave people emotionally.
My suggestion is that you keep a journal other than this blog in which you reexperience every day, tell yourself what matters in just the amount of detail you feel catches it.
We have to be our own number one self starters, and give and take all the love we can. And be willing to wait out the hard times, knowing we’re special folks who are loved and respected.
And some times simply
Are as Ray Charles sang “hard times.”
We’ll do it and I send trust in and friendship to you,
Linda Chown
Here Benjamin Franklin can be very helpful in his insistence that we make a point of encountering ourselves every day to find out what we accomplished big or small—what did we do with our lives today? Did we Change or achieve anything? If not, make a plan to take steps tomorrow. He’s a great model cuz he did so much.
Thanks
Mike,
The last two years has caused my family to reflect on trying to keep balance in life. Why? My brother-in-law. He rose in the business world to CFO of a large company, traveling the world, and making big decisions…and making big money. He went to work at 7am and came home at 9pm. For decades, he was an absent husband, an absent family member, an absent friend, but a wonderful father (the one thing he saved time and energy for). Almost two years ago, he lost his job. The company had a new Board, and he refused to do something he felt was unethical. All of a sudden, he wasn’t working. And about that time his nephew died unexpectedly–a nephew he adored as a youngster, but didn’t have time for during most of his life. It seemed that all of a sudden, he was a new person. He talks to us. He calls to see how I am doing and texts me every couple days! He became our social calendar–getting everyone in the family and extended family together. He has spent months helping his future son-in-law and his sister-in-law to start businesses. He helps our cousin with a family foundation. He sits reading his Bible and talks about the sermons at church. He is a new person — to the point that his brother called my sister one day and asked what was the matter with him. We figured out that for decades he worked so hard, he didn’t have physical or mental energy left over. He didn’t have mental energy to even have a decent conversation with any of us. Now, he is so completely different. I’ve known him since elementary school, and I said to my sister, “Hey, the old Barry is back!” It is such a stark difference that it makes us talk about it a lot — how do we guard against allowing this to happen? How can we keep a balance in life and still do a great job at our professions? How can we guard again burnout? And why? Why do we work so hard at our careers? … There are lots of answers to that. But what is the bottom line? I wonder.
Thanks for sharing. I was hoping that reading about someone else would give you some new thoughts.
Praying for your continued healing!
What an amazing story! Thanks so much for sharing it. It really makes me think!
Raw, real and respective. Thank you for sharing your reality which is essence is our reality, one way or another..if only we could grasp it, see it in clarity as God intends.
Exactly!
Excellent post! Scribes for the EMR need to happen- the burden of documentation is weighing everyone down! The boundaries around personal time is one I totally struggle with- know I need them but have trouble making it happen!
Purple Haze is history.
First, you are going to feel very tired with the treatment. That’s a given.
You’re ruminating over what makes a good life and questioning all the interferences to the exercise of your knowledge, your caring, your passion. As a professor, I saw that the administration did not pay attention to overloading my
Teaching life so that I felt emptied out sometimes, unable to muster the energy to give my best.
One thing I learned thru student evaluations was that when I had that magical “it,” they always knew it and their words would sometimes make me cry in wonder.
I have learned some since
my husband died to slow down and be on this planet, in its trees, its weather and to really be myself here.
(Purple haze was sometime Tom Petty through out one time in one of those Travelling Willburies classics. Later I learned it was a Jimmy Hendricks special so I imagine you might have been surprised to see a purple haze writing).
It’s way too late but I wanted to send some good energy after my microwave fire.
I want to learn to be there when I am there. (To be present.)
And an odd thing is that one is more completely there, I think, when one ego is out of the way. It’s a vital new kind of transparency.
Well, I just had a touch of mortality here when my microwave caught on fire. I looked at the flames and thought what if they get bigger, what’ll I do? Until I thought turn it off and unplug it. Now I’m in the cleaning of the stench. Life is a very delicate balance for us. And yes in one moment I called myself purple haze and I think it’s going to be harder to change it than to keep it.
This is Linda Chown who had a true burning/fire today and who does not know how to
Get rid of the name purple haze which I heard through Tom Petty.
Thanks for being so open and honest. As you can tell from the comments, this reasonates with non-physicians as well. I liked your reference to compartmentalizing work and home. When you are home- be home. In yoga we call it being present. I lost my eldest son in Jan and it was a stark lesson in what really matters in life. It is the people we love and who love us in return
Wow. Thanks so much for responding and being open. It is indeed the people. In everything it is the people. Even now, my eyes can mist over by the kindness and care that we have been shown. Your openness in sharing is a gift to me (us). Thanks!
Beautifully stated. I know the burnout turmoil well. It is an important, but difficult self-diagnosis to make, hopefully before you lose compassion and patience for your patients or your family. Finding balance is hard, as is trying to please everyone you try to make commitments to. As a physician, stress and burnout are hard to recognize and harder to admit. When I did, I learned how many others were struggling as well. Those friends, family, and sympathetic coworkers are invaluable in providing support and perspective. Sometimes, drastic changes are needed, but are rarely easy. Don’t underestimate the healing power of a consistent, full night sleep, having the time to relax with family, and taking some time for yourself. For me, focusing on this time away from the hospital made me a better doctor (at least I feel that way). I know you wrote this before your diagnosis, I am sure recent events have reinforced the importance of balance. My wife’s longstanding health issues did for me. The mixed blessing of illness . I wish you the best of luck with your cancer and long life beyond.
Thanks so much for your insights and kind words. I used to say I needed 5 hours of sleep. That was wrong. The hard thing is that you can destroy yourself and no one will stop you. You add the very good points of a full nights sleep and not feeling guilty about having a life outside of the hospital. And you are right. I have learned a lot since 10/1/18. I still feel like I have just started learning… Thanks!
I am continually looking for the right life/work balance. It is elusive. In addition to work demands, I find family, church and exercise demands also fill my time. If you find a medical center that does sabbaticals, please let us all know!!
I know of one private practice group that does them. They make a lot of sense in terms of career longevity. Even once every several years. Or even once!
I am not a physician and understand our worlds are vastly different, but I am fighting burnout from a Supervisor level. I feel like I don’t have the energy to do life after I leave work most of the time. so many projects, so many emails, so much to do it wakes me in the middle of the night and leaves me anxious. I am trying to make that fence around work but it is so hard with a 24/7, 365 department.
I hear you. I have heard this from a lot of people (not just physicians) since this post. We are all learning. The “ring-fence” is important. Letting yourself relax and enjoy and shut down is key. Having friends is really important. I am working on “Burnout, The Sequel” based on the helpful feedback I have received. I hope to post that in a few weeks. Thanks for joining me in the battle by being open and honest!