“You’re being a little harsh right now, I did nothing wrong…” – The mother of my 3AM admission over a busy weekend in a short-staffed hospital with few empty beds on the West Coast.
I was caught off-guard, I paused and became silent.
I’m usually good at this, I thought… What just happened? What exactly did I just say? Was it my tone? My body language? My words? During a late night admission after a string of very busy nights in a month of almost no time off, I had unintentionally come across terse with an exhausted mother trying to jumble through the details of her daughter’s recent illness. I stepped away from the computer I was diligently taking notes on, sat down, turned to face her and apologized. I spoke slower, reflected in the moment and recognized that I had had a temporary undesired lapse in empathy.
I was burnt out, and I had been ignoring the signs.
Wellness and self care have become the centerpiece of medical education and practice in the last decade or two. As a profession, Physicians have some of the highest rates of suicide in the country, considered to be a direct result or association of the stressors and gravity of the work itself (as opposed to non-associated mental illness, although the two are not mutually exclusive). Dealing with heavy emotional subjects, pushy administration, feelings of ravenous stress, hours that serve to unhinge circadian rhythms, and the constant pressure to increase output without the tools to do so in a consumer-driven practice, it’s not really a surprise. While not my favorite subject to perseverate on, especially given the amount I choose to work and my self-admitted poor balance of life and work, I’ve written about burn-out before and even been part of a podcast called Sharp Conversations started by a woman personally affected by these unfortunate situations. The vortex of working in medical care culminates in a multifactorial cause of burn-out, and I’m not writing this to talk about that in particular, nor the ideal ways to avoid it.
But, what about when too much is too much? Then what?
A colleague of mine that I got to know closely over several months at one of my jobs, had gone through multiple life events in a short period of time and we had many lengthy conversations about burn-out. She was at a tough crossroads that would change her involvement with the group and for many good reasons decided to take a leave of absence. While hopefully avoidable with some maneuvers of jobs and life, many of us may inevitably feel burn-out – I do, often. “I am human before I am a doctor,” a phrase I repeat all of the time. If my emotional and mental health are fading, it is only a short amount of time until my objectivity, clinical acuity and empathy suffer. Sometimes as much as I want to continue helping out colleagues and jobs in need, taking on more to balance out a team, it comes at the expense of pushing myself beyond boundaries of exhaustion that have become wary with years of being immersed in a world of hard and endless work – maybe it’s the type A personality finally meeting its maker.
Thus, at a certain point one must realize that they themselves must come first. Especially as a doctor it is impossible to care for others unless you care for yourself. Many jobs are starting to point help towards burnout, and hopefully overtime as a society, at least in the United States, we find better ways to prevent or manage its occurrence. In the meantime, I am slowly learning to pay more attention to my own personal needs. Over time, I am learning to recognize and pull myself out of these situations if possible. Working locum tenens has given me the flexibility to control this element of my life, and perhaps this is why despite working so much, I have experienced less of these feelings than others. However, it is still difficult to tell someone that hasn’t quit much of anything in their lives that a break might be needed, but nobody is very good at looking at themselves from the outside in.