The saying goes that when you face a tough situation, you can either change your attitude or change the situation (or some of both).

There's a lot of truth to this. Because you're often far more in control of yourself than you are of the situation around you, you're better off starting with yourself. Regaining your emotional stability and your composure can be the only possible and long-lasting route to equanimity when you're under tension or strain.

Many factors can cause physicians to emotionally withdraw from their work. They may have had a string of cases in which patients didn't respond to treatment, or they may have encountered problems in their work life and private life at the same time. They may be being sued for malpractice, or a patient might have died under their care.

When these crises happen, some doctors have an easier time recovering than others. Physicians who dealt with major calamities earlier in life—such as an earthquake, hurricane, or even combat—may be more resilient and less at risk for burnout.

For example, foreign medical graduates frequently come from countries torn by war, natural disaster, or economic crisis. Having to face those daily challenges certainly helps create resilience. Even physicians who grew up in a US suburb may have had to develop resilience through different challenges.

A series of bad experiences or simultaneous crises can push a doctor into burnout. When this happens, it's essential to get right back in the saddle.

Once on my oncology unit, when one of our residents did not properly secure a jugular line in a patient with advanced cancer, the patient inadvertently pulled her line out and she bled to death. Needless to say, the resident was beside himself with remorse and guilt.

The teaching physicians in the program, including me, understood the consequence of this mistake, but we also felt the resident's pain and we didn't want him to lose confidence in himself.

We wanted him to know that as doctors, we are constantly dealing with life and death and we are bound to face accidents or medical errors. So the very next day, the resident's mentor coached him about the emotional side of the case and had him place a jugular line for another patient who needed it. That helped the resident recover his self-confidence and heal emotionally.

Although physicians may often feel that they have no control over causes of burnout, in many cases they do have some control.

In oncology, for instance, burnout may come from having to deliver bad news to patients who have unrealistic expectations about their ability to recover. These expectations may have resulted from not adequately discussing the prognosis with them. So when the patient's condition deteriorates and death is around the corner, the patient is unprepared and can be extremely traumatized.

Oncologists can avert this by having a very honest dialogue starting on day 1 of treatment. Setting realistic expectations prepares the patient for the inevitable, and the physician becomes a kind of life coach for the patient. The patient and physician are on the same page, the patient is not badly surprised, and the doctor does not feel burned out.

Some physicians consciously apply psychological techniques that help them deal with stress. For example, Neelum Aggarwal, MD, a neurologist at Rush University Medical Center in Chicago, is an advocate of yoga and meditation.

"The one cause of burnout you truly have control over is yourself," she said. ^[1] This approach involves "modulating your breathing, focusing on the present, and tuning out personal issues," she says. "The breathing exercises lower your blood pressure, which has a calming effect."

Other physicians use a form of meditation called "mindfulness" to deal with stress. Mindfulness is about being fully involved in the present, which is a way of separating work life from private life. When you're at work, you're not supposed to think about problems at home, and when you're at home, you're supposed to not think about work problems.

"Mindfulness is not about living life in slow motion," according to Rasmus Hougaard and Jacqueline Carter, who conduct mindfulness workshops for major corporations. ^[2] "It's about enhancing focus and awareness both in work and in life."

Hougaard and Carter recommend becoming mindful as soon as you wake up. "Spend two minutes in your bed simply noticing your breath," they recommend. "As thoughts about the day pop into your mind, let them go and return to your breath."

Then, when you get to the office, "take 10 minutes at your desk or in your car to boost your brain," they say. "Close your eyes, relax, and sit upright."

After lunch, they recommend setting a timer to ring every hour. At that point, cease activity and do 1 minute of mindfulness practice. Finally, on the commute home, turn off your phone and radio, and simply be for about 10 minutes, Hougaard and Carter say.

Plenty of data show that mindfulness works. For example, a 2009 study found that physicians taking an 8-week course followed by 10 months of maintenance showed improvements in mindfulness, burnout, and empathy. ^[3] Even shorter mindfulness courses have been linked to lower burnout scores for primary care physicians. ^[4]

Is mindfulness something you should try? By all means, go ahead. However, I personally do not know one physician who practices mindfulness. This suggests that most physicians will be looking for other techniques to prevent burnout.

Another attitudinal change is to look for ways to rekindle enthusiasm for your work. This involves regaining your sense of purpose and appreciating that you are making an important difference in peoples' lives.

Internist Christine Sinsky, MD, vice president for professional satisfaction at the American Medical Association, says that physicians should celebrate their successes rather than be dragged down by occasional failures.

"Periodically step back and ask what was really good about today. What's the reason I came to work today?" Dr Sinsky advised a gathering of members of the Michigan State Medical Society. ^[5]

At Dr Sinsky's practice in Dubuque, Iowa, "we share with one another something that felt good or [was] especially well done," she says, "and we celebrate that on a regular basis by institutionalizing the celebration in team meetings."

The age-old tradition of physicians dedicating themselves to their patients has been evolving into a more realistic work ethic, in which physicians consider their own needs without feeling guilt. Always putting the patient first has been a medical imperative for many generations, but it is now under reexamination.

"Doctors are programmed that 'the patient comes first' and to 'never show weakness,'" observes family physician Dike Drummond, MD, a physician coach and author of Stop Physician Burnout: What to Do When Working Harder Isn't Working. "No one shows you the 'off' switch," he says. ^[1]

In 2016, the Congress of Delegates of the American Association of Family Physicians (AAFP) removed a clause in the AAFP oath stating that physicians should put care for the patient "above all else." An AAFP delegate at the meeting told Medscape that his efforts to always put patients first led to burnout so severe that he had to take a 6-month leave of absence to recover. ^[6]

This change, however, is still not totally accepted in the medical community—especially if doctors are cutting back on call or missing productivity requirements. These physicians may be considered selfish, spoiled, or not team-oriented.