Your Burnout Isn't Your Fault, but You Should 'Own' It

Jillian Horton, MD, FRCPC

Disclosures

January 15, 2020

Two decades ago, during a low point in my residency, I was greeted by a banner in the hospital lobby that read "Resident Wellness Day." The entire event consisted of a plate of free muffins. I didn't need a muffin. I needed a psychiatrist. I needed sleep. I needed a reasonable limit on the number of hours I could work in a week. I was suffering, and my institution responded by…offering me a muffin. That gesture, along with so much other rhetoric and literature, left me with a clear message: It was my job to fix my burnout.

Ask any group of medical students, residents, or practicing physicians, "What are you doing to avoid or fix your own burnout?" and you'll probably find yourself in a heated conversation. The available research on physician burnout overwhelmingly suggests that organizational factors are the primary causes. Medical education exposes learners to situations that lack basic psychological safety, and many of us sustain significant emotional injuries as a result. So it's no wonder we get angry when people ask what steps we've taken to fix a problem they caused. It feels like someone throwing us into a fire and then asking what we're doing to avoid getting burned.

But our outrage at misplaced blame can prevent us from accepting and embracing those things that can actually help us. I'm not talking about tone-deaf offerings, like the occasional yoga class or a plate of muffins. Beyond these pitiful homeopathic wellness efforts, there are meaningful actions we can take to help ourselves. I know, because I have found some that have had a powerful impact on my life.

Mind Matters

The first thing we can do to help ourselves is learn to be more aware of our thinking patterns and associated emotions, and how we react to them. As medical students, we aren't typically taught helpful cognitive strategies to combat maladaptive thoughts because our teachers and leaders often don't have those skills themselves. If you think of these strategies in the way that you think of any other highly technical skill, it makes sense that you would need to seek out people with the specialized expertise to teach you.

Mindfulness is one pathway to developing these skills. I'm well aware that mindfulness is a "trigger" word for a lot of medical students, residents, and staff. They say that the practice feels like offering a life preserver to a person who is drowning. A common problem with mindfulness training is that many people's initial experiences are too brief, of poor quality, or not tailored to clinical environments. Perhaps our attitude toward mindfulness would be better if we called it "self-regulation and situational awareness training for high-cognitive- load environments in medicine," because that's really what it is.

Personally, I have trained in an evidence-based, JAMA-published, physician-created and physician-led program offered by the University of Rochester School of Medicine and Dentistry. This taught me how mindfulness, self-regulation, and greater self-awareness can be applied moment to moment in an actual clinical setting. These skills have offered me a way to deal with some of my most challenging emotions. As a result, the program has not only made me a happier and better doctor but also a better administrator. I can more readily withstand working from within those damnable, abusive systemic conditions to affect change for others.

To be clear, an administration that asks its employees or learners to engage with mindfulness has not absolved itself of having to address the root causes of burnout. However, asking learners and staff to take this step as part of a larger strategy acknowledges that individual actions and behavior are part of what create institutional culture. The Gold Foundation is one example of an organization that offers mindfulness training to medical schools.

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