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

Jillian Horton, MD, FRCPC

Disclosures

January 15, 2020

After working on awareness of our thinking patterns, a second step is to build self-valuation. Mickey Trockel, MD, PhD, describes self-valuation as the "prioritization of personal wellbeing coupled with growth mindset perspective towards personal imperfection." Trockel has found that physicians who score higher on measures of self-valuation have a lower risk for burnout. Tough self-talk is an example of a dysfunctional habit that gets trained into medical students. Learning to see and speak to ourselves with the same constructive empathy and growth mindset that we would offer a close friend is an example of a way we can increase self-valuation.

One concrete strategy to develop this skill is describing difficult events and feelings in the third person. For example, instead of a self-critique of your own performance, you might say to yourself in the third person, "Sarah managed a very tough case just now. She's never dealt with a patient like this before, and she will know how to do it better the next time." This technique can be helpful for managing emotions that can quickly become maladaptive, such as shame, guilt, and feelings of being an imposter. Try using this strategy with classmates and friends when they are stuck in a loop of berating themselves, and ask them to take note of how they feel before and after.

Again, this is not a validation of the theory that we are somehow to blame for our own burnout. It is a practical strategy for building a capacity that has been shown to be protective, and one that can offer benefit in any clinical environment.

Body Matters, Too

Although practices designed to strengthen the mind are critical, taking care of our bodies is just as important. I continue to work on aggressively seeking and following health advice that pertains specifically to physicians. In essence, I try to conceptualize my body as a complex, specialized medical machine. As Trockel has said, it is the most important "instrument of practice."

Maryam Hamidi, PhD, has published extensive information on nutrition that is specific to physicians. One of her research papers demonstrates the optimal time to avoid eating during night shifts in order mitigate sleep-related impairment. Other research correlates dehydration with mild cognitive impairment.

Familiarizing ourselves with such literature makes it much harder for us to embrace cultural norms that encourage us to neglect our basic needs. Again, the system is the largest culprit, and I'm fully aware that autonomy in medical school and residency is often very limited. However, when I was a learner, my own early impulses to ignore physical needs also arose from my personal attitudes and beliefs around self-care. This is yet one more example of how developing insight into my thinking patterns allowed me to take care of myself in a way that has affected my quality of life and the care I provide to my patients. Small changes are additive, and we can benefit from them whether we work in a toxic or healthy environment.

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