The following is my first guest post and it comes from Dr. Floriane Wu, an emergency physician, military veteran, and physician coach!
She runs her coaching practice at Coach Dr. Wu.
We are both members of a physician online entrepreneur group in which she had posted the following “10 Myths about Burnout.” I found value in her list asked her if I could incorporate them into a blog post, to which she assented.
Below are her 10 myths and her explanations about each. I’ve added notes and commentary in [bracketed italics]. And, of course, GIFs!
Enjoy!
[Before we dive in, I just wanted to define burnout so we’re all on the same page.
Burnout is a syndrome resulting from chronic workplace stress involving three realms: emotional exhaustion, depersonalization, and lack of sense of personal accomplishment.]
Myth #1: Burnout is abnormal
Burnout is actually a perfectly normal human response [my emphasis added] to chronic exposure to highly stressful abnormal life events.
[Dr. Wu astutely leads off with normalizing burnout. Too many physicians view burnout as a personal shortcoming, that they are not resilient enough or that they are somehow weak.
That’s in part because of the imposter syndrome rampant amongst physicians. But it’s also in part because of how employers and administrators frame their response to burnout putting the onus on the individual physician to spend time building their resilience.
Burnout is not hypo-resiliency. It is a normal response to a traumatic environment. Studies have shown that physicians are more resilient than the general populace and that up to 30% of the most resilient physicians still suffer from burnout.
Telling us to be more resilient is simply blaming the victim and an abdication of responsibility to fix the toxic environment (which employers control).]
Here, just do this resiliency module to combat your burnout. Oh, and it needs to be on your own time.
Myth #2: Burnout affects only selfish people
Burnout affects the compassionate people who care about other people’s suffering, yet may be sustaining unacknowledged mistreatment themselves, leading to compassion fatigue.
[The extreme commitment to others in the context of being overworked leads physicians to neglect their own needs.
One misconception is that burnout is an indulgence. Like it’s something you allow yourself to feel only if you want, no matter your work stresses. This is certainly not the case.
Sometimes burned-out physicians feel selfish and shameful for feeling the way that they do while being told that everything they’re doing is for the benefit of patients.
Furthermore, sometimes burned-out physicians seem self-interested as they become distant towards others due to their burnout. One of their manifestations of burnout is self-preservation, which can appear as selfishness.]
Myth #3: Burnout means being weak
Burnout affects the courageous, strong people who devote their lives to helping others, and in the process deplete themselves.
[As I mentioned under #1, burnout is not a function of hypo-resiliency or weakness. In fact, one defining feature of physicians is our strength—we train and practice under some of the most emotionally, intellectually, and physically demanding situations anyone faces. However, our tanks are only so big (like, fuel tanker big!) and we can only endure a toxic environment for so long.
Even the sturdiest architectural achievement given enough time will develop stress cracks or even crumble. Similarly, even the most resilient of people will succumb at a certain threshold given the constant (and arguably, ever-increasing) pressures.]
Myth #4: Burnout means I am not enough
Burnout actually indicates that you have probably been functioning at “more than enough” for quite some time now.
[Truth. Burnout amplifies imposterism. Physicians use it as proof that they weren’t “cut out” for doctoring. They think, “if I were good enough, then I wouldn’t be struggling right now.” This is simply not true.
A lot of this has to do with keeping up appearances: many a burned-out physician can maintain a veneer of having all their $#!^ together, even if they’re paddling furiously to keep their heads above water. Now couple this with the stigma of openly discussing burnout and individuals’ struggles (remember how administrators and employers focus on burnout being an individual problem?) and others who suffer in silence believe they are unique in their struggling.
They don’t see it as the pervasive, systemic issue that it is, and instead believe that they are the problem.]
Myth #5: Burnout is mental illness
Burnout is actually the result of the survival brain having to be switched ON most of the time. This chronic sympathetic overdrive adversely affects multiple organ systems, besides the brain.
[Many physicians believe that burnout and depression are synonymous, when they are are, in fact, not. There is a lot of overlap but they are distinct entities. Burnout can lead to mood disorders like anxiety and depression.
One reason the distinction between the two is important is because treatment for each differs; appropriately treating each requires a correct diagnosis.
Moreover, burnout is a syndrome with multiple effects on a person.]
Myth #6: Burnout is individual and the system did not cause it
Burnout is the result of chronic moral injuries sustained as basic human rights have been violated and held as bragging rights in our present medical culture.
[This article caused quite a stir in 2018 when it brought the idea of moral injury to the forefront of discussion about burnout in medicine (at least within my sphere).
The authors contend that burnout is a symptom of a broken healthcare system, and the actual issue, moral injury, is that the system does not allow physicians to provide healing and high-quality care.
Many of us, myself included, view these as one and the same—that they are two descriptors of the same thing. I prefer to encapsulate moral injury within the definition of burnout since there is already a movement to address burnout and the term is more widely recognized by physicians and the other involved parties.]
SchruteCare.
Myth #7: Burnout develops later in the medical career
The traumatic moral injury actually starts in medical school when we are trained to “dissociate” from our caring souls the moment we cut into a dead human body in gross anatomy lab. This is repeated over and over throughout the course of medical careers with ongoing patient sufferings, traumas, losses and deaths.
[It is critical to understand that the forces in medicine that cause burnout start at the very beginning of our training. They propagate from there as we advance from year to year in medical school, into residency and fellowship, and subsequent attendinghood.
This means that as we strive to revamp or reconstruct the US healthcare system, we must include medical training in our endeavors. Interventions must help trainees navigate their medical education in a healthier manner and empower them against the old guard who cling to the way things have always been done.
For example, the GME will have to actually hold residency programs accountable for duty hour violations. I think we can find a system where residents work enough hours to learn what they need to know to care for patients (instead of just staring at computer screens) while still being treated as real people.
As a physician coach, I would love for all med students and residents to have coaching throughout their training. Thankfully, there are some good peoples working on making this a reality!]
Myth #8: Burnout doesn't affect everyone
There is a spectrum in how much moral injury or trauma a person has experienced in their lifetime. All physicians are exposed to the causative conditions.
[I think there are elements of burnout that probably every physician experiences at some point in their careers. The question is whether or not it impacts their lives in any significant way.
As mentioned above, studies have shown that physicians are more resilient than the general populace and that up to 30% of the most resilient physicians still suffer from burnout.]
Myth #9: Burnout cannot be fixed
There are effective and simple techniques to rewire the brain and the nervous system to self-regulate and discharge the traumatic stresses. Neuroplasticity works.
[There are solutions for addressing burnout at multiple levels—individual, workplace/institutional, overarching medical culture.
Dr. Wu above references thought work involved with coaching that can help tremendously with burnout at the individual level. This is the story of most physician coaches and why we are so excited to bring coaching to our colleagues.
Please note again that this does not mean that burnout is a deficiency of any individual physician. However, it does mean that there are strategies to address burnout at the individual level. But this does not remove the impetus for addressing burnout at the other levels.]
Myth #10: Burnout means being broken
It may feel like that, but the truth is burnout is our body’s way to alarm us to make self-care a priority now! Oxygen to yourself first, then you can give it to others. It is actually an opportunity to live with all parts of self being realigned.
[See commentary on Myths 1 & 3. I love the airplane analogy here about placing your own oxygen mask on first prior to helping others with theirs. If physicians take care of themselves first, then from a place of strength they can best serve patients.
I’ll say it again because I’m sure many will disagree: in order to best serve patients, physicians need to prioritize themselves first.
If we’re not burning out and exiting medicine prematurely (hopefully by simply leaving, although physician suicide is its own epidemic), we can remain in the workforce longer practicing our craft and helping our patients. It’s that simple.]
Many thanks to Dr. Floriane Wu for sharing these 10 burnout myths with this blog! Again, you can find her at Coach Dr. Wu.
What do you think of these myths? Do any particularly resonate with you? Let me know in the comments below!
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