The Battery Fallacy
When I deliver a training at a Med Staff Meeting, I always ask, "Raise your hand if you have ever said, 'My batteries are run down, I just need a recharge'. All the hands go up.
The batteries-run-down is the most common metaphor for burnout and it is TOTALLY INACCURATE.
The Battery Theory of physician energy management is a myth, a fallacy.
It is a blind spot.
It is a barrier to recognizing and preventing physician burnout.
Our work with over 40,000 doctors in the last 12 years has revealed a working model of physician energy that provides:
An accurate representation of energy balance in doctors
The energetic source of the symptoms of burnout
Burnout treatment and prevention mechanisms you can put into place today
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Physician Energy Physiology
Let's start by debunking the Battery Myth
I am walking along beating my little drum and my battery runs out.
What do I do? (the word starts with an "S")
Right, I STOP
So if your energy was like a battery, when you were sufficiently depleted, you would stop. Yes?
WHEN DID YOU EVER STOP????
When did you stop in residency?
When did you ask for a break, walk off the job or fail to show up in Med School, Residency or Fellowship? When?
When do you stop or take a sick day or slow down in any way when you are taking care of patients or on call? When?
This is your first clue that the Battery Metaphor is a FALLACY.
You Never Stop
You never have and you never will. After all, what would happen if you had stopped anywhere from your first day of Medical School to today?
Stopped - as in called in sick when you had a full clinic schedule because you were too tired.
Stopped - as in someone called you in on a consult and you took a nap in the call room instead.
Stopped - as in you canceled an O.R. case because you were too tired to do a good job.
What would have happened if you had stopped like that?
We never stop. It is part of the conditioning of our medical education and the second of healthcare's two prime directives, "Never Show Weakness".
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YOUR ENERGY BANK ACCOUNT
It's like the account that holds your money at the bank, only this one holds your LIFE FORCE.
It has a very simple structure:
A FULL Mark
an EMPTY Mark
a Positive Energy white section on top
a Negative Energy red section on the bottom
As a point of orientation, the Energizer Bunny® stops at the EMPTY line. He keels over and quits cold unless and until you change his batteries.
Why is it doctors never quit?
You were programmed to keep going even if your energy is BELOW ZERO.
For physicians, that red area on this bar chart is called Residency.
From an energy perspective, Residency education is the equivalent of Waterboarding.
During the course of your Residency and Fellowship(s) you will have multiple opportunities to show up when your energy is well below zero. It will feel like you have no choice but to keep going, no matter how exhausted, wounded and traumatized you are at the time.
If you stop or fail to show up ... you will be gone / disappeared / ghosted and you will fail. The little voice in your head will shower you with guilt, shame and "what if they find out". You will put those scrubs back on and head back in for another shift.
No one does this to Residents and Fellows on purpose. When asked, "why do you train residents like this?" the universal reply is, "Because that's the way [ ____________ ] "(you know how to fill in that blank) If you are not aware of the origins of residency education please research Halstead and Osler and the rest. It is a sordid origin story that carries forward to today. Here is an article to get you started: "How cocaine created the residency programs of today"
The end result is simple:
We are trained to ignore our energy levels
We are trained to ignore any urge towards self care as dangerous to our career and something we should never request
We are trained to never mention our own struggle because it could be interpreted as a sign of weakness
My description of the energy waterboarding of residency and fellowship is born of the old school, non work hour restricted experience of my generation of physicians who graduated into practice before 2004.
I am 64 and vividly remember a series of 120+ hour weeks on a Pediatric ICU rotation as an intern and dozens of 100+ hour weeks in my training. From an energy perspective that is waterboarding. I got off easy compared to other specialties in both depth of the red zone and the length of exposure to negative energy milieu. I saw surgery interns go through such abuse, I could only conclude their attendings were trying to kill them in karoshi by proxy. It was always justified by "you should have seen MY training program."
I am told things are different now. Work hour restrictions appear to be reasonably well enforced. Residents these days are different. You may have only had brief exposure to the red zone in your training.
NOTE: When you do burn out the best model for what is happening in your energy balance in your burnout is this energy account. This will be true regardless of when you graduated residency.
Remember: - the lifetime incidence of burnout in physicians is well over 100%. Everyone burns out in training or practice. Most doctors in their 60's have multiple burnout stories. Check this Energy Account model with your own experience right now. Does it appear accurate for you? (Please Leave a Comment Below)
Let's look at some Energy Chart examples.
As you look at the charts below I invite you to become aware of your energy levels over the last couple of weeks.
How are you doing?
Remember, your energy level is what it is and not a reflection on you as a person or your skill as a doctor.
Healthy Physician Energy Chart
Notice the line goes up and down, day to day depending on your stress levels (energy drain) at work and home and your ability to recharge. The trend line here is Horizontal and Positive.
"Walking the Line" Energy Chart
This doctor is walking the line between positive and negative energy levels. This is often experienced as frequent episodes of exhaustion requiring multiple days for only partial recovery.
This can become a stable pattern of smoldering burnout in some physicians.
Burnout Energy Chart
Energy drops into the red and stays there without recovery, despite the doctor's early awareness of their struggle.
The little voice will whisper in your ear, "I'm not sure how much longer I can keep going like this" and "what's the use?"
This can become a stable chronic pattern in some.
This pattern also places the doctor at significantly increased risk of depression, alcohol and drug addiction and suicide.
The most recent physician burnout study shows the percentage of of US doctors with an Energy Chart of "Walking the Line" or Burnout is 63%
Does the physician's energy level effect the quality of the patient care they provide?
If you compare the quality of your work when your energy is in the red, with the quality of your work when you are in the white ... can we measure a difference?
The physician burnout literature shows this to be an emphatic "YES".
For over 40 years, burnout studies have shown the most common symptom of burnout is "physical and emotional exhaustion".
Studies looking at burnout and physician performance show pervasive negative effects of burnout on the quality of a physicians practice and their life.
Burnout effects on patient care
Quality / Safety / Patient Satisfaction / Physician and Staff Engagement and Satisfaction
Medical Error Rates, Malpractice Risk, Physician and Staff Turnover
Burnout effects on physician quality of life
Depression, divorce, drug and alcohol addiction and suicide rates
Residency education programs physicians to ignore stress and energy levels and ignore their own physical and emotional health. This behavior is a natural extension of the two prime directives of healthcare:
The patient comes first.
Never show weakness.
The Battery Fallacy denies the truth of physician's showing up to work with negative energy levels - 63% of us, every day, in the most recent survey.
Burnout is Everywhere, All the Time and somehow we manage to never talk about it.
IN THE NEXT BLOG POST:
I will show you the 3 Energy Bank Accounts. That's right, there are 3 of these accounts.
Each one holds a different energy
Each is filled in a different way
A negative balance in each produces a different symptom of burnout
You can Choose to Change Your Practice for the Better and Actively Manage Your Energy Level
If you notice yourself in one of these charts and don't like what you see, there is a way up and out and into the positive side.
You can only walk this path by taking NEW ACTIONS.
Most often this is a series of baby steps towards your definition of your Ideal Practice. Here are two ways to get started:
Our 3-Layer Physician Support ECOSYSTEM
Training - Weekly Coaching - A Community of Like-Minded Physicians
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PLEASE LEAVE A COMMENT
Do these bar charts help you understand burnout and energy in a different way?
How are you doing with your energy these days?
Have you researched the origins of residency education before?
Does the history of residency shock you at all?