Physicians On Purpose Podcast 003 What is Burnout

Posted by Dike Drummond MD

physicians on purpose podcast mark jaben md vision strategy tacticsPhysicians on Purpose Podcast 003
What Is "Physician Burnout"

  • The 3 Cardinal Signs of Physician Burnout
  • The words that Little Voice in your head will whisper to you when you are in the downward spiral.
  • Gender Differences in Burnout
  • How to reach out to a Colleague in Distress

You must be able to recognize the beast BEFORE you can smell his breath.

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Podcast Transcript:

Hello again, Dr. Dike Drummond here in the latest edition of the physicians on purpose podcast. In this podcast, we're going to talk about what is burnout?
• What are the three Cardinal symptoms of burnout?
• How are they different in men and women?
• What's the little voice in your head say when you're flirting with burnout?
• And last but not least, how do you reach out to a doctor in distress with a conversation, beginning a conversation to ask them how they're doing in a way that they might actually hear you and listen, and it might make a difference.

But before we get started, as always, let's step out of the whirlwind together. Being a doctor is like being in the middle of a little tiny hurricane of stuff coming your direction. Here's the way I typically drawn with me, please take a big deep breath. And as you exhale, let go of anything that doesn't need to be here right now. And pop yourself out of the whirlwind with me spend a few minutes outside the Whirlwind with me.

Let's talk a little bit about burnout. So You can recognize the beast before he's close enough that you can smell his breath.

Let's talk about what is burnout.

But if you want to know what burnout is, you have to recognize the name Christina Maslach. Ms. Maslach was an industrial psychologist in the 1970s. She and her research team worked with large employers in the Bay Area, San Francisco, studying employee engagement, and they did find employee engagement in these workplaces. But they also found its opposite burnout.

She wasn't the person to coin the term, but in her world burnout and engagement are on opposite ends of a continuum. If you were more engaged, you are less burned out. If you were more burned out, you were less engaged. And she and her team defined three Cardinal symptoms of burnout and they're actually fairly simple.

Symptom Number One is exhaustion, physical and emotional exhaustion.

Typically, the little voice in your head will say something to you, when you get to this level of low energy. It'll say something to you like, I'm not sure how much longer I can keep going like this.

Now, you may have heard friends say this, you may have said it to yourself, you may have heard it inside your own head. That's a warning sign of exhaustion. And actually, exhaustion is the most common of the three symptoms of burnout.

Symptom Number Two: is when you become cynical and sarcastic about the people you're supposed to be caring for. Another word for this is compassion, fatigue.

Sometimes, this symptom, cynical, sarcastic, venting is so common that people think it's normal. Like, I have to vent or I can't continue to see patients. And typically, in a venting culture, what's happening is everybody's burned out. There are services, wards and wings, where the burnout rate is extremely high up at 90%. And that's when you see venting being something that everybody has to do in the culture in order to keep seeing patients.

And some people also think that venting is potentially healthy. Here's what I'll tell you venting, I believe as a coach, as a physician coach, and I've worked with thousands of doctors who are burnt out and overstressed as a coach, as a trainer as a consultant. What I'll tell you is venting can actually be dangerous. And here's what I mean.

If when you vent about a patient, where you talk to somebody and you're and you're getting cynical and sarcastic about them, it feels good for a short period of time. But the next thing is going to happen is you're going to need to get back to work. You're going to walk back out on the ward or the wing of the service. And you're going to realize, somehow that wasn't right, because the next person you will be standing in front of is going to be another patient.

That's when you realize that you violated the first of Healthcare's two prime directives.

That Prime Directive, of course, is the one we all know the patient comes first.

The patient comes first, but we also know this deep down in our hearts. And I've asked audiences about this all over the world. Can the patient come first 22/7/365 and you have any hope of being a normal human being?

Well, the answer is obviously, no.

Now when you're with the patient, the patient comes first. But when you're not with the patient, it's important to have an off switch on that we're going to talk about that in future podcasts. an off switch on patient comes first when you go home so that you could recharge yourself and to the extent that you vent and you let off just enough steam just enough anger and frustration that that enables you to go back and keep doing the same thing over and over again. It actually It can keep you in Einstein's insanity trap.

It's one thing to be cynical and sarcastic and vent, but recognize it as a sign of burnout. And tell yourself, I need to change what I'm doing. Change your actions, you'll change your results. New actions give you new results, which is the escape hatch to Einstein's insanity trap.

So if you're listening and you found yourself being cynical and sarcastic lately, what could you change to lower your stress level?

Symptom Number Three: you begin to doubt that your work actually serves a purpose. “What’s the use.”

Another thing that can happen at this stage three is you might have a little voice in your head say something like, I'm worried if something doesn't change. I'm going to make a mistake and somebody's going to get hurt.

• Exhaustion
• Cynical and sarcastic
• What's the use?
Those are the three Cardinal symptoms of burnout.

And we now know from studies that were done just in the last 10 years, that there's a difference between the way men and women experience burnout.

Women usually experience those symptoms in that order. They get exhausted, they become cynical and sarcastic, and they wonder about the use and what they're doing the purpose in what they're doing.

Men tend to get cynical and sarcastic first, then become exhausted, and they tend not to experience the lack of efficacy. It's actually fairly simple to understand from a testosterone perspective. No matter how burned out a man gets he tends to never doubt the quality of his work. So those are the gender differences.

What happens when you're feeling exhausted, cynical/sarcastic, “What's the use” and your energy is in a downward spiral? I'll show you in future lessons that your energy is actually below zero, but you continue to see patients and continue to work full steam as much as possible.

What happens is the doctor goes into survival mode. And survival mode is when you go to bed at night praying that you're going to feel better tomorrow. But when you wake up in the morning, and you don't, you might have another little voice in your head that says something like, maybe if I'm lucky, I'll get hit by a car on the way to work today. And I won't have to see patients.

Now typically when I say that people will laugh, but even though that is, you know, morbidly funny, it's a huge, it's a huge red flag. So if you're hearing that voice in your head, or you hear that come out of one of your colleagues mouth, this is when you need to really, really pull your head up and think about taking a break and recharging yourself.

So you go into the office, obviously you don't get in a car wreck. You do have patients that you have to see and you act like a little train a little set of tracks when you get to the office. You put your head down and you churn through those patients as quickly and efficiently as possible hoping that there's no work-ins, no walk-ins, no complications, nobody barfs on your shoes, because you're just trying to get to the end of the day to drag your sorry butt home, go to bed praying it'll be better tomorrow and hoping that you wake up with more energy.

Okay, so cynical, sarcastic, what's the use, all of those different little voices, the head down, grind in and out survival mode. In your practice.

It's much easier for you to see this and other people than it is yourself. As a matter of fact, the individual doctor, you are the last person to see your own burnout. You may actually be so used to it, you don't recognize it, especially if there was a lot of stress in your training program coming through medical school and residency.

Let's talk a little bit about if you to notice that in a colleague or a friend, how might you reach out to them?

Well, we'll talk about this in future podcasts. But there's a second Prime Directive in healthcare for doctors. The first one we just said, the patient comes first. Everybody acknowledges that one that by itself is unhealthy. If we don't have an off switch when we're not with the patient, we'll talk about that again in future podcasts.

The second Prime Directive for doctors is never show weakness. coming up through our education, it's important that nobody ever think that our need to rest or use the restroom or eat or anything like that is a sign of weakness. So one of the things that happens when you reach out to a colleague who you believe might be burned out is they're not going to admit it right up front. If they think it could be perceived as a sign of weakness.

So one of the things you have to do when you're going to reach out to a colleague in distress is to let them know that you let them know this conversation is not meant to be held with two doctors talking to each other.

You have to take your doctor hat off. So put your hand on your head. Imagine you're taking a hat off in mind that you're taking a hat off and say I'm taking my doctor hat off now, actually put your hand on your head and act like you're taking that hat off. I'm taking my doctor hat off now.

And here's how the conversation might go. Hey, John, it's Dike. Do you have a minute?
JOHN says Sure. What's up?
And I say, Well, first of all, John, I'm taking my doctor hat off now and I've just taken my hand and mimed I'm taking a hat off of my head. I'm taking my doctor hat off now. This is just you and me heart to heart. I've been watching you and I'm concerned brother.

How are you doing?

Now, how is John going to respond to me immediately it's going to come out right away. He's gonna say, I'm fine. Right? I'm fine. Now my question to you is, is that him or is that his programming?

Almost certainly that's his programming.

However, you approaching him in this fashion has sent a signal, hasn't it? What signal have you sent John?

• I'm awake.
• I noticed and I'm concerned.
• Whenever you want to reach out and have talk about this, I'm a safe place for that conversation.

And don't, don't push John right here, especially if it's your first time reaching out to him, especially if you aren't especially close friends at this point in time. But as long as you continue to be concerned about him, please reach out to him at regular intervals don't stalk him.

About every other week or so. Reach out again, John. I'm taking my doctor head off again. I'm still concerned. How you doing brother? And you may do this every other week for a year. However, what you've done is repeatedly send the signal that I'm awake, I'm noticing I care and I'm a safe place for that conversation.

That outreach could save his life.

And if you have someone that you know right now that you're concerned about, please take your doctor hat off and reach out to them.

So there you go.
The three prime symptoms of burnout,
physical and emotional exhaustion,
cynical and sarcastic compassion, fatigue,
what's the use my works not serving the purpose here?

gender differences women tend to experience them and then order exhausted, cynical, sarcastic. What's the use.
Men tend to be cynical and sarcastic than exhausted and tend not to doubt the quality of their work?

How do you reach out to a colleague in distress?
I'm taking my doctor hat off now. I'm concerned about you. How are you doing? and expect it Intense denial. That is their programming. They really can't do anything other than that the first couple of times he asked.

So there you go, Dike Drummond, at the home of the happy MD and beautiful Seattle, Washington.

I'll see you on the next Physicians On Purpose Podcast.



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