Burnout and surgeons: We don’t like admitting it, but it’s real

Today will be my first “theme-based” blog.  Last Thursday I wrote about the challenges of ICU care and family conflict, and the implications that has for staff burnout on the ICU team.  Today?  I’m tackling that issue of burnout in surgeons.  It’s real, it’s prevalent, and it’s something we simply have to do better in both confessing and addressing.  For my readers, I am focusing on general surgeons today, recognizing that burnout does impact other surgical specialties and other medical specialties.  In the last 5 years enough literature has been generated on general surgeons alone that I wanted to focus on “my people,” as it were.

What I know about burnout from my personal experiences:

It’s awful.  I felt isolated, and I was certain that none of my colleagues could have ever possibly felt this physically and emotionally dreadful.  For me, it meant that a job that is truly a source of joy became a source of misery- I did not want to go in for the routine work, much less get called back in for anything.  I questioned anything and everything in my decision-making.  I talked myself out of my usual sources of stability (dinner with friends, running, yoga, reading fiction) because I foolishly thought that the martyrdom that might come with that deprivation would make things better.  I whined.  I self-medicated with food.  I contemplated who could take care of my cats if I moved to Alaska to be a river guide.  I was chronically pissed off, often short-tempered, and couldn’t understand why my life was so awful and how people would consciously sign up for this sort of misery.  If I had to summarize it in three emotions, I would go with exhaustion, shame, and fear.

What I know about burnout from observing colleagues and reading the literature:

Risk factors for burnout include being younger (which I believe is more a function of early-career, rather than chronologic age), having children, working more hours, being on call more, and working in an “eat what you kill” system.  Burnout increases medical and surgical errors, likely because we don’t have the cognitive bandwidth to use our best judgment.  Work-home conflicts heighten risk for burnout, and because in our society the burden of balancing work and home still falls disproportionately on women, this risk impacts female surgeons more than their male colleagues.  Oh, and residents aren’t immune.  I’ll confess that the worst burnout of my career was the last 6 months of my general surgery training when two colleagues were out on maternity leave and another was out interviewing for fellowships.  That business about work hours and being on call (and needing time off) is real, folks.  Trust me.

What we should be doing better:

The first step to addressing a problem is acknowledging it, right?  So, yes, we need to be honest about the fact that we do get burned out, and we need to admit it when we’re heading to that place or have arrived there (easier said than done in an ego-driven, indestructible lot like my colleagues).  As practicing surgeons, to care for ourselves and our future colleagues we need to model adaptive coping strategies and maintain a culture wherein surgeon well-being is encouraged.  We need to be honest with ourselves about how we’re  really doing, and if colleagues tell us we’re not doing so well, we should listen.  We should participate in fitness activities, find meaning in our work, and maintain a sense of gratitude (and therefore, by proxy, maintain a positive outlook).  Yes, that means that sometimes we need to flip the switch on being a surgeon and just be a mortal for a bit.

What has saved me:

  • Walks with my dog.  She finds so much joy in each moment that if I’m paying attention I can’t help but go along with her happiness.
  • Being creative.  For me this means writing (reasonably well) and painting and drawing (pretty poorly).
  • Yoga.  Do you know how hard it is to just SIT STILL and be with your body for 75 or 90 minutes?  It’s really hard!  It’s also really good for me because I can’t focus on anything else during that time.
  • My friends and family, and many of my coworkers.  They call me on it when I’m out of line.  They bring me chocolate when it’s a bad day.  They give me hugs when I need them most. They remind me that I’m doing good things and making a difference when I forget that I am.  In short, they love me when I feel like I least deserve it.
  • Being grateful for three things every single day.  Some days those things are pretty silly sounding because I’m struggling to find anything at all.  But, as Brené Brown reminds us, gratitude is at the core of joy.

What have your burnout experiences been, and how have you dealt with them?  More importantly, what keeps you from getting there?  Please share with me so I can learn, share with the other readers so they can get ideas.

I’ll close with a thank you.  This blog has been in existence for just shy of a month.  I am over 1000 views- and with lots of positive feedback- from you, my readers.  Thanks for reading, thanks for thinking, and thanks for being part of my journey.  I am grateful for you.