The Road to Burnout?

I’m experiencing a bit of writer’s block.  I’ve spent most of the past week thinking about what to write and decided that maybe if I just start writing I’ll think of something.

I’ve been following quite a few blogs and recently read a great post about a new mom, a physician, going back to work and she talked about Compassion Fatigue.

After a quick google search, I realized that I suffer from this at least once a month.  Sometimes I just can’t muster up the compassion a patient is seeking.  Sometimes I just don’t care.  Does that make me a bad doctor?  Sometimes, I think it does.

I have some patients who don’t cope.  With anything.  Traumatic childhoods lead to traumatic adolescence which inevitably lead to traumatic adulthood.  These patients learn to rely on others to fix their lives, most commonly their doctor.  Finding support for these individuals is difficult.  While they may present as depressed or anxious, or with chronic back pain, not only are they seeking the golden answer to solving their pain, they often come to the office expecting it.  As if they are somehow entitled to it.

  • “What do you mean I can’t get my physiotherapy covered?”
  • “How am I supposed to pay for that if I can’t work because my back pain is so bad?”
  • “Why can’t I see a psychiatrist once a week?”
  • “Why won’t you help me?”

I’m fairly lucky that I have only a few of these kinds of patients in my practice.  Yet, somehow I always seem to see them in the same week.  Is it the cycle of the moon?  I’m not sure, but I do know that at the end of such a week (this was last week), I am tired.  Mentally tired and emotionally drained.  I can see how dealing with these “chronics” can lead to a physician’s burnout.  I can see how it can lead to my burnout.

So how does one avoid burnout?  In particular, how does a physician avoid burnout when dealing with these kinds of patients?  A colleague of mine gave me some great advice a few years ago.  He told me something really simple.  “You can’t fix these people.  Don’t even try. Support them as much as you can, but don’t expect to save them.  You’re going to lose one or two and it’s not your fault.  Remember that and you’ll be fine.”

I’ll pose the question to my readers, physician or not …

What do you do to avoid burnout?


11 thoughts on “The Road to Burnout?

  1. To answer your rhetorical question about the cycle of the moon…YES. I was a veterinary nurse for many years and everything is worse once a month – the problems, emergencies (I worked in an emergency clinic and regular animal hospitals), the patient behavior and the owner’s behavior. Remember that it IS cyclical. It wasn’t this bad last week, last month, last year and it won’t be this bad next week, next month, next year. Someone will come your way to lift you out of your funk and the truth is he or she probably won’t do anything terribly amazing to do that – a patient you actually CAN help and who DOES take your advice or even a stranger with a kind word. It will stick with you and your whole attitude will change. Watch for it, wait for it and it will amaze you all the more.

  2. We have a culture where we have been told if we vote for the right person, buy the right pill, exist in the best country, we will be rewarded with infinite happiness. Some people realize the sales pitch, others buy it. Truth is your health and happiness are in your own hands and require hard work, maintenance and riding a bumpy road. I can only provide so much as a doctor, I can lead a horse to water… But I can’t garuantee he’ll win the Kentucky Derby!

  3. We have someone in our life that is like your patients above. Nothing is ever good enough, they always have things the hardest, etc. I know that for me I just have to remove myself in order to not get sucked in to things. I’m not sure what advice I can give as to you being their physician, but a good venting over some M&M’s with a girlfriend is never a bad idea 🙂

  4. I would love to know the answer to this question myself. I very much worry about burn out, and I haven’t even finished my fellowship. I think not trying to fix people, but support them, is a very good piece of advice. And leave work at work. As much as possible.

    • Thanks for the comment, Red Humor. I do find though, that the process of “supporting” patients often leads to even more mental exhaustion. I just don’t know how to find the right balance. I do try to leave work at work but it is hard. I always wonder if I could have done something more, you know?

  5. I just wrote a post about this topic, but if I had to choose one thing, it would definitely be to say no to a few obligations and learn to relax. I’m actually pretty stressed these past few weeks and having to remind myself to slow down to avoid burnout has been key.

  6. I am late to this party- I wrote the post on MiM to which you referred! I had a rough stretch there. I really believe that lack of sleep, and some extra responsibility piled on top of an already pretty burdensome job (primary care) makes me less compassionate. I’ve had a nice 4-day weekend, but I know that the time will come again where I won’t have the patience for my patients. And my mind will stary, thinking about that job at Uptodate or consulting or maybe even writing the great american novel…

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