Healthcare Burnout

In Brene Brown’s most recent work, Atlas of the Heart, she fills me with wonder, excitement and passion. She navigates the complex feelings and human emotions by providing us a beautifully written roadmap in her genuine storytelling style. As a healthcare worker, working on the front lines of the pandemic in my family medicine office and hospital-based practice, we have experienced our share of emotional turmoil as we endure this pandemic over the last few years. I felt truly connected with this book and the way Brene dissects human emotions and feelings. I noticed many parallels to feelings I experience within myself at home and especially at work. I realize that much of this work speaks to healthcare workers who experience burnout – the continued leaking of resources or overwhelming depletion of resilience factors without proper time and ability to replace those assets.

Burnout can be defined as feeling of hopelessness and difficulties in dealing with work or in carrying out one’s job effectively (1). It has also been described as a work-related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment (3). “This circular process between resource pooling and stress resistance is well described in the Conservation of Resources Theory. In this theory, burnout is a continuous process caused by ongoing, usually low-level, resource depletion resulting from either actual loss of resources or the failure to acquire fresh resources after significant resource investment.”(4)

Why do we care if physicians burnout? Burnout leads to loss of job satisfaction, decreased productivity, increase health care utilization, depression, substance misuse, increased risk of suicide and motor vehicle accidents (5).

In Atlas of the Heart, Brene’s discussions around compassion fatigue were eye opening. According to Brene “compassion fatigue occurs when caregivers focus on their own personal distress reaction rather than on the experience of the person they are caring for”. YES. I realize that it isn’t about me or my feelings. It is about inserting myself into the feeling the other person is experiencing and keeping a soft boundary with their feelings. She reviews Theresa Wiseman’s Attributes of Empathy, and notes that you are not to insert yourself into the patient’s story, rather emulate that they are not alone in the feeling they are experiencing. In Dare to Lead, Brene Brown talks about not leaping into the hole of struggle with someone who is also struggling, as this just results in two people stuck in a hole with no way out. We all want connection, and we just need to emulate to another that they are not alone in their feelings.

My favourite components to preventing and reducing symptoms of burnout include the work I can do on myself. The realization that self-care cannot be compromised, pushed aside or skipped. That work without limitations and boundaries is a sure recipe for symptoms of compassion fatigue and burnout. That empathy requires boundaries (6). That self-awareness includes learning mindfulness techniques, being actively engaged in my wellbeing, setting limitations, prioritizing my self healing.

I would highly recommend if you are interested in doing the work in learning about your emotional connection to others and yourself, that you have a look at Brene Brown’s books Dare to Lead, and Atlas of the Heart.

Lorraine

References:

(1) Bhutani J, Bhutani S, Balhara YP, Kalra S. Compassion fatigue and burnout amongst clinicians: a medical exploratory study. Indian J Psychol Med. 2012;34(4):332-337. doi:10.4103/0253-7176.108206

(2) Brown, Brene (2021). Atlas of the Heart. New York, NY.

(3) Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual, 3rd ed. Palo Alto, CA: Consulting Psychologists Press, 1996

(4) Hobfoll SE. Conservation of resources. A new attempt at conceptualizing stress. Am Psychol. 1989;44:513–524. 

(5) West, CP, Dyrbye, LN, Shanafelt, TD. (Mayo Clinic, Rochester, MN; and Stanford University Medical Center, Stanford, CA, USA). Physician burnout: contributors, consequences and solutions (Review). J Intern Med 2018; 283: 516– 529.

(6) Brown, Brene. Dare to Lead.