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Wednesday Sep 05, 2018

Letting Life Take You by Surprise Can Stave Off Burnout

Pause. Breathe. Assess. Engage. Let life take you by surprise.

[Kurt Bravata, M.D., and family]

Here I am enjoying a light moment with my family at a Missouri AFP event. Finding the right balance between work and home life is critical.

The first three words might make you think of meditation, but I am going in a different direction here. In relaxation, one seeks to disengage, but if you are a clinician, you likely feel uneasy with the idea of letting go of the reins and intentionally opening yourself up to the unexpected.

Physicians don't like to lose control, so we tend to meet life head on. Yet the life of a physician can be overwhelming. Sometimes this is because we commit to too many tasks, but mostly it's because the nature of the job pulls us in many directions at once. The pressure of feeling that we have to take responsibility for so much can lead us to neglect our own well-being, as the upcoming National Physician Suicide Awareness Day(www.cordem.org) on Sept. 17 reminds us.

I'm not immune to this drive to take on a great number of responsibilities.

As I write this, in fact, it's 7 a.m. on a Saturday morning, and I'm flying from Kansas City, Mo., to Albany, N.Y., for a cousin's wedding. I'm feeling sleep-deprived, and I've got a row to myself. If I wasn't such a workaholic, I'd probably be stretched out across the seats taking a nap.

I worked until 7 last night, as is typical for me, trying -- unsuccessfully -- to finish my medical documentation and addressing tasks from my day in the clinic. After that, I rushed home, had dinner while squeezing in 45 minutes with my family, who had already eaten (not unusual), then packed my bags and drove 2.5 hours to my airport hotel, where I stayed up until 2 a.m. working and getting organized for my morning flight. I managed a restless 2.5 hours of sleep and was up by 5 a.m. to catch a shuttle to the airport.

I actually enjoy being on an airplane. Like an office, it's a dedicated space of calm and serenity. There are minimal distractions, and I can work on what I want without interruption. I seem to thrive in such controlled environments.

That need to stay in control may be part of a physician's DNA. We all had to develop certain traits and habits that allow us to meet the demands of this life we chose. Although they improve our accuracy, I believe they can stifle the psychosocial characteristics that make for healthy interpersonal engagement. One can easily lose sight of what really matters -- the real people at the center of every encounter.

Fortunately, I think family physicians are the least likely to have this struggle because most of us enjoy the relationship-building that our specialty offers. Still, the demands of clinical life can threaten our ability and resolve to keep the human connection in focus. It becomes easier to stay in work mode, and we do that so well that it often spills into our personal lives.

When I decided to go to medical school, I promised myself and my family that I wouldn't let it change me. I determined that I would still be the same version of myself that everyone knew, and I would find a way to maintain a balance between work and relationships. This sounds naïve now, but how could I have known how utterly undoing and remaking the process of becoming a physician would be? Yes, other doctors had warned me, but I thought I would be the exception. Reality check! Medical school and residency are, by nature and necessity, transformational.

I first sensed this change in organic chemistry lab. My aching head throbbed with the persistent reminder that my mind was conforming to a new way of analyzing and processing information. I felt sequestered, both physically and mentally, by the dungeon-like lab and the dry, unforgiving subject matter that seemed detached from the warm, living bodies of patients who survive thanks to these unforgiving chemical equations.

Now, 15 years later, I still often feel like I am in that lab, analyzing cold, hard data, processing the information, predicting outcomes, and drawing conclusions on which I base life-altering decisions in rapid sequence for patients I sometimes barely know but who depend on me for their health. As a consequence, the life of a clinician gets distilled down to a series of controlled clinical encounters, and sometimes there is little room for personal reflection and building deep, meaningful relationships.

This way of thinking and interacting becomes so entrenched that it can take the first few days of a vacation just to disengage the cogs enough so we can re-engage with the nonclinical outside world. The chaotic and dynamic nature of the real world is such an unnerving contrast to our clinical lives that we want to clean up and organize the perceived mess of it all. If we act on this impulse, we may be surprised to learn that we are not the saviors we think we are, and not everyone and everything needs -- or wants -- our help.

I am not bemoaning the life of a physician. I love it more than ever. I feel incredibly fulfilled by my work and enjoy the challenges that come with it. At home, my wife and children are a great source of motivation and rejuvenation. I find new inspiration from involvement in my church, community and medical associations.

However, I know that not everyone is as fulfilled in their career or blessed with a revitalizing life outside of their work. No matter what job you have or lifestyle you lead, the laws of energy renewal and expenditure are inescapable. You can't expend energy you don't have, and trying to do so leads to burnout. This may be why physicians have the highest suicide rate of any profession in our country, more than double that of the general population.(www.medscape.com)

I recently read an insightful article on NBCNews.com titled "The Doctor Is Out?"(www.nbcnews.com) that highlights the unfortunate trend of students giving up the idea of becoming doctors and physicians quitting their practices in search of less stressful and more fulfilling lives.

Clearly, something is wrong. The need for good health care has never been greater, yet we are failing to keep up with demand. Yes, the number of midlevel providers is increasing, but they cannot replace well-trained, highly capable physicians who are practicing at the top of their skill sets.

The Council of Emergency Medicine Residency Directors has collaborated with a number of stakeholders to dedicate the third Monday in September as National Physician Suicide Awareness Day. The collaboration calls on individuals, residency programs, health care organizations and national groups to break down stigma, open communication, decrease the fear of consequences, reach out to colleagues, recognize warning signs and learn to approach colleagues who may be at risk.

The organizations emphasize that each physician lost is a devastating blow to everyone -- including family, friends and colleagues -- and that these deaths affect as many as 1 million patients per year.

The risk of burnout is becoming a common concern that's not out of the realm of possibility for any of us, so we must remain watchfully aware that for some who have lost all hope, suicide is a real and looming danger.

September is Suicide Prevention Awareness Month.(www.nami.org) If you are feeling overwhelmed and are struggling with thoughts of hopelessness, or if you or someone you know is dealing with suicidal ideation, please take advantage of the AAFP's suicide prevention resources. Don't hesitate to utilize the National Suicide Prevention Lifeline,(suicidepreventionlifeline.org) where confidential help and support are available 24/7 at (800) 273-8255.

Let's work together as a medical community to correct the course of health care. The challenges are daunting, and the job is never easy, but with the right tools and support, it is certainly possible to mold our clinical lives into ones that are manageable and fulfilling.

I am grateful to work for a hospital system with an administrative team that truly listens to physicians and works to meet our practice needs. I find that blogging and physician advocacy allow me to be a voice for other physicians while reinforcing my own motivational drivers for maintaining a sustainable lifelong career in health care. My encouragement to other clinicians facing a similar challenge in balancing work and everything else is that with a concerted effort, it can be done, and your family, community and patients will thank you for it.

To stay motivated, relevant and competitive, it is important for us clinicians to find ways to recharge our batteries and reinforce the things that drew us into health care in the first place. We must take advantage of the opportunities we have for physician advocacy and mental health, remembering that if we don't put our health first, we will ultimately fail our practices, our patients and our families.

So, pause. Breathe. Assess. And engage. Don't be afraid to let life take you by surprise.

Kurt Bravata, M.D., is a family physician who practices primary care, geriatric medicine and addiction recovery in rural southwest Missouri.

Posted at 10:24AM Sep 05, 2018 by Kurt Bravata, M.D.

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