It is a truth universally acknowledged, that a single doctor in possession of a good job, must not be in want of a life. I have adapted Jane Austen’s famous opening line to highlight how we are all potential victims of our own and other’s pride and prejudices.1 Assumptions based on appearances really can be dramatically different from the reality.
You’ve made it! After all those years of study and toil you’re a GP – working in a practice, doing sessional work, out of hours or in the midst of GP training – what more could you want? Doctors continue to be held in high regard and are seen as the most trustworthy of professionals.2
On the surface others whom you work with and patients may think you’re doing ok, that you’re coping (well perhaps not so well when you’re on call), that you’re competent and compassionate. You really are worthy of the respect and status our society bestows on you! So why do you think you, or a colleague, might be burning out? Why are you reading this article? Could it be possible that you realise that you may be at risk of, or in fact are already suffering from burnout, or worse you may feel that you are already burned out beyond any hope or help?
As a 46-year-old GP of nearly 24 years who has come through a number of episodes of varying degrees of burnout. I have found ways to reinvigorate my career and to help others.
This article suggests five steps to tackle burnout. I share them in the hope that if you need it you can find some hope – for you or your colleagues. It was Jean Kerr who said, ‘Hope is the feeling you have that the feeling you have isn’t permanent’.3
1 Take stock – am I in denial?
‘It keeps changing.’
‘It’s no fun.’
‘It makes me ill.’
Are you bored, desperate for more variety or control of your work and workload, counting the days to retirement or looking to do less GP sessions or even change your career or considering emigrating? Are you wondering what is happening to the career you went into and perhaps used to really enjoy? Perhaps you’ve never actually enjoyed it but it’s getting even worse.
‘Burnout’ is for other people – perhaps you think ‘burnout is for wimps?’ What is ‘burnout’ anyway – we never studied that at Medical School? It’s not really a proper condition or disorder, is it? It does not feature at all in the diagnostic manual DSM IV - in ICD10 it is just described as ‘a state of vital exhaustion’ in the section ‘Problems related to life difficulty.’ (Note, Post-traumatic embitterment disorder (PTED) has been proposed as a new diagnosis for DSM V but at the time of writing I am not aware of ‘burnout’ as a proposal despite the widely accepted work of Maslach, Jackson and Leiter).4
Burnout is regarded by most of us as meaning exhausted – emotionally drained, just plain worn out or in the vernacular ‘knackered.’ Often emotional exhaustion is accompanied by depersonalisation (manifesting as cynicism and negativity) and a reduced sense of accomplishment. It is these three aspects that form the basis of the Maslach Burnout Inventory, which can be completed online as part of Pulse’s ‘Battling Burnout’ campaign.4
What does burnout really look or feel like? Emotional symptoms include loss of humour, irritability, resentment, bitterness, depressed mood, apathy and feelings of failure guilt and blame. Cognitive symptoms include poor concentration, rigidity and resistance to change, suspicion and mistrust. Also stereotyping, objectification and distancing and rumination (perhaps about getting out, retiring, frustration with colleagues or getting even). Signs can include work avoidance (absenteeism and clock watching), deterioration in interpersonal conduct, inflexible behaviour, habitual lateness and perhaps acting out (typically alcohol, drugs, sexual affairs and shopping). Physical symptoms can include tiredness; sleep disturbance and increased illness such as backache, headache and IBS.
Consider whether you might be at high risk for burnout – are you a bit of an obsessive perfectionist, overly conscientious (perhaps striving until all tasks are cleared completely – is that even possible?) Do you seek approval? Do you need to be in control? Do you harbour self-doubt, dislike praise or delay gratification or rewards from your work? Do you feel you do the lion’s share -why won’t colleagues knuckle down and work as long, quickly and efficiently as you? Are you starting to count who sees most of the extras?
Like all questionnaires the survey comes with a health warning – it is a tool to identify possible burnout traits and possible population incidence in different professions. It has no established specificity or sensitivity for confirming or refuting burnout in an individual. But it might get you thinking and help you to tackle things.
Remember if you think you may have a physical or mental health problem such as severe stress, depression, drug or alcohol abuse the first thing you need to do is to see your own GP. You should remember that you are a patient as well and that you may wish to pursue appropriate treatment options for any possible coexisting medical conditions. Each person needs to find his or her own route through possible career burnout. I will show you that there are positive steps you can take to tackle and survive it. Don’t rush to retire, change jobs, emigrate, become part-time, become a locum or do out of hours just yet (unless that is what you are doing already!) – don’t bank on winning the Euromillions rollover – just begin to take some more positive steps.
2 Take stock - admitting to yourself that you may have burnout
Are you neglecting yourself as you work so hard to support the people you care for? Try to take a step back and see yourself objectively. Perhaps you need to look after yourself. If you are not getting the compassion and care and attention you need how can you pay that forward to your patients? Give yourself some time and space to think. If you can book some time off go ahead! Better still book that sabbatical you keep promising yourself.
You may think that others haven’t noticed but colleagues, family, friends and patients may have noticed something is wrong and if they value you, or what you were like before, they need to invest in you to help you sort yourself out. Read the articles in this Battling Burnout campaign, complete the survey to get your score to see how good or bad things might be.
3 Admit to others that you may have burnout
It is usually helpful to appreciate that you are not alone – many of your colleagues are also struggling and they might be as good if not better than you at masking things or possibly they are in denial. There is lots of help available for all of us if we only ask.
It is good to confide in close family and friends and to seek counsel from one or two fellow professionals that you really trust (these don’t need to be GPs). Your spouse or girlfriend/boyfriend are likely to have been worrying about you for some time – show them your survey results and ask them what they think.
4 Get help
‘What can I do?’
‘How do I figure this out?’
Your Local Medical Committee, Local Educational Training Board (‘deaneries’ still to most of us) or your local appraiser team may know of someone who could act as a mentor and confidante. Consider finding yourself a good careers coach and life coach.
There are some excellent books - I particularly recommend Banishing Burnout: Six strategies for improving your relationship with work by Michael P. Leiter and Christina Maslach.5
There are many organisations and resources available online which have featured in other articles in Pulse’s Battling Burnout Campaign (see the ‘Sources of help’ article).
5 Work with others to make things better for all of you
If possible work collaboratively with colleagues to tackle workload, to give each person a sense of control, to ensure people feel appropriately rewarded and valued and to review the culture and support of your workplace community. Invest in developing a sense of fairness and of shared values. Enough people scrutinise you – work on supporting each other.
Most Local Medical Committees can help you with personal, practice, professional or contractual issues or will advise you to help you to find organisations and facilitators to improve your work environment and organisations culture and efficiency.
Finally – workload and demand management in the NHS is a serious issue - a bubble waiting to burst. Until then try to be proud of being a doctor with the resilience to have kept going until now - as Churchill used to say, ‘KBO’ – Keep Battling On (or words to that effect).
Dr Chris Hewitt works as a part-time GP in Leicestershire – he has worked as a GP for 24 years (15 as a full-time principal). He has recently been appointed as Medical Executive Director of Leicestershire and Rutland LMC and to the faculty of the NHS Staff College, UCLH. He has previously worked as a medico-legal adviser, clinical complaints advisor, medical director, associate postgraduate dean and associate appraiser, as well as developing and running workshops to help GPs tackle burnout.
1 Austen J. Pride and Prejudice. T Egerton, Whitehall, 1813
2 Ipsos Mori. Trust in Professions. 2011. http://tinyurl.com/3q33xsq
3 Kerr, J. Please Don’t Eat the Daisies. Double Day, 1957
4 Maslach C, Jackson S, Leiter M. MBI: The Maslach Burnout Inventory: Manual. Consulting Psychologists Press, 1996
5 Leiter M, Maslach C. Banishing Burnout: six strategies for improving your relationship with work. Jossey Bass, 2008