Guest Post by Dr. Rajeev Kurapati
Burnout among medical professionals is an epidemic, and it’s impacting nearly every aspect of healthcare. For oncologists and practitioners working with cancer patients or other patients navigating difficult or terminal diseases, burnout can be especially insidious.
One reason burnout can be so insidious is that even many medical professionals don’t recognize the signs or ask for help until they’re at the point where they need to quit their career altogether. In the Medscape National Physician Burnout & Depression Report for 2018, only about 9% of the physicians interviewed reported seeking professional help when facing symptoms of burnout. Even then, psychiatric assessment may not always be the right kind of help. Here’s why: psychiatric evaluation may not reveal the problem. A psychiatrist is likely to speak with a patient for a few minutes and may prescribe counseling, an antidepressant, or other psychotropic medication based on a description of prominent burnout symptoms, which only masks the problem.
Adding to the complication, burnout manifests in plenty of different ways.
While it may present as depression or anxiety, it can also exacerbate any number of other underlying psychiatric illnesses, such as bipolar disorder or borderline personality disorder. Despite this, burnout alone doesn’t fit in any diagnostic criteria for established mental illnesses. In fact, there’s not yet specific diagnostic criteria for burnout in DSM-5 (the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders), which represents the most comprehensive and widely used information currently available for clinical diagnosis of mental disorders.
What Burnout Really Feels Like
Recognizing early warning signs of burnout is difficult, but the end result is the same in all cases: You become what we’ll call DEF. When in burnout, you experience Depersonalization, Emotional exhaustion, and decreased Function at work. Another way to look at this is that you become cynical, exhausted, and perform poorly.
For healthcare professionals, burnout may translate to a day-to-day experience of feeling like you’re rushing from one patient or procedure to the next without any sense of fulfillment. For caregivers, it may feel more like you’re trapped in a cycle of all work, no satisfaction.
In order to determine if you’re suffering from burnout, here are two simple steps to help you make that call.
Step 1: Answer this question:
Do you often feel like “I can’t do this anymore,” even after an initial period of adaptation to your job?
If you answered yes, go on to the next step.
Step 2: Look out for the following symptoms:
- You have less patience with others than you used to.
- You feel physically exhausted right at the beginning of your workday.
- You habitually feel like you’re making errors of judgement despite adequate training.
If you answered yes to these three questions, you’re likely burned out.
The above feelings may culminate in a host of symptoms, including sleepless nights, mindless preoccupations, becoming socially withdrawn, nervousness, irritability, avoidance of exercise and social interaction, and craving junk food.
If you did answer yes to those questions, you aren’t alone. Understanding you’re experiencing burnout means you can take actionable steps toward solutions.
Am I Stressed Out or Burned Out?
Burnout is an individual, subjective experience that happens in the space between your ears. To determine if you’re experiencing burnout, it’s important to distinguish between regular job-associated stress and actual burnout.
When reality doesn’t match our expectations, we experience stress.
Workplace stress is not uncommon for physicians and other healthcare workers. It can come from many directions and may be the result of too many expectations, mounting pressures, or external factors, like too little staffing.
While stress is often destructive, we can’t ignore its ability to push us to optimal alertness and performance. The existence of stress hormones is an incredible biological adaptation that provides us with the ability to deal with high-intensity situations—imbuing us with the power of resiliency and helping us adapt to whatever our jobs (or lives) may throw our way.
While small amounts of stress can propel us forward, as a constant condition, chronic stress becomes harmful. To manage it, one of the most helpful things we can do is identify specific problem areas and take concrete steps to address the source. While some types of stress may be difficult to manage, in most cases, stress is easy to recognize.
Burnout is a different animal. It’s the great imitator, so we may not recognize it for what it is.
For instance, you may be a high-performing leader or a well-loved team player, doing all the things that count as being “successful” and yet, after many years of following your passion, you may suddenly feel that nothing you do is meaningful anymore. You may feel unmotivated, unchallenged, or bored at a job you were once very enthusiastic about. You don’t want to quit the job you spent years training for, but at the same time you dread (or feel restless) going to work day after day. Waiting to see if this feeling will pass only seems to make it worse.
It’s important to remember these feelings aren’t occurring because you’re less competent or capable or that you’re lacking in some way. You’re still the right person for the job, but your energy and enthusiasm are tapped out because they haven’t been nurtured and balanced.
It’s not uncommon to experience stress if you’re early in your career, where it may take time to adjust to new responsibilities, a new workplace culture, and the demands of working full time. In this case, initial jitters typically melt away with experience and adaptation.
Tell-Tale Symptoms
Burnout can masquerade as numerous other mental and physical conditions, but here are key symptoms to look for:
Depersonalization:
This symptom, in which a healthcare professional meets their patients with cynicism and callousness, should be a big red flag to physicians and caregivers who are drawn to their work precisely because of their desire to care for others.
Exhaustion:
There’s the feeling of being tired at the end of a long workday, and then there’s exhaustion—where sleep doesn’t refresh you, your energy crashes sooner than expected, or you find yourself constantly tired no matter your sleep, eating, or exercise habits.
Apathy:
Feelings in burnout can range from recurring sadness to extreme irritability to a loss of interest in activities. It can show up as trouble concentrating, feelings of worthlessness, or at its most dangerous: thoughts of self-harm or suicide.
Anxiety:
It’s normal to worry about things from time to time, but if worry persists or leads to panic attacks, it becomes an anxiety disorder. Anxiety can also manifest as intrusive thoughts; may incite an avoidance of situations and people; and can include physical symptoms like sweating, shortness of breath, rapid heartbeat, and other hyper-activation of the nervous system.
Dread:
You once looked forward to going to work or seeing patients, and now you feel reluctant, unwilling, or dread the work day.
Irritability:
An occasional lack of tolerance that manifests in a cranky mood is normal, but if you find that you’re consistently irritable with patients or colleagues and/or at home with family and friends, there’s a good chance burnout is the cause.
Impatience:
Impatience and irritability often go hand in hand when burnout sets in. Where once you had all the patience you needed for aspects of your work, as well as for your social life, now you find yourself snapping, easily frustrated, and annoyed by regular interactions.
Lack of will to work:
Often accompanying or prefacing depression, you may suddenly find that you don’t have the will to get up and go to work each day. This feeling may not fully manifest as depression or dread, but you may find yourself dragging your proverbial feet, taking longer to get into work, even running late.
Sleep disturbances:
Trouble falling asleep, or waking up not feeling refreshed, is often an early sign.
Loss of appetite:
Lack of pleasure in eating is often one of the first signs that there’s something going on psychologically. Since burnout is different for everyone, before you notice your feelings, you may notice a change in your eating habits.
Craving comfort food:
Likewise, if you find yourself eating even when you’re not hungry or bingeing on sugary or salty foods, you may be trying to give your body a shortcut to the energy that’s being drained.
Body aches and pains:
If you’re experiencing an unusual amount of discomfort that seems unrelated to any health condition, pay attention. Often, people in a state of burnout stop exercising and don’t engage in healthy self-care, which can worsen this symptom.
Using drugs, alcohol, and other substances as a replacement for energy and health:
When we have trouble managing the energy to work, many people turn to “easy” fixes: alcohol, sugar, caffeine, illicit substances, and junk food. If you notice you’re drinking every night or picking up fast food on the way home because cooking feels like too much work, this can be a symptom of something bigger.
While this may look like a comprehensive list, burnout is personal and affects people in different ways. Regardless of how it manifests for you in particular, any of these symptoms (or others that suggest you’re no longer thriving) should be considered potential warning signs that you’re currently in or are headed toward burnout.
This article is an adapted excerpt from Burnout in Healthcare: A Guide to Addressing the Epidemic.
Rajeev Kurapati practices hospital medicine with St. Elizabeth Healthcare in Northern Kentucky. He is the author of Physician: How Science Transformed the Art of Medicine and Unbound Intelligence. He’s been featured in Slate, Cincinnati Enquirer, Medical Economics, Aging America, and other outlets.
Note from The Hopeful Cancer Doc: for more articles on physician burnout, see the physician burnout resources page