“Internation Classification of disease” (ICD) is the international standard for reporting health conditions used by physicians and researchers.
The ICD-11 defines burn-out as:
“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
- Feelings of energy depletion or exhaustion;
- Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
- Reduced professional efficacy.
Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”
Burn out can occur in any occupation, but it is particularly common in medical and nursing careers, police, teachers and lawyers. As a result, all these professionals will suffer personally and perform less well professionally.
Burn Out Symptoms
Burn out is often portrayed as something you are or are not. It is largely suggested preventable by “wellness” interventions. Medical and nursing professionals often feel “wellness” rammed down their throats by hospital administrators. If you are burned out, it is implied. you have been neglecting the yoga and self care, and it is all your fault.
But in reality, health systems (and many other professions) and complex and flawed. They often place unreasonable and incessant demands on staff.
These demands, and and our own values, or the needs of our clients (and patients) are often in direct conflict. Failing to meet any of these opposing demands results can result in disciplinary action, poor patient outcome and a lot of guilt.
Trying to make even small improvements in such a large and complex organisation feels like trying to turn around the Titanic. This constant pressure, the high stakes nature of the work, all mean burn out is inevitable.
Burn Out in Health Care
I look around my senior colleagues, and they are all, at times, burned out. I’m no exception. What changes is the degree of burn out. On returning from a relaxing holiday, staff are kinder, happier and more resilient to work place stress.
At times of sustained excessive demands, staff spiral into cynicism, exhaustion and inefficiency. If this continues, a sense of control is lost, and replaced with apathy.
Other symptoms can include difficulty focusing, worsened relationships at home and unexplained pain syndromes and health complaints.
Burn out can lead to insomnia, depression and even alcohol and drug abuse.
How Burned Out Are You? The Maslach Burnout Inventory
The Maslach burnout inventory is used to study burn out. It has validated versions for health care professionals, educators, students and general.
The inventory looks at three major factors to assess burn out
- Emotional exhaustion
- Personal Accomplishment
What’s really helpful, is being able to identify the area you score worst on. For me, this was having a low sense of personal accomplishment, and to a lesser extend depersonalization.
There is a simplified version of the inventory set out as a quiz here.
How to Prevent and/or Treat Burn Out
I actually don’t think it is possible to prevent burn out in the kinds of work environments that so expertly create it.
Burn out can be delayed, monitored and reduced. The first step, is like many issues, to be aware.
Watch out for signs from yourself. Dreading going to work multiple days in a row in a career you normally love is a good sign. Insomnia and cynicism are others.
Watch out for your colleagues too. If someone makes an off colour comment or is irritable with a junior colleague? Call it out. Check they are OK. Some gentle prompting to self reflect is likely all that is needed.
Identify the Specific Cause of Burn out in your Case
Work load: Is this excessive? Is this controllable. In the ED, work is routinely unpredictable, and frequently overloads resources available. Like buses, there may be no patients for an hour then ten in ten minutes.
Autonomy: How much control and freedom do you have over your work? This is an important factor in reducing employee stress, improving learning and productivity.
Communication within the team: Is the team dynamic working? Do they communicate well, or is there a lot of infighting? Toxic work environments can be hard to turn around, but social events can help humanize colleagues to each other.
Recognition of work: Do you feel when you work especially hard, you receive recognition for this? This is pretty easy to improve in a work place, starting with a simple thank you face to face or by email for a job particularly well done. I have experienced being on the giving and recieving end of recognition, and find it’s impact remarkable.
Discrimination: Is the work place fair? Is there discrimination going on?
Are you and your employers values aligned? If you believe in the ultimate cause your employer is working for, you will gain a sense of personal achievement from work. Being forced to act against your core values by your employer has been termed Moral injury.
How to Prevent and Treat Burn Out
Basic Healthy Living Routines
Sleep, eat well and exercise. We all know we should be prioriziting these. These three factors have an immeasurable effect on your physical and mental health as well as preventing or reducing burn out.
A havey work schedule can negatively affect your sleep, diet and exercise schedule. Make sure you prioritize eating, sleeping and exercise in your down time. Set boundaries on work so that it doesn’t encroach regularly into your time off. Saying no to extra shifts is OK if you need the down time.
A good support network outside work, to help you rest and have fun outside work is essential. Nurture your marriage, friendship and family relations and don’t neglect them for the sake of work.
Make Sure You Have Enough Down time
Relaxation time between work is a major factor in preventing, or suppressing burn out. How many hours you work before you end up feeling burned out depends on issues in your work place, your own emotional response to them, other demands on you and how long it takes you to recuperate. This will probably change over time.
Financial Planning for Burn Out
And here is where the finance bit comes in. Financial stress can reduce your ability to cope with work dramas, and cut down your choices in terms of changing employers, careers, or work schedule.
Part time work is only available to those who have control over their finances. Those that have commited huge chunks of each pay cheque to enormous mortgage and car loan payments often lock themselves into full time work.
Provide yourself with options by not over committing. You may not feel you will ever suffer burn out in your optimistic and energetic first year at work. Things change. You change. Leave yourself options.
If burn out kicks in pretty badly, you may want to take a break from work altogether. Again, money will be the limiting factor of whether this is possible.
A burn out fund is beyond an emergency fund. An emergency fund will cover a car repair, or your investment loan repayments if your property is untenanted for a while. A burn out fund is what the FI crowd call “FU money”. If you need some time off for any reason, you have money saved up that you can use. If you want to change jobs, it takes away the stress of not knowing the impact of a change in pay.
Spend Your Down Time Doing What You Enjoy
There is nothing less relaxing than the Downward dog if you can’t stand yoga (especially with chanting!) It’s a great way to stretch and improve mobility, but if you don’t enjoy it, you won’t do it.
Don’t feel guilty to enjoying the hobbies that suit you. That may be running marathons or playing in a heavy metal band. Whatever makes you feel like the best version of you is the right activity.
Watch Your Alcohol and Drug Intake
Substance abuse is often insidious in onset. Two glasses turns into a bottle turns into two bottles over time. Professionals are not immune. They just tend to hide it for longer.
The most up to date Australian guidelines recommend up to 10 standard drinks per week, no more than four in a day for men and women. A standard drink of 13% wine is just 100ml.
Improve Your Work Situation
What is contributing to your burnout? What do you enjoy at work? How can you tip the balance of your time more towards what you enjoy.
When I am feeling burned out I stop taking on extra shifts, and try to get away from managing staff for a while to actually chat to a patient, and practice some medicine (what a treat!). I find it helps to unravel the dehumanization.
Ironically, I found that taking on shifts elsewhere often helps to reignite my passion for medicine. Being able to work in a new department for a few shifts helps. Although each department has issues, I’m usually not around long enough for them to start frustrating me. Also, I can choose departments where I get to do more of the work I enjoy (and less meetings).
Can you improve your autonomy? Is it worthwhile chatting to your employer to see if they can provide any flexiblity either in the work you do, or your schedule.
A large reason I started this blog was due to my lack of autonomy at work. Many times, I am a cog in a giant machine, constantly shuffling beds to squeeze more patients in. There are endless key performance indicators to hit, and plenty of criticism when they are missed. Key performance indicators don’t necessarily relate to patient experiences. They are factors that are easy to measure, and often result in meaningless actions.
Options to Improve Your Work Situation
- Reducing work hours
- Taking a break
- Doing a different type of work, or in a different workplace
- Tilt your time at work towards tasks you enjoy / find rewarding
- Improving work schedule or flexibility
- Consider asking for more autonomy over the work you do
I hope you have found this article on burn out useful. The solution is not all financial, but good control over your finances gives you more tools.
Aussie Doc Freedom is not a financial adviser and does need offer any advice. Information on this website is purely a description of my experiences and learning. Please check with your independent financial adviser or accountant before making any changes.