Clinician burnout has been a hot topic of conversation lately. I’ve been thinking about what burnout really means. No one who trains to be a healer just shows up at work one day in a callous state of mind. It creeps into one’s heart and mind over time. This is something I know firsthand.
I felt the callousness that’s often a symptom of burnout when I was a resident in downtown Baltimore. Let me share a little of my story.
It was the height of the AIDS epidemic. We knew it was a viral infection, and we had a test for HIV. However, we had few treatments for the many opportunistic infections that resulted from the infection. Being diagnosed with HIV/AIDS was akin to a death sentence, and the diagnosis came with a burden of stigma. I was frequently required to tell young people they were going to die, and that before they passed away, others would fear to be around them.
I was on call every third night, working up to 100 hours a week. I was sleep-deprived and overwhelmed by the emotional toll of the discussions I was having with newly diagnosed patients. I went into survival mode, which for me meant boiling my work down to a manageable checklist for each patient interaction. What I didn’t realize was how my obsession with my checklist and being efficient was affecting the person on the other side of the conversation.
One day, a young man of 17, a senior in high school, came in with a cough and shortness of breath. He thought it was asthma, but it was PCP pneumonia, a sure sign of full-blown AIDS. As I asked him about his history, I went through my checklist, which included what I now realize were judgmental questions.
I asked him which behavior he engaged in to contract the virus – did he have high-risk sex or did he use intravenous drugs? He sat silently for a moment, and I watched a tear slip down his cheek as he quietly answered, “Neither. I’m just a regular kid.” This was heart wrenching and it brought me up short.
As a result of my effort to be efficient, protected by the armor I had put on to get through the day, a vulnerable person in need of compassion and kindness instead got callous disregard. Worse, this young person, who needed understanding and support on the worst day of his short life, heard from a doctor that his illness was his fault.
Of course, a projection of blame wasn’t what I intended to convey, but it’s what he heard in my words and felt from my cold demeanor. I was horrified, and I vowed to pay attention to the wake-up call playing out before me.
I thought long and hard about the fact that I’d become callous to the suffering of others, and I worked to regain the open heart that called me to medicine. I thought about the Hippocratic Oath and the goals I had when first entering this healing profession. I can’t say I never again experienced burnout or its desensitizing effects, but I learned to watch for the signs. I learned from other, wiser clinicians how to maintain compassion without becoming overwhelmed by the emotional ups and downs of being a bedside caregiver.
This realization, and the emotional toll it took on me, prompted me to create a new checklist for how I interact with people. Here’s an abbreviated version of my updated checklist:
- Listen first
- Imagine yourself in the other person’s shoes
- Ask questions through a compassionate lens
- Banish judgmental thoughts
- Avoid absolutes when possible
These simple reminders help ensure I’m living the values of compassion, dignity and integrity to foster real connections with people.
When you see the signs of burnout in yourself, a friend or a colleague, know that help is available. At Providence, as at most health systems, we offer our caregivers a host of resources that support their physical and mental well-being. Regardless of your profession or title, I encourage you to seek out resources to help you cope when you start to question how you’re approaching your job, especially if you interact with other humans.
While some may dismiss it as cliché, the notion that we are better healers when we are healthy ourselves is a reality we all should embrace. Moreover, know that you’re not alone, and that you can come back from burnout.