Burnout Exhausts Easy Answers

“Most health professionals know how to take care of patients, but not how to take care of themselves.” Healthcare professional and lecturer Yinka Vidal spoke for many about one of the main factors contributing to burnout. Whether academic, career and generally life, burnout afflicts all levels among healthcare professionals expected to give their all – and then some – around the clock, year after year. Burnout can arise from overwork and resultant stress. It also can grow from and compound personal problems. Vidal cited several factors:

• Overwork, the absence of self-nurturing, lack of time for yourself.
• Need for self-adulation to receive awards and recognition from others.
• Lack of a romantic relationship -- or crisis relationship -- can lead to looking for external validation.

“We all need to be nurtured one way or the other,” Vidal said. “We spend passion taking care of patients. At a point, our passion bank is empty. We need replenishment. At times, a massage can help release stress. “Burnout is not just being physically tired,” he said. “It's more of emotional fatigue or both.” “Doctor to the Barrio” Jaifred “Jim” Lopez is on the faculty of the University of the Philippines College of Public Health where he teaches and studies epidemiology. The threat of burnout is never far away. “As humans, we hope we could get affirmation,” he said. “Our world has become too busy for us to take time and thank others. For me it's failure to delegate, often linked with the difficulty to entrust one's work to other capable people. “We fail to anchor ourselves to a Power greater than us,” Lopez said. “This Power can be anything. It can be religion -- which is the case for me -- or meditation or support groups. Personally, I say yes when I really should say no, wanting to do it all.” Internist John Jefferson Besa knows the conflict of desires and the real world. “Being jaded by circumstances leads to helplessness such as when your once idealistic self faces reality and becomes weary,” he said. “We can choose to stay jaded and wail in helplessness or face reality with a positive outlook. “We romanticize the idea of taking all tasks, not saying ‘no’ and being a ‘martyr,’” Besa said. “We fail to recognize our limits and end up burnt out.” Speaking from the administrative side, orthopedic surgeon Dr. Remo Aguilar is chief of clinics at General Santos Medical Center at the Southern Philippines Medical Center in Davao City. “Wearing ‘too many hats’ in a resource-strapped healthcare environment leads to burnouts,” he said. “Actually, there’s a study that says giving out via advocacies beats burnout. It's in the book ‘Give and Take’ by Adam Grant.” Personality types contribute to burnout vulnerability. “They take on too much and commit to doing it all,” Dr. Aileen Dualan said. She is the Asia Pacific Medical Affairs Lead for MSD, a global biopharmaceutical company. “People on the obsessive-compulsive end of the spectrum get burnt out more than the laid-back types,” she said. “Plus, in the hospital, if you say no, you are accused of not caring.” Psychiatrist Dr. Stephanie D. Miaco is well versed in the psychological aspects. “Too much time working, and not enough rest,” she said. “No other outlet, and no hope of a reprieve are common culprits. “Burnout can also be from working with personnel you are not comfortable with, or with attitudes toward work that you cannot control,” Miaco said. A simplistic suggestion to minimize burnout is to get away. Take a break. It’s a notion that burnout survivor and entrepreneur Mark Carruthers laments. “Oh, I wish it was that simple,” he said. “Working long hours leads to mental fatigue, which contributes to perceived physical fatigue, but burnout is so much more than fatigue. Although mental fatigue contributes to burnout, stress is what turns mental fatigue to burnout. “During my days when I worked tax seasons, I worked seven long days per week for about six and a half months every year,” Carruthers said. “Resting and time off helps mental fatigue. When someone is burning out, taking time off usually only adds to the stress and can worsen the burnout.” Those encountering burnout need stronger “medicine.” “They need to do much more than ‘taking a break’ and have brief times away,” Carruthers said. “I’ve been there and have lived it. “For some time, I have been reading a lot of articles about burnout, written by true experts in the field of study, because of my own experiences and battles with it,” he said. In the summer of 1975, before university, Carruthers experienced what he believes was true physical fatigue. “During my first university co-op work-term from Jan. 1 to April 30, 1976, I believe I experienced true mental fatigue,” he said. “Looking back, in neither case did I experience any level of burnout, in my opinion. In both cases, I was exhilarated by each, and it was empowering.  “In a couple of positions since, including my last one, I battled burnout,” Carruthers said. “I am not sure whether I won or lost, but I also discovered that even hating or being frustrated by your job is not burnout, either.” And yet, he believes it could have been worse. “I was fortunate that I did not experience the very worst symptoms of burnout, which is severe depression and even suicidal thoughts,” Carruthers said. “That is not to say that what I experienced did not take a toll on me and those around me.” Clinical psychology student Jarvin Tan also has had a brush with burnout. “I mainly draw from my psychotherapist's inputs when I first mentioned my red flags for burnout,” he said. “I originally set my warning signs for impending burnout by basing on how other people would notice the small things. The therapist remarked how externally based they were, and I fully realized what she meant when I saw how late they came. “By the time I noticed the signs, it was too late,” Tan said. “A hard lesson is to devise my own internally-based warning systems and corresponding plans.” That gave him insight into others’ struggles. “I know a big chunk of the 140 students I handle now were very close or had probably already reached burnout,” Tan said. “Was frustrating to not be able to help better, but there’s only so much I can do within a 26-unit semester.  “The first thing I can do is better myself,” he said. “The classroom should be viewed as part of the healthcare system because it is where our future healthcare professionals come from.” Dr. Sids Manahan teaches with interests in gout and evidence-based rheumatology. He agreed that healthcare providers should be allowed downtime.  “Level expectations, yours and others,” he said. “Learn to accept some imperfection. Distract yourself by doing something else, either a hobby or merely taking a break. “Anyone rotating in the emergency room is prone to burnout -- regardless of specialty,” Manahan said. “I recall a colleague asking our residents to watch for symptoms while rotating in the ER. The conclusion was mild to moderate levels of burnout.” Aguilar offered burnout-prevention tips:

• Be generous but not selfless.
• Make sure that the benefits of helping others outweigh the costs to you.
• Find ways to give without depleting your time and energy.
• Find a loved one, or at least attempt to.
• Nurture yourself in a hobby such as hiking or photography.
• Meditate five to 10 minutes each day.
• Find an advocacy to channel your giver efforts.

“Sometimes is not just about saying no,” Aguilar said. “It's about giving a yes that doesn't drain your giving energies. Giving is itself an outlet to curb burnout. Tan calls himself a work in progress in overcoming burnout. “I set aside a day and a half during All Saints Day break to just be by myself and try to get back into photography,” he said. “It must've been weird for passersby to see me lugging a tripod that evening, but it was refreshing. “I also take social media breaks,” Tan said. “I'm now able to fully deactivate Facebook, Messenger, and Twitter for short periods of time when the toxicity really peaks.” Internal medicine resident Dr. Gino Gomez carries forth, benefitting from early career lessons. “When I had burnout as a trainee, I introspected to pull out all the reasons why I was doing this job in the first place,” he said. “Now I try to prevent further burnout by helping others overcome it and by helping process others’ decisions in their quitting or burnout spell.”