By Gabrielle Rieth
This topic seems particular relevant and timely for me and my classmates, as we are currently in the happy limbo-land that our school dubs “Research Block.” It takes place following our second year of medical school, sitting for the USMLE Step 1 examination, and just prior to beginning our tenure as mini-docs in the arduous final two “clinical” years of our undergraduate medical education.
On some level, I anticipated what I’d find when I began researching this topic. The concepts of self-care, emotional welfare, and professional burnout are hot-button issues in the medical world. In April, Surgeon General Vivek Murthy brought it to national attention in an interview at the annual meeting of the Association of Health Care Journalists. The culture of medicine was documented on the well-known website, Humans of New York. A student at another medical school shared a candid commentary on her struggles with anxiety and mental health throughout her pre-clinical training.
I read on. In just under the span of an hour, I’d amassed an assortment of 20 blog posts, digital news articles, and formal journal publications focused on the cultivation of well being in healthcare providers and provided strategies for detecting and dealing with burnout. Clearly this was more than just a “hot-button issue.” The more I researched, the more I realized that this phenomenon is ubiquitous in medical schools and hospitals across the country.
So what is burnout? “Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice.1” It’s like the phenomenon of the boiling frog: one majorly catastrophic transgression is enough for a trainee to realize there’s something off, but a long sequence of nearly imperceptible slights continues to build unchecked, until the weight of this collection becomes unbearable and the trainee succumbs to burnout.
An article published in World Psychiatry2 this month defined it as a psychological syndrome that develops in response to prolonged chronic interpersonal stressors on the job. The three key dimensions of this response are overwhelming exhaustion, feelings of cynicism, depersonalization, detachment from the job itself, and a sense of ineffectiveness and lack of accomplishment. The authors introduced the Malasch Burnout Inventory, a psychometric burnout measure which assessed all three elements.
Some of the key signs of burnout include physical manifestations of the disease with musculoskeletal pain and depression as the most common problems. These can be followed by periods of vital exhaustion with instances of low energy, difficulty concentrating, irritability, emotional instability, dizziness, and sleep difficulties. Sometimes the symptoms are more insidious. Psychology Today reports more subtle physical symptoms of burnout including chronic fatigue, insomnia, forgetfulness, impaired concentration and attention, increased illness, loss of appetite, anxiety, depression, and anger. Signs of cynicism and detachment include loss of enjoyment, pessimism, isolation, and detachment, while signs of ineffectiveness and lack of accomplishment include feelings of apathy and hopelessness, increased irritability, and a lack of productivity and poor performance. It is important to recognize (either in yourself or in a colleague) what it looks like, to take time to recover, and to prevent escalation.
If you recognize these symptoms in either yourself or a friend, take action. Don’t try to wait it out or ignore the feelings, hoping they’ll dissipate on their own. Reach out and seek support from friends and family, or talk with your school’s counseling department. Take time to recharge! Obviously, this is easier said than done, but figuring out what makes you feel refreshed and renewed is a step in the right direction. Engaging in those activities is important and can help cultivate an attitude of resilience that may make surviving the ebbs and flows in medical school more manageable. Here is a helpful Resilience Prescription.
Last, but certainly not least, if you or a colleague is struggling with thoughts of suicide, reach out. Talk to a friend or family member you trust or find out what’s available to you at your home institution. Most medical schools and hospitals have confidential and private resources for students and staff that may be feeling overwhelmed. The National Suicide Prevention Lifeline also operates 24/7 at 1-800-273-TALK (8255). Don’t isolate yourself. Don’t try to weather the storm alone.
2. Malasch C, Leiter MP. Understanding the Burnout Experience: Recent Research and Its Implications for Psychiatry. World Psychiatry 2016. 15: 103-111.
Gabrielle Rieth, MS, is an third-year medical student at Case Western Reserve University School of Medicine. She is originally from the Albany, New York area and completed her undergraduate work at Cornell University before migrating to the midwest.
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2 Replies to “Physician, Heal Thyself: Recognizing and Understanding Burnout”
Thank-you Gabrielle! What a thoughtful piece. I really appreciate your emphasis on resilience, on developing a support group and on taking action if you suspect a friend or colleague is in trouble. Having lost amazing colleagues to suicide I know how important this is.
Thank you for writing this Gabrielle. It’s important that this issue be brought up starting at the medical school level. As I’m sure you are aware, suicide is the most common cause of death in medical students. I suggest that we have an outbound strategy where we routinely query students, residents, and physicians on their wellbeing because many times we don’t ask for help and simply take our lives. Again thanks for bringing awareness to this topic