Author:  Duncan Campbell

Reviewer:  Leena O’Brien

 

Recognising an institutionalised problem

We are increasingly recognising the contribution of various factors towards burnout. Of course there are individual factors (e.g. perfectionism and poor coping strategies such as avoidance), but with such a high proportion of doctors affected, we can’t deny the existence of institutionalised factors. A highly hierarchical and bureaucratic system fraught with a culture of silence, blame and bullying discourages junior doctors from speaking up. The conscientious among us might volunteer for committees and working parties focused on improving patient care and doctors’ mental health. This work can be exceptionally rewarding. But the more complex and ingrained the problem, the more difficult it is to solve. And when faced with a series of unpredictable and absurd obstacles, it can become exhausting. Any significant change takes time to roll out. And in the meantime, we have to focus on looking after ourselves.

 

Tips on how to cope

Whilst there is no quick fix when it comes to burnout, I have reflected on my own experiences found it beneficial to change the way that I think about life and about work. There are numerous issues that contribute to stress and burnout among junior doctors, and each one is significant. But to prevent these from intruding into your life outside of work, everything needs to be kept in perspective. For me, it comes down to a question of how you measure your self-worth. For some people, this will be intrinsically related to the work they do, and in the medical profession this might be crudely derived from how many lives they’ve saved. For doctors in training it might be directly related to exam success. But there are risks if you measure your self-worth directly from what you do, what you achieve, or how you compare to those around you: all it takes is a bad day or a failed exam for everything to come tumbling down.

When you fail an exam, it’s hard to not take it personally. The time and energy put into preparation is one thing, but when the results of the exam determine whether or not you can progress in your training program, it’s easy to equate failing an exam to being an incompetent doctor. As one of my colleagues recently said to me, ‘I’ve just failed a clinical exam that assesses what we are supposed to be doing day-in-day-out. If I can’t do that right, how can I continue to work as a doctor?’ I know she is not the first person to feel this way.

Each of us needs to feel good about who we are as a person. I might be a junior doctor, but I’m also much more than that. Thinking back to the extra-curricular activities of my previous life, these were the things that kept me sane throughout high school and university. They are activities that I enjoy, but they are also fundamental to my identity, and they help me to keep things in perspective. If I’ve had a bad day at work or university, I can still come home at the end of the day to prepare and enjoy a fantastic meal. If I’m having a horrendous week at work, I can meet with a group of friends to create beautiful music, and everything else fades into the background. Every aspect of our lives deserves equal attention, and we must learn to recognise every accomplishment, no matter how big or small, and no matter whether it is work or study related, or not.

Moving forward, I am doing my best to achieve a work-life balance. This doesn’t necessarily require an equal division of time spent working and not. The most important thing is the principle behind it: to recognise that there is more to life than work and study. Burnout is an incredibly complex issue, but hopefully this is a step in the right direction.

 

Part 1 – Front lines:  evolving systems, escalating pressures and attempting to exceed expectations

 

Useful resources

Employee Assistance Program

Doctors Health Advisory Service

Lifeline