• We are Emergency Physicians, a profession which requires a unique skill set and offers unique challenges. The appeal of the profession can simultaneously be a drawback, dependent on the perspective you take.
• Burnout does not occur suddenly, it is progressive. Therefore, if recognised, it can be reversed. For me, recognising that I was burnt out came as a surprise.
• I entered the healthcare setting in Australia optimistic and excited. In my spare time, I would surf. As I began advanced training, I acquired extra responsibilities, such as a mortgage, marriage, and children, all whilst preparing for my final exams.
• I eventually found myself coming to work with a knot in my stomach. I felt distant from my patients and colleagues. Sometimes I felt like crying and walking out. I was performing terribly. I found myself at the end of the day dreading going back to work the next day.
• At the time, burnout was an issue barely recognised, and therefore modes of addressing it did not exist. This completely changed once I recognised the issue, my outlook changed, and I began to respond.
• At the time when I found myself closer to that end of the spectrum where ‘burnt out’ was the final point, I encouraged myself to do something about it. I did not want to be that doctor who left the profession to pursue another career.

• This is true, not only in intuitively, but also is evidenced by the current literature.
• There are large companies investing in wellbeing because of the benefits to the productivity of the workforce, and these are companies notably distinct from the medical profession.
• There is a study from the Mayo Clinic advocating for physician wellness as it is a key quality indicator that drives patient care. It also minimises costs, as doctors less frequently call in sick or make errors.

Features of burnout encompass:

• Emotional exhaustion.
• Depersonalisation. For example, labelling patients and viewing them as none other than their presentation, the ‘chest pain in bed 5’, or the ‘geriatric patient with urosepsis’. If the connection between the doctor and the patient does not exist, the ability to gain a good history and decipher the differential diagnoses is difficult. The joy of the interaction is lost.
• Lack of personal accomplishment. For example, the outlook that your presence at work will make no difference to the turn-around of patients in the emergency department.
• Of course, at times we all feel elements of these features. It is when they become heightened that we start suffering.

• The study by the Mayo Clinic notes, the drivers from engagement and thriving to burnout include the sense of control and flexibility. A lack of autonomy can be an issue amongst junior doctors.
• I have known colleagues who take time off to physically rest, however, the same issues persist when they return to work as their mindset toward the constant challenges within the workplace don’t change.

• Burnout is not only a result of personal actions, but also the culture you are working in. There is an equal responsibility by both the employee and the organisation to prioritise wellbeing.
• I can make suggestions which have been critical in helping me. For example, exercise, which has a multitude of benefits, and meditation, which allows me to feel more present, and has transformed my perspective working in a busy and dynamic emergency department. Meditation helps me to stay task-focused, and less distracted by interruptions.
• Practicing gratitude has also had positive benefits for me. Spending time, before going to bed or before driving home, to contemplate what went well that day.