Burnout . . . It's practically the birthright of the ED physician. The long hours, the erratic schedules, the incredible pressures – what human being could spend years in such an environment and not suffer the consequences?
And yet, say the experts, there are ways to recognize and perhaps prevent burnout. And if you do find yourself going down that unhappy path, there are ways to turn things around.
"The important thing to note is that at some point in time and in all careers people must find . . . what recharges their intellectual batteries," says Gregory
Henry, MD, FACEP, Risk Management Consultant for Emergency Physicians Medical Group, in Ann Arbor, MI. "The reason we go to meetings with other professionals is not necessarily for the information; we get to commune with people who understand the world from the same perspective we do. You get to understand you're not alone."
One major problem in emergency medicine, he continues, is that you are virtually isolated. "We work next each other, but not with each other; yet parallel play is something all children learn below the age of two," says Henry. "In addition, we live in a punishing society; we have set out for ourselves unachievable goals, such as zero defects. You will have good days and bad days; if you fail to recognize that, you will be manipulated and forced into certain positions that over time will wear you down."
"Sometimes we are our own worst enemies," adds John L. Lyman, MD, FACEP, Chief Clinical Officer for Premier Healthcare Services, a Dayton, OH-based emergency physician management group. "One of the things we should ask ourselves is, are we happy with what we do? Do you enjoy going to work or not? If you do not have that feeling of enjoying what you do, you need to examine things. But for many of us it is fun, and we feel we are cheating by getting paid."
Know the warning signs
There are a number of signs, says Gregory, that would indicate you or a colleague is suffering from burnout. "One is coming late to work; people who are chronically late don't want to be there," he says. "You look at your watch instead of your patient; you fail to be interested in the new and different things that come before us and do not actually listen to the patient. Instead of treating what they have, you decide they have what you want to treat. I distrust the doctor who does not occasionally feel bad for the patient, or who does not quietly cry sometimes. You can't see what I see every day and not do that."
"You look for changes, like a difference in sleep patterns, avoidance of some things you used to like to do like reading books, going on vacation, or changes in relationships," adds Lyman. "If your relationships in the ED with colleagues has deteriorated, that is often a sign."
Recognizing certain signs, he continues, takes insight, while others are more obvious. "Happiness does not require insight," he points out. "If you have it, you know it."
Finding your 'center'
To successfully combat burnout, says Gregory, "the bottom line is you need to have a calm 'center of the earth,' because the ED is the central place for unhappiness, loneliness, depression, suicide, beaten children, and battered wives in the community. Nobody sees the world like we do. In the outside world, you tend to see a scrubbed or modified version of humanity; we see you at your worst."
What an ED physician needs to do, Henry says, is 'mature' his career. "You can't wrestle drunks forever," he asserts. "I'm in my 60's now, and I can't do certain things I did in my 20's. This is never discussed in residency, never talked about publicly, but if we don't learn how to do this we will not know where we are going or what we are doing."
There are two kinds of veteran doctors, he explains: Those with 20 years of experience, and those with one year of experience 20 times over, "Because we never re-examined what we learned each year." You can have a job, Henry says, or you can have a career; the difference is perspective.
"A job is a place you go to where you make money and come home; a career is where you utilize your talents to meet the needs of certain groups of people and continue to refine those applications of skill to the excellent production of the product," Henry explains. "The more things you can bring in, the better off you are."
For Henry, this includes working with the American College of Emergency Physicians (ACEP), which he says has been tremendously helpful. "My political medical time helps me understand the larger picture," he notes. "You can either light candles or curse the dark."
He also recommends volunteering or teaching. "My teaching literally saved me; it has made me a better doctor and a better person," he says. "Sometimes when you have to talk about the issues, you become better."
Counseling is vital
It is critical, says Lyman, to seek counseling for burnout. If you are an employee of the hospital, and the hospital has an Employee Assistance Program, you should definitely take advantage of that service. "Premier has its own EAP, and it is very crucial," he says. "One needs to know where they can turn and know it is confidential." Even a small physician group must pay attention to the problem, he adds, and perhaps outsource. "Even a phone number where you can call and remain anonymous would be helpful," he points out.
Creative scheduling can help prevent or lessen burnout, he adds. "Being a '24/7' entity, we are at risk for alteration of our sleep/wake patterns," he notes. "One approach is to rotate forward and not backwards; if you do day shifts for a period of time, then do swing shifts, and then night shifts, rather than an erratic pattern -- like a night shift, skipping a day, then a day shift, and back and forth. There are logical approaches to it, and an ordered, patterned schedule will serve you well in the long run."
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